Douleur chronique

Pain Manag Nurs. 2026 May 27:S1524-9042(26)00161-X. doi: 10.1016/j.pmn.2026.04.021. Online ahead of print.ABSTRACTOBJECTIVE: This study employs bibliometric methods to systematically analyze the current state and developmental trajectory of acupuncture research in chronic pain treatment over the past decade, aiming to identify key research areas and emerging frontiers.METHODS: This study collected animal experiment publications related to acupuncture for chronic pain from the Web of Science Core Collection database and utilized CiteSpace 6.3.R1 to perform a visual analysis, thereby constructing a corresponding knowledge map.RESULTS: China leads in total publication volume, while the USA excels in international collaboration networks. Zhejiang Chinese Medicine University and author Fang Jianqiao rank first among institutions and authors, respectively. As a highly cited scholar, Han JS's research demonstrates that electrical stimulation at different frequencies can promote the release of specific neuropeptides to exert analgesic effects. Neuropathic pain, inflammatory pain, and hyperalgesia represent current research hotspots. Highly cited literature primarily focuses on investigating inflammatory mechanisms.CONCLUSIONS: Research indicates that the mechanism of acupuncture involves regulation of the neuroendocrine-immune network, with improvement of peripheral sensitization and central sensitization serving as the core mechanisms for acupuncture treatment of chronic pain. Emerging mechanism research focuses on deeper molecular mechanisms, such as phosphorylation, signaling pathways, and epigenetics. However, research into molecular-level mechanisms such as epigenetic regulation remains in its infancy, and the interactions between molecules are still unclear. Furthermore, the dose-response relationship of different acupuncture parameters in chronic pain treatment has yet to be elucidated. These issues demand further in-depth research in the future. These mechanisms will better enable nurses to provide more scientifically sound explanations during patient education and make more effective intervention decisions in comprehensive pain management.PMID:42203553 | DOI:10.1016/j.pmn.2026.04.021

International Journal of Sports Physical Therapy; 05/01/2026Background and Purpose: Chronic low back pain (CLBP) is a disabling injury for athletes with an unclear pathway to return to sport (RTS). Biopsychosocial (BPS) treatment can address the complex needs of athletes recovering from injury by considering the interplay between body and mind. Current BPS models lack specific guidelines for clinicians. This case report presents and applies a novel BPS framework, SPORT (Systematic Progressive Overload Rehabilitation Training) to a young athlete with CLBP. Description: An accomplished 18-year-old male athlete who engaged in soccer, football, and powerlifting presented with CLBP. The symptoms originated with kicking and worsened for 13 months. Despite five months of treatment from clinicians, there was no RTS or improvement in pain and disability. The SPORT framework consisting of 18 evidence-based principles was implemented. The outcomes tracked were strength, sport participation, and reported pain and function. Outcomes: A 17-week intervention resulted in strength gains as measured by performances on the squat and deadlift. Squat improved from 45 lb to 335 lb. Deadlift improved from 45 lb to 385 lb. The subject's recreational sport participation increased from inactivity to 45 minutes of play for five consecutive days. He improved from daily pain and disability to near pain-free living and function. Seven weeks post treatment, post-case outcomes included a 435 lb squat, 465 lb deadlift, participation in recreational sports, sustained improvements in pain and function, and successful flare-up management. Discussion: The subject presented with unique challenges which required a holistic approach to RTS. SPORT provided tools for managing his CLBP. Future studies could compare SPORT to other treatments for CLBP in young athletes, ideally on a larger scale and with diverse populations. Conclusion: The case presents the creation and application of an original BPS framework, resulting in reductions in pain and a RTS in a young athlete suffering from CLBP. Level Of Evidence: 4(AN 193685626); ISSN: 21592896CINAHL Complete

Canadian Journal of Occupational Therapy; 06/01/2026Background. Chronic pain brings on many lifestyle changes. Redesign your Everyday Activities and Lifestyle with Occupational Therapy (REVEAL(OT)) is an evidence-based Danish intervention that benefits the daily functioning of individuals living with chronic pain. Purpose. To understand the perspectives of patients, clinicians and managers about REVEAL(OT) and identify format- and content-related modifications that are necessary to adapt to the Canadian context. Method. Based on a qualitative descriptive approach, focus groups and individual interviews with partners (n = 45 participants in total) were conducted in two Montreal specialized pain clinics. The interview guide was inspired by Proctor's implementation model and a qualitative rapid analysis was performed. Findings. Participants recognized the need for (a) a flexible, personalized and hands-on intervention, (b) integrating multimodal approaches, (c) support to develop and implement healthy life habits, (d) addressing gaps in care supporting the need for an OT intervention, and (e) pragmatic organisational considerations for implementation. Conclusion. REVEAL(OT) is capable of addressing the occupational needs of patients but adaptations are required to fit within a new healthcare ecosystem. Our findings promote the use of lifestyle-oriented interventions along with current care and will generate the initial intervention manual to be tested and refined.(AN 193858254); ISSN: 00084174CINAHL Complete

