Body Image and Body Awareness Interventions in Chronic Pain: A Systematic Review of Effects on Pain-Related Variables and Emotional Distress.

Growing evidence highlights the high prevalence of body image (BI) and body awareness (BA) disturbances in individuals with chronic pain. Moreover, these constructs appear to play a significant role in pain experience. Despite a growing number of interventions targeting BI and BA in chronic pain populations, no systematic review has synthesized their effects. This systematic review was conducted in accordance with PRISMA guidelines and included 24 randomized controlled trials (RCTs). Studies were identified through four databases (PubMed, APA PsycNET, Scopus, and Web of Science), searched on November 14, 2022, and updated on February 26, 2025. Inclusion criteria were: (1) adults (≥18 years) with chronic pain; (2) BI or BA-based interventions; (3) RCTs; and (4) outcomes assessing BI, BA, pain intensity, disability, interference, catastrophizing, kinesiophobia, or emotional distress. Quality assessment was carried out with The Panacea Project Quality Assessment Tool for Quantitative Studies and the results were synthesized narratively. Most studies involved female participants (20 out of 24 RCTs). The most studied conditions were fibromyalgia (N=8) and chronic low back pain (N=4). Interventions including physical activity (N=4) (e.g. aerobic exercise, dance, Pilates) consistently showed positive effects on BI and pain intensity. Evidence on kinesiophobia, catastrophizing, and emotional distress was limited and heterogeneous. Overall, while BI appears to be a relevant therapeutic target in chronic pain, the evidence remains modest. In contrast, BA-focused interventions yielded more robust effects. Taken together, these findings highlight the effects of interventions targeting body image and body awareness and support their integration into multidisciplinary chronic pain management.