Is Exercise Effective at Reducing Pain Catastrophizing in People with Chronic Non-Specific Spinal Pain? A Systematic Review and Meta-analysis

OBJECTIVES: This review assessed the effectiveness of exercise in reducing pain catastrophizing for people with chronic non-specific spinal pain. METHODS: Seven databases were searched from inception until May 2025. Randomized controlled trials and secondary analyses assessing exercise interventions for chronic non-specific spinal pain with pain catastrophizing were included. Methodological quality was assessed with the Cochrane Risk of Bias V2 and the Grading of Recommendations Assessment, Development and Evaluation tools. RESULTS: Eight studies (1271 participants) were included. All studies had 'some concerns' or 'high risk' of bias. Seven studies involved people with chronic low back pain and one involved chronic neck pain. For neck pain, there was low certainty of evidence supporting neck and scapular muscle strengthening for reducing pain catastrophizing. For low back pain, primary meta-analyses showed no significant superior effects of exercise compared with control in the short-term (<3 mo, four studies, 536 participants) and intermediate-term (3-6 mo, three studies, 258 participants) (SMD=-0.4 to -0.32; I2=82.8% to 84.5%). Exploratory post-hoc sensitivity analysis, excluding one study on motor control exercise because of the heterogeneity with the other forms of exercise interventions, demonstrated better effectiveness at both short- (SMD=-0.49, 95%CI: -0.80; -0.18; I2=59.2%) and intermediate-term follow-ups (SMD=-0.67, 95%CI: -1.05; -0.30; I2=16.9%). DISCUSSION: The findings suggest that exercise interventions may potentially be effective for reducing pain catastrophizing. Nevertheless, the overall certainty of evidence was rated very low to low such that higher quality studies are needed.