Author Names: Zhang, X.,Liu, W.,Liao, Y.,Zhou, A.,Chen, S.,Zhang, D.,Wei, J.,Hu, Y. Database Source: Embase Weekly Updates Journal Title: BMC Psychiatry Article Title: Predicting sleep disorder trajectories in older patients with chronic pain: an explainable machine learning approach Year: 2026 Issue: 1 Volume: 26 Abstract: Background: Sleep disorders exhibit a high prevalence among chronic pain (CP) patients, yet knowledge gaps regarding sleep disorder trajectories in older CP patients may hinder healthy aging. This study aimed to identify sleep disorder trajectories and their predictive factors, and to develop tools for predicting these trajectories using an explainable machine learning (XML) approach. <br/>Method(s): This prospective cohort study was conducted in hospitalized older adults (aged >= 60 years) with chronic pain. Data on general characteristics, pain level, anxiety, depression, and perceived social support were collected at admission. Sleep disorder was assessed from admission to six months during routine chronic pain management, including pharmacologic treatment, non-pharmacologic interventions, psychosocial support, nursing care, and discharge education. Predictors were selected using Boruta algorithm and LASSO regression, and ten XML models were developed. <br/>Result(s): Among 596 patients, the prevalence of sleep disorders in the overall cohort ranged from 42.8% to 52.2% across the four assessment time points. Four heterogeneous sleep disorder trajectories (stable-low, high-declining, moderate-increasing, and high-persistent) and seven predictors were identified. The XML model determined pain level, depression, anxiety, and perceived social support were the most important predictors. <br/>Conclusion(s): Sleep disorders in older CP patients exhibited a high prevalence from admission to six months, manifesting in four distinct trajectories of deterioration or improvement. These findings may enhance the understanding of the heterogeneous progression of sleep disorders. Prioritizing key factors such as pain level, depression, anxiety, and perceived social support in preventive strategies and risk stratification may inform more targeted interventions to improve sleep health outcomes.<br/>Copyright © The Author(s) 2026.

Author Names: Guerra-Armas, Javier,Moral-Munoz, Jose A,Roldan-Ruiz, Alberto,Montero-Cuadrado, Federico,Ceniza-Bordallo, Guillermo Database Source: APA PsycInfo <May 2026 Week 3> Journal Title: Neuroscience and Biobehavioral Reviews Article Title: Neurocognitive impairments in chronic pain: Transdiagnostic approach and clinical implications. Year: 2026 Issue: Volume: 186 Abstract: Chronic pain (CP) affects over 30% of the global population, as leading cause of disability significantly impairs quality of life and daily functioning. Evidence suggest that 20% of people with CP experience neurocognitive impairment. Various CP conditions, including nociplastic, neuropathic, nociceptive (i.e., musculoskeletal, post-surgical pain, among others), demonstrate distinct yet overlapping neurocognitive impairment, underscoring the need for transdiagnostic approaches. Although the problem remains underestimated, the impact of this burden is likely to increase further with the aging population and increasing prevalence of CP. To better understand how a transdiagnostic approach may be helpful in the comprehension of the co-occurrence of neurocognitive impairments and CP, this systematic-narrative hybrid literature review aims to synthesize the state of the art regarding neurocognitive impairments associated with CP, emphasizing clinical implications. A systematic literature search was conducted in PubMed, SCOPUS and EMBASE using keywords related to CP and neurocognitive impairments including peer reviewed articles published from inception to May 2025. Emerging evidence highlights the bidirectional relationship between CP and neurocognitive impairments, particularly in domains such as attention, memory, language, executive function, and perceptual-motor function across diverse populations with CP. A transdiagnostic perspective is needed to bridge the gap between clinical implications and future research. This study highlights the clinical significance of incorporating neurocognitive evaluations and treatments into CP management, advocating a shift towards more personalized and multimodal healthcare approaches. Considering the limitations of this review, further high-quality research is needed to better understand the underlying mechanisms and associated clinical implications. […]

