COGNITIVE behavioral therapy (CBT) and mindfulness may offer sustained reductions in pain and disability for adults with non-specific chronic low back pain, according to a new systematic review and meta-analysis of 75 randomized controlled trials encompassing over 15,000 participants.
The comprehensive analysis evaluated the long-term (1–2 years) and very long-term (≥2 years) effectiveness of non-surgical treatments for chronic low back pain, a condition that imposes significant personal and societal burden. Investigators found that CBT and mindfulness interventions provided moderate-certainty evidence for pain reduction, with mean differences of −7.2 and −10.0, respectively, on pain intensity measures. Disability was similarly improved, with reductions of −5.7 for CBT and −9.3 for mindfulness.
In addition to these psychological therapies, goal setting and needling were also associated with probable long-term improvements in disability. At the ≥2-year mark, multidisciplinary care showed a possible reduction in pain intensity (mean difference −10.1), while exercise interventions were linked to reduced disability (−10.2), albeit with low certainty.
However, the study notes that a high risk of bias was present in nearly 70% of included trials, and the effects observed were generally modest. Heterogeneity across studies and varying intervention protocols also limit the strength of the conclusions. These findings underline a pressing need for the development and rigorous testing of interventions that can provide durable outcomes.
Despite these limitations, the evidence suggests that psychological therapies and holistic care strategies may hold promise in alleviating the long-term impact of chronic low back pain, supporting a shift away from reliance on surgical or short-term solutions.
Reference:
Jenkins HJ et al. Long-term effectiveness of non-surgical interventions for chronic low back pain: a systematic review and meta-analysis. Lancet Rheumatol. 2025:S2665-9913(25)00064-5.
