Currently submitted to: Journal of Medical Internet Research
Date Submitted: Mar 12, 2026
Open Peer Review Period: Mar 13, 2026 - May 8, 2026
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Effectiveness of Digital Psychological Interventions for Primary Chronic Pain: A Systematic Review and Recommendations for Clinical Practice
ABSTRACT
Background:
Chronic primary pain is a complex condition involving biological, psychological, and behavioral mechanisms and is commonly associated with emotional distress and reduced quality of life (QoL). Digital mental health interventions (DMHIs) offer scalable and accessible solutions for delivering psychological care in chronic pain management; however, evidence regarding their effectiveness across delivery modalities and outcome domains remains heterogeneous.
Objective:
This systematic review aimed to (1) evaluate the effectiveness of DMHIs on clinical (pain intensity, disability) and psychological outcomes (QoL, anxiety, depression, catastrophizing, and self-efficacy) in adults with chronic primary pain; (2) examine whether specific digital delivery modalities are differentially associated with particular outcomes; and (3) identify methodological gaps to inform future research and implementation.
Methods:
A systematic literature search was conducted in PubMed, Scopus, PsycINFO, Cochrane Library, Web of Science, and Google Scholar following PRISMA guidelines. Two independent reviewers screened randomized controlled trials (RCTs) and assessed risk of bias using the Cochrane Risk of Bias 2.0 tool. Given substantial heterogeneity in study designs, interventions, and outcome measures, a narrative synthesis was performed.
Results:
Twenty-two RCTs were included. DMHIs were effective in improving psychological functioning and pain-related disability, often independently of changes in pain intensity, particularly when grounded in evidence-based psychotherapeutic frameworks such as cognitive behavioral therapy and acceptance and commitment therapy. Guided web-based interventions demonstrated the most consistent benefits, whereas unguided interventions showed smaller effects. Mobile applications and virtual reality–based interventions also showed positive effects on emotional functioning, self-management, and pain interference. Interventions incorporating some form of human guidance were generally associated with superior outcomes.
Conclusions:
DMHIs represent a promising, scalable, and person-centered approach to improving psychological well-being and functional outcomes in adults with chronic primary pain, particularly when integrated into stepped-care or hybrid care models. Clinical Trial: CRD420251010767
Citation
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