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 randomized controlled trials were identified. Study quality was poor overall. Meta-analysis showed that psychological interventions were complex, that is, contained multiple components delivered alongside other interventions, which together were associated with reduced sick leave (SMD −.41, 95% CI: −.64 to −.18) and a small increase in those working at long-term follow-up (>12 months) (RR 1.03, 95% CI: 1.01–1.06; I2 = 0%) but not work ability/capacity (SMD −.02, 95% CI: −.12–.08, I2 = 0%) or return to work (RR .98, 95% CI: .91–1.05, I2 = 0%). No intervention components appeared most effective, but five common components were identified: education, skills/training, social support, emotional regulation, and confidence building. Conclusion: Complex psychological interventions can positively influence work outcomes for people with chronic pain. Future research should prioritize high-quality studies and incorporate the five components to enhance work-focussed support.