Effectiveness of Digital Psychological Interventions for Adolescents With Chronic Pain and Comorbid Anxiety and/or Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
TL;DR
Future efforts should prioritize integrated intervention programs that combine pain management with emotion regulation, establishing them as foundational components within the broader care system to complement routine clinical practice.
Abstract
Background
Adolescence is a high-risk period for co-occurring conditions like chronic pain, anxiety, and depression. Although digital psychological interventions offer a scalable and accessible alternative to traditional care, their comprehensive efficacy in addressing these interconnected symptoms remains underexplored. This meta-analysis evaluates the effects of digital interventions on pain in adolescents with comorbid emotional problems, with secondary outcomes including anxiety and depressive symptoms.
Methods
We systematically searched five databases for randomized controlled trials through October 5, 2025, ultimately including 12 studies. Statistical analyses were performed in Review Manager 5.4 and Stata 17.0 using a random-effects model and specifically focused on adolescents with comorbid conditions. The review protocol was registered with PROSPERO. Subgroup analyses were conducted based on intervention type (Internet-based Cognitive Behavioral Therapy [iCBT], self-management, and Internet-based Acceptance and Commitment Therapy [iACT]).
Results
A total of 12 studies involving 1403 adolescents were included. Meta-analysis indicated that digital interventions significantly improved pain (SMD = -0.21, 95% CI: [-0.35, -0.06]) and anxiety (SMD = -0.15, 95% CI: [-0.21, -0.10]). The effects of digital psychosocial interventions on depression were not statistically significant.
Conclusion
Digital interventions show potential in managing pain and anxiety among adolescents with comorbidities. Future efforts should prioritize integrated intervention programs that combine pain management with emotion regulation, establishing them as foundational components within the broader care system to complement routine clinical practice. TRIAL REGISTRATION This systematic review was prospectively registered with PROSPERO (CRD420251270961) on 12 December 2025. REGISTRATION DETAILS https://www.crd.york.ac.uk/PROSPERO/view/CRD420251270961.