Author Names: Loke, Ryan W. J,Ortiz, Oscar,Gustin, Sylvia M,Hubli, Michele,Linnman, Clas,Livny, Abigail,Quide, Yann,Scheuren, Paulina S,Kramer, John L. K Database Source: APA PsycInfo <May 2026 Week 3> Journal Title: Brain Communications Article Title: Convergent structural brain alterations in chronic pain: A multi-metric individual participant data meta-analysis. Year: 2026 Issue: 3 Volume: 8 Abstract: Chronic pain is a leading contributor to all-cause morbidity and disability, encompassing numerous biopsychosocial dimensions that persistently engage complex networks of brain regions. Meta-analyses have advanced our understanding of structural brain differences in chronic pain but rely exclusively on summary statistics which may introduce heterogeneity related to completeness of reporting and differences in methodological approaches. To address these limitations, we conducted the first individual participant data (IPD) meta-analysis of brain structure alterations in chronic pain. Using traditional morphometric measures (i.e. volume, cortical thickness, and surface area) and differential-geometric shape metrics (i.e. intrinsic and extrinsic curvature), we aimed to reveal alterations in brain structure convergent across chronic pain conditions. We hypothesized that chronic pain would be associated with region-specific grey matter reductions in regions previously implicated in chronic pain (e.g. parahippocampal gyrus and insula) and explored whether curvature metrics would reveal additional structural changes. Anatomical MRI images from eight publicly available datasets spanning five conditions and 401 individuals with chronic pain (and 245 age- and sex- matched healthy controls) were analysed: (i) knee osteoarthritis, (ii) chronic low back pain, (iii) fibromyalgia, (iv) migraine, and (v) primary trigeminal neuralgia. FreeSurfer was used to parcellate T1-weighted anatomical images, and metrics for cortical and subcortical regions were extracted. Meta-analysis revealed a range of structural changes in the brain associated with chronic pain. Cortical thinning and volume loss were small and localized to the temporo-occipital regions, including bilateral volumetric reductions in the entorhinal cortex in individuals with chronic pain. Increases in intrinsic curvature […]

Author Names: Lunasin, Ray M Database Source: APA PsycInfo <May 2026 Week 3> Journal Title: Dissertation Abstracts International Section A: Humanities and Social Sciences Article Title: Effects of dry needling and therapeutic exercise on sleep in individuals with chronic neck pain and sleep disturbance: A pilot randomized clinical trial. Year: 2026 Issue: 9-A Volume: 87 Abstract: Although there is evidence demonstrating a bidirectional relationship between sleep and pain, non-pharmacological interventions are lacking to address both sleep dysfunction and pain together. Therefore, research that investigates the effects of non-pharmacological interventions not only on pain but also on sleep dysfunction is warranted. As dry needling (DN) has been shown to influence biochemical substances that are associated with both pain modulation and sleep regulation, it has potential as an effective intervention in addressing sleep disturbance (SD) in patients with chronic neck pain (CNP). Before a large-scale randomized clinical trial (RCT) is carried out to examine the effects of DN for individuals with CNP and SD, a pilot study was conducted in order to examine the feasibility of an RCT. Therefore, the purposes of this pilot RCT were to determine: 1) the feasibility of an RCT aimed to examine the effects of DN in addition to therapeutic exercise (TE) in individuals with CNP and SD, and 2) the effect sizes of DN in order to estimate an appropriate sample size for a large-scale RCT. Thirty eligible participants were randomly assigned into two groups: DN plus TE (n = 14) and TE only (n = 16), but two from the TE group dropped out. The outcome measurements included total sleep duration using wrist actigraphy, sleep quality using the Pittsburgh Sleep Quality Index (PSQI), pain severity using the Numerical Pain Rating Scale (NPRS), and disability level using the Neck Disability Index (NDI). Sleep duration was collected four times: at baseline in week 1 and weekly in the following 3 weeks. The PSQI, NPRS and NDI scores were collected three times: at baseline, the 4-week follow-up, and the 12-week follow-up. The results demonstrated that a large-scale RCT is feasible and provided necessary insight into budgetary and personnel requirements. Additionally, a sample size of 68 was […]

