Comparative Effectiveness of Mind–Body Exercise Modalities on Pain Intensity and Fatigue in Patients with Non-Neuropathic Cancer-Related Pain: A Systematic Review and Network Meta-Analysis

Zhoushuai Yuan,1,2,* Jian Shi,3,* Weinie Xiang,1,4 Hairui Yu,1 Biru Wang,5 Qiang Chen,6 Huijuan Yuan,7 Ping Xiao,1 Huajuan Weng1,4 1Department of Rehabilitation Medicine, The Affiliated Hospital of Jiujiang University, Jiujian, Jiangxi, People’s Republic of China; 2Division of Exercise and Movement Science, Institute for Sport Science, University of Göttingen, Göttingen, Germany; 3Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China; 4Jiujiang Key Laboratory of Modern Scientific Research on Traditional Chinese Medicine Rehabilitation Technology, Jiujiang university, Jiujiang, Jiangxi, People’s Republic of China; 5Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China; 6Department of Rehabilitation, Shangrao Municipal Hospital, Shangrao, Jiangxi, People’s Republic of China; 7Center for Disease Control and Prevention of Lianxi District, Jiujiang, Jiangxi, People’s Republic of China*These authors contributed equally to this workCorrespondence: Huajuan Weng, Department of Rehabilitation Medicine, The Affiliated Hospital of Jiujiang University, Jiujian, Jiangxi, People’s Republic of China, Email [email protected]: Cancer-related pain (CRP) is a prevalent issue among cancer survivors, especially during extended periods of survivorship. Existing therapeutic approaches for CRP present certain limitations. To investigate safe and accessible non-pharmacological interventions that may reduce both pain and fatigue, we performed a network meta-analysis (NMA) to compare various Mind–Body Exercises (MBEs) in cancer survivors experiencing CRP, excluding cases of neuropathic pain.Patients and Methods: We systematically searched eight databases for randomized controlled trials (RCTs) assessing MBEs in adult patients with CRP. Data extraction was conducted using standardized forms. The Cochrane Risk of Bias tool was employed to evaluate study quality, and the certainty of evidence was appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The primary outcome was pain intensity, with fatigue as the secondary outcome. Both pairwise meta-analyses and the NMA were performed using random-effects models. Treatment rankings were derived from the surface under the cumulative ranking curve (SUCRA).Results: Fourteen eligible RCTs, comprising 1070 participants, were included in the analysis. For pain intensity, Qigong had the highest SUCRA value (98.6%) and was associated with greater reductions in pain than Pilates (SMD = − 2.16, 95% CI: − 3.90 to − 0.42), dance (SMD = − 2.31, 95% CI: − 4.27 to − 0.35), and yoga (SMD = − 2.36, 95% CI: − 4.07 to − 0.64). Taichi was also associated with greater pain reduction than standard exercise (SMD = − 1.18, 95% CI: − 1.88 to − 0.48). For fatigue, Qigong ranked first based on SUCRA (94.7%) and showed a favorable effect compared with usual care (SMD = − 1.30, 95% CI: − 2.59 to − 0.01).Conclusion: Within the limited and mainly breast cancer–based evidence, Qigong showed the most favorable ranking probabilities for pain intensity and fatigue in patients with predominantly non-neuropathic CRP. However, these findings should be interpreted with caution and regarded as exploratory rather than definitive evidence of clinical superiority. Taichi showed relatively more stable evidence for pain relief, although the overall certainty of evidence remained limited.Keywords: mind-body exercises, cancer-related pain, cancer pain, fatigue, exercise