Which type and dosage of mindfulness-based interventions are most effective for chronic pain? A systematic review and network meta-analysis.

Chronic pain exerts an enormous personal and economic burden worldwide. While clinical trials have confirmed the benefits of mindfulness-based interventions (MBIs) in chronic pain management, knowledge on the best type and dosage remains unknown. This study aims to compare the clinical effectiveness of different MBIs on chronic pain and to identify the optimal dosage of MBIs. The primary outcome was pain intensity and secondary outcomes were physical function and depression. We applied a random-effect pairwise meta-analysis to synthesize data, and network meta-analysis to compare effectiveness among different types and dosages of MBIs. The findings were further categorized according to the partially contextualized framework. A total of 68 studies with 5,339 participants were included. Mindfulness-based stress reduction demonstrated the most promising results for improving pain intensity (SMD -0.76, 95 % CI -1.06 to -0.46, Surface Under the Cumulative Ranking Area (SUCRA) 0.75) and depression (SMD -0.77, 95 % CI -0.98 to -0.56, SUCRA 0.86), supported by moderate and high certainty of evidence, respectively. On the other hand, mindfulness-oriented recovery enhancement emerged as the most effective for enhancing physical function (SMD -1.42, 95 % CI -2.28 to -0.57, SUCRA 0.96), albeit with low certainty of evidence. An 8-week course, conducted once per week, with sessions lasting between 90 and 120 min, appeared to be the optimal dosage for addressing pain intensity, physical function, and depression. Our findings contribute to the evidence supporting the use of MBIs in chronic pain management and informing the development of evidence-based guidelines and standardizing the course structures of MBIs. Systematic review registration: PROSPERO