Effects of Non-Pharmacological Interventions on Pain and Psychological Outcomes in Patients with Burns: A Systematic Review and Meta-Analysis

Abstract

Background Non-pharmacological interventions are used alongside analgesia in burn care, but the evidence comes from clinically diverse interventions, populations, and settings. Methods We searched nine databases from inception to July 1, 2026. Controlled studies of virtual reality, music, massage, hypnosis, relaxation, distraction, or structured psychological interventions in patients with burns were eligible. Continuous outcomes measuring the same construct were synthesized as Hedges’g standardized mean differences (SMDs) using random-effects models. Multi-arm trials contributed one independent study-level effect by combining eligible intervention arms sharing a common control. Risk of bias was assessed with RoB 2 or ROBINS-I, and certainty with GRADE. Results Sixteen studies were included; 10 contributed to meta-analysis. Pain was lower with non-pharmacological interventions (4 studies, n=354; SMD=−0.78, 95% CI −1.27 to −0.29; I2=78.8%). A restricted pain analysis remained favorable (2 studies, n=206; SMD=−0.61, 95% CI −1.16 to −0.06). Randomized-trial analyses favored interventions for general anxiety (3 studies, n=261; SMD=−1.03, 95% CI −1.63 to −0.43) and depressive symptoms (2 studies, n=141; SMD=−1.31, 95% CI −1.91 to −0.72). Pain-related anxiety was lower in 2 studies (n=360; SMD=−0.83, 95% CI −1.28 to −0.38; I2=70.3%). Certainty was low for pain and pain-related anxiety and very low for general anxiety and depressive symptoms. Conclusion Selected interventions were associated with lower procedural pain, pain-related anxiety, and some short-term psychological symptoms. Substantial clinical and methodological heterogeneity limits the certainty and generalizability of the pooled estimates. These interventions should be considered adjuncts to, not replacements for, pharmacological analgesia and appropriate psychological care.