Interventions to enhance work participation in people with chronic pain: a systematic review and meta-analysis including analysis of complex psychological intervention components

Purpose.
Chronic pain impairs work participation. Psychological interventions can support people with chronic pain to work, yet little is known about which components are most effective. A systematic review and meta-analysis assessed the effectiveness of interventions targeting sick leave, return to work, work ability and work-related self-efficacy in chronic pain populations. Intervention content was analysed to identify effective components.

Methods.
A search strategy was developed and applied to six databases from inception until 2nd March 2023, being updated in December 2024: PsychInFO, Medline, Cinahl, Web of Science, Cochrane Library and Embase. Intervention descriptions were coded for intervention functions, theoretical domains and behaviour change techniques. Risk of Bias was assessed using the ROB-2 tool.

Results.
51 randomised controlled trials were identified. Study quality was poor overall. Meta-analysis showed that psychological interventions were complex, i.e. contained multiple components delivered alongside other interventions, which together were associated with reduced sick leave (SMD -0.41, 95% CI -0.64 to -0.18) and a small increase in those working at long-term follow-up (>12 months) (RR 1.03, 95% CI 1.01 to 1.06; I2=0%) but not work ability/capacity ( SMD -0.02, 95% CI -0.12 to 0.08, I2=0%;) or return to work (RR 0.98, 95% CI 0.91 to 1.05, I2=0%). No intervention components appeared most effective, but five common components were identified: education, skills/training, social support, emotional regulation, and confidence building.

Conclusions.
Complex psychological interventions can positively influence work outcomes for people with chronic pain. Future research should prioritise high-quality studies and incorporate the five components to enhance work-focussed support.