Treating pain and trauma: A systematic review of non-randomized studies of psychotherapeutic approaches.

The co-occurrence of chronic pain and trauma symptoms is prevalent; thus treatment approaches that address both are required. This systematic review of non-randomized studies aims to describe available psychotherapeutic interventions that concurrently target chronic pain and trauma-related symptoms for adults. Five databases (MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, PsycINFO) were searched from date of inception until October 8th, 2025. Eligible studies featured a psychological intervention addressing chronic pain and trauma-related symptoms. We screened 12,597 articles at the title and abstract phase, with 23 full-text studies meeting our eligibility criteria to be included in this review. Risk of Bias was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Eight studies assessed pain as the primary outcome, with five showing a significant improvement in both pain and trauma outcomes. Seven studies assessed trauma-symptoms as the primary outcome with three finding significant improvement in both pain and trauma-related outcomes. Eight studies assessed both pain and trauma-related symptoms as primary outcomes, with six showing an improvement in both categories. Due to the heterogeneity of the interventions and inconsistency of the results, it remains unclear which intervention approach(es) are effective to manage co-morbid chronic pain and trauma-related symptoms. However, overall, the synthesis underscores that psychological therapies can improve both pain and trauma symptoms; thus, advancing the field will require rigorous study designs that can delineate which specific therapies and mechanisms of action are most effective in treating individuals living with these comorbid conditions. PERSPECTIVE: Our results highlight the inconsistency in how chronic pain, trauma-related symptoms, psychological interventions and related outcomes are assessed in the current landscape. There is a necessity to streamline and standardize trial design and reporting in this field to improve knowledge acquisition and translation.