Effectiveness of multicomponent pain therapy interventions for the reduction of pain catastrophizing in fibromyalgia syndrome: A systematic review and meta-analysis

Abstract

Fibromyalgia syndrome (FMS) is a chronic condition characterised by widespread musculoskeletal pain, fatigue, sleep disturbances, emotional symptoms and cognitive impairment. Pain catastrophising, a maladaptive cognitive-affective response to pain, has been consistently associated with greater symptom burden and poorer pain-related outcomes in FMS. Multicomponent pain therapy (MPT), an interdisciplinary approach that combines several therapeutic modalities, may address the multifaceted symptom burden of FMS. This study aimed to synthesise the available evidence on whether MPT was associated with reductions in pain catastrophising among adults with FMS from a transdisciplinary perspective. A systematic review and meta-analysis were conducted in accordance with Cochrane Collaboration guidance and the PRISMA statement; the protocol was registered in PROSPERO (CRD42024596489). Randomised controlled trials (RCTs), including pilot RCTs, were eligible if they assessed pain catastrophising in adults diagnosed with FMS. Data were extracted and analysed using Comprehensive Meta-Analysis software, and subgroup analyses were conducted according to intervention duration. The certainty of evidence was assessed using GRADE. Thirteen RCTs comprising 1,314 participants were included. At post-intervention, MPT was associated with a medium reduction in pain catastrophising (SMD = −0.668; 95% CI: −0.953 to −0.383; p  < .001), with moderate heterogeneity ( I ²  = 43.5%). At the 3-month follow-up, 6 studies comprising 472 participants yielded a larger pooled estimate (SMD = −0.957; 95% CI: −1.543 to −0.370; p  = .001), with moderate heterogeneity ( I ²  = 49.4%). Medium-duration interventions (11–20 sessions) yielded the largest subgroup estimate. Funnel-plot asymmetry was detected, although trim-and-fill-adjusted analyses remained in favour of MPT. Overall, MPT may reduce pain catastrophising in adults with FMS, and medium-duration interventions yielded the largest subgroup estimate. However, the certainty of evidence was low at post-intervention and very low at the 3-month follow-up; therefore, the magnitude and stability of these findings remain uncertain.