Author Names: Gabathuler, Felix,Wurth, Kristina,Hodel, Martina,Glassel, Andrea,Biller-Andorno, Nikola,Schwind, Bettina Database Source: APA PsycInfo <May 2026 Week 3> Journal Title: Journal of Bioethical Inquiry Article Title: Reflections on epistemic injustice to advance person-centred care through the experiences of persons with chronic pain. Year: 2026 Issue: 1 Volume: 23 Abstract: Rationale: Persons with chronic pain report that their voices are marginalized in healthcare, despite efforts to achieve person-centred care. Aims and Objectives: This study aims to explore the healthcare experiences of persons with chronic pain through the lens of epistemic injustice to advance person-centred care. <ovid:br/>Method: A secondary analysis of cross-sectional interviews with twenty German-speaking Swiss participants, originally collected as part of the DIPEx Switzerland project, was conducted. Data were examined using thematic analysis. <ovid:br/>Results: Results revealed two overarching themes. Under Epistemic Challenges, participants felt dismissed, misunderstood, or relegated to passive roles by a system privileging quantifiable measures over subjective experiences. This overreliance on objective data fosters epistemic injustice by discounting patient testimonies and perpetuating systemic inadequacies. Under Epistemic Opportunities, participants reported more effective knowledge exchange when their expertise was acknowledged, empathy was shown, and professionals recognized their own limitations. <ovid:br/>Conclusions: Findings underscore the need to balance objective assessments with patients' subjective perspectives, recognizing persons with chronic pains as legitimate collaborators. By integrating their lived expertise, healthcare systems may mitigate epistemic injustices and provide more empathetic, effective care. (PsycInfo Database Record (c) 2026 APA, all rights reserved)

Author Names: Weissman-Fogel, Irit,Treister, Roi Database Source: APA PsycInfo <May 2026 Week 3> Journal Title: The Journal of Pain Article Title: Neuromodulation to prevent the chronification of phantom limb pain: A theoretical neural circuit model. Year: 2026 Issue: Volume: Abstract: The central mechanisms of chronic phantom limb pain (PLP) are widely investigated, yet those underlying the transition from acute to chronic PLP (PLP chronification) are overlooked. Using insights from neuroscience of phantoms and pain phenomena, we propose a new, theoretical neural circuit model for PLP and its chronification. In this focus article, we suggest that maladaptive connectivity within and between specific neural circuits (multisensory integration, salience, and prefrontal modulatory) underlies PLP and its chronification. This conceptual theoretical model is supported by findings that a combination of neuromodulatory techniques (mirror therapy and transcranial direct current stimulation) prevented PLP chronification. Current literature suggests that mirror therapy modulates the multisensory integration circuit and that transcranial motor cortex stimulation may modulate the salience and prefrontal modulatory neural circuits. According to our proposed conceptual theoretical model, the combined therapy applied at the acute stage of PLP might prevent chronic PLP, suggesting the importance of these neural circuits in PLP chronification and its persistence. This framework aims to generate testable hypotheses, and its validity depends on future empirical studies. PERSPECTIVE: This paper offers a perspective on phantom limb pain (PLP), highlighting the often-overlooked shift from acute to chronic PLP. It introduces a theoretical neural circuit model connecting multisensory, salience, and prefrontal circuits, while emphasizing early combined neuromodulation as a promising approach to preventing PLP from becoming chronic. (PsycInfo Database Record (c) 2026 APA, all rights reserved)

Disability & Rehabilitation; 05/01/2026Purpose: To assess the effect of combining virtual walking (VW) with physical exercise (PE) compared to PE alone in people with incomplete spinal cord injury (iSCI). Methods: A randomised controlled trial was designed. Thirty-eight people with iSCI performed 18 sessions (6 weeks) according to assigned group: i. Experimental Intervention (EI): VW with PE; or ii. Control intervention (CI): Placebo VW with PE. Chronic pain, muscle tone, and spasticity were assessed at baseline (T1), after the intervention (T2) and at 4 (T3) and 12 weeks (T4) follow-up. Results: The EI group exhibited a decrease in pain severity at T2 (p = 0.02), and a reduction in interference with mood and walking at T2 (p = 0.02 and p = 0.04). In the CI group, pain interference with mood and work decreased at T3 (p = 0.03 and p = 0.04). For spasticity, the EI group showed a reduction at T2 (p = 0.02), T3 (p = 0.01) and T4 (p = 0.03) compared to T1, whereas the CI group only showed a decrease at T3 (p = 0.02) compared to T1. No changes were found in tone at rest. Conclusions: Combined use of VW and PE is effective in the short term in reducing pain and spasticity, unlike the application of PE alone, in individuals with iSCI. However, this intervention is not effective for improving muscle tone. IMPLICATIONS FOR REHABILITATION: A 6-week protocol of virtual walking combined with physical exercise may lead to an improvement in functional mobility and overall quality of life for individuals with incomplete spinal cord injury. This intervention does not significantly improve muscle tone at rest, indicating that its clinical benefits are limited to dynamic or functional contexts rather than passive muscle properties.(AN 193467992); ISSN: 09638288CINAHL Complete

Pain Management Nursing; 06/01/2026Diabetic peripheral neuropathy is a significant cause of chronic pain in patients with type 2 diabetes. Although pharmacological treatments are available, complementary therapies such as reflexology massage may offer additional symptomatic relief. However, evidence on the efficacy of reflexology massage in this context remains limited, particularly among women with type 2 diabetes. This study aimed to evaluate the effect of foot reflexology massage on neuropathic pain in women with type 2 diabetes. This study was conducted between April 2023 and March 2024. The study was conducted as a randomized controlled trial and included 65 women diagnosed with type 2 diabetes and neuropathic pain, randomized into intervention (n = 33) and control groups (n = 32) using a computerized randomization program managed by an independent researcher. The intervention group received routine treatment plus foot reflexology massage administered by trained nurses, while the control group received routine treatment only. Outcomes were assessed using validated instruments for neuropathic pain and sensory function: Douleur Neuropathique 4 Questions (DN4) , a 10-item questionnaire identifying neuropathic pain; Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), differentiating neuropathic from nociceptive pain; Visual Analog Scale (VAS) , measuring pain intensity on a 0-10 scale; Monofilament test (SWM), evaluating peripheral touch sensation; and Neurothesiometer , assessing vibration perception thresholds. Effect sizes (Cohen's d) and 95% confidence intervals were calculated. Preintervention measurement characteristics and pain scores did not differ significantly between groups (p >.05). Postintervention, the intervention group demonstrated significant reductions in DNQ4 (p =.001, d = 3.55), LANSS (p =.001, d = 2.34), and VAS scores (p =.001, d = 2.26) compared to the control group. No adverse events related to the intervention were reported. Foot reflexology massage administered by trained nurses effectively reduces neuropathic pain in women with type 2 diabetes. As a low-cost and accessible therapy, it can serve as a valuable adjunct to routine care and is recommended to be incorporated and maintained in nursing practices for the management of neuropathic pain in individuals with diabetes.(AN 194002678); ISSN: 15249042CINAHL Complete

Pain Management Nursing; 06/01/2026Chronic pain in America has reached a tipping point, utilization of effective therapies is needed in primary care. This quality improvement project evaluated the impact of adding group hypnotherapy to the chronic pain treatment plan, on pain interference, global health, and pain intensity in primary care patients. Using a pre-test/post-test survey to compare the effectiveness of adding group hypnotherapy to the pain regimen, participants were invited to undergo one session of group hypnotherapy lasting two hours either in person or virtually Three data points were evaluated to assess the impact of chronic pain on participants: pain interference (PEG), pain intensity (NRS), and global health (PROMIS). All measures were self-reported and statistically analyzed using Microsoft Data Toolkit. The percentage change in each measure was evaluated from pre-intervention to post-intervention. There were 65 participants who were mostly female (83%). African-Americans represented 77% of the group and 72% of participants experienced chronic pain for more than five years. Pain intensity and pain interference were reduced following hypnotherapy by 24% and 23%, respectively. Global health was directly impacted by audio recording adherence, with a notable 19% improvement at follow-up. The inclusion of one group hypnotherapy session into chronic pain management can reduce the overall pain experience with reduced pain intensity and interference. Chronic pain management in primary care needs to shift to a tailored approach. Collaborating with alternative medicine practitioners for a comprehensive pain management approach is needed. The development of multidisciplinary teams, including hypnotherapists for chronic pain management, has potential to efficaciously address chronic pain(AN 194002666); ISSN: 15249042CINAHL Complete

Pain Management Nursing; 06/01/2026High levels of stigma among patients with chronic pain contribute to negative psychological well-being. Existing measures have not focused on opioid stigma among individuals with chronic pain who may have legitimate need for opioid therapy. We developed a measure of opioid stigma that captures two constructs: perceived stigma (awareness of others' negative attitudes) and internalized stigma (application of stereotypes to oneself) among individuals with chronic pain. We recruited 180 participants with chronic pain via the online platform CloudResearch to modify an existing stigma scale. We developed items related to perceived stigma (8 items) and internalized stigma (5 items). Concurrent and discriminant validity were evaluated using the Center for Epidemiologic Study Depression Scale-10, Rosenberg Self-Esteem and Brief Resilience Scales. Factor structure were based on Iterated principal factor analysis with Promax rotation. The final sample included 151 participants, primarily Caucasian (80%), between 30-39 years old (40%), with a history of opioid use (81%). A two-factor solution was identified (MSA =.90), representing perceived and internalized stigma (Eigenvalues 7.23, 2.53; inter-factor correlation =.45, alphas =.94,.94). Semi-partial item correlations ranged from.61-.78 for perceived stigma and.73-.82 for internalized stigma. Significant correlations were observed between perceived stigma and CESD-10 (0.19, p = 0.02), and internalized stigma and resilience (−0.26, p =.001). The adapted 13-item measure demonstrates sound psychometric properties in evaluating awareness and agreement with stigmatizing attitudes, supporting its reliability and validity. Nurses are uniquely positioned to identify opioid stigma, develop interventions, and reduce its impact for individuals with chronic pain.(AN 194002695); ISSN: 15249042CINAHL Complete

Pain Management Nursing; 06/01/2026In recent years, artificial intelligence (AI) has demonstrated great potential in the field of managing chronic pain (CP). AI can optimize treatment decisions, improve the quality of life of patients with CP, and promote the rational allocation of medical resources. However, the existing studies are mostly scattered, lack systematic integration and analysis, and have not yet constructed a knowledge map reflecting the whole picture of the research. This study aims to apply bibliometric analysis methods to explore the current research status and hotspots in the intersection of AI and CP, providing valuable insights for researchers in this field. In this study, the Web of Science Core Collection was used as the data source, and the search time limit was from the establishment of the database to October 2025. The search scope included the Science Citation Index Expanded (SCI-EXPANDED), Current Chemical Reactions (CCR-EXPANDED), and Index Chemicus (IC). VOSviewer software was used to conduct a visual analysis of the cooperation networks among countries, institutions, journals, and authors, as well as the co-occurrence relationships of keywords. Furthermore, the CiteSpace tool was adopted to identify burst keywords to reveal the latest research trends. A total of 356 studies related to AI and CP were ultimately included for analysis after a systematic screening of records retrieved from the Web of Science Core Collection. These studies originated from 882 institutions across 54 countries and regions, were published in 190 journals, and involved 2,207 authors. The number of publications increased rapidly between 2018 and 2025. The United States ranked first in both the number of publications and total citations. At the institutional level, Harvard University was the most productive institution. In terms of journal distribution, the journal Pain published the largest number of documents and received the highest total number of citations. The keyword co-occurrence network revealed four major research clusters: CP, machine learning, low back pain, and prediction. Recent trend analysis revealed that prediction, neural networks, pain management, and neck pain have emerged as key research areas in the application of AI to CP. Although significant progress has been made in the application of AI in CP management, there are still some key challenges, including a lack of cooperation among countries and institutions, limited adaptability […]

European Journal of Physiotherapy; 06/01/2026Background Although matched care is increasingly regarded as the more evidence-based approach for chronic musculoskeletal pain, reimbursement systems often require Interdisciplinary Multimodal Pain Treatment (IMPT) to be delivered as the final step in a stepped care approach to ensure transparent attribution of effects. This study therefore evaluates the effectiveness of IMPT specifically after preceding lower-intensity treatments. Methods Adult cohorts receiving IMPT after unsuccessful less-intensive treatments were included. Eligible studies reported ≥12-month follow-up. Standardised mean change (SMC) scores from pre-treatment to follow-up were synthesised for health-related quality of life (HRQoL), pain interference, physical functioning and pain intensity. Results Sixteen cohorts from 13 studies met criteria. Most showed positive long-term outcomes across all domains. Meta-analyses demonstrated significant moderate-to-strong improvements, over all outcome domains, despite substantial heterogeneity. Conclusions IMPT as the final stepped-care intervention provides consistent, clinically meaningful long-term benefits for chronic primary musculoskeletal pain, supporting its continued implementation and funding.(AN 194088735); ISSN: 21679169CINAHL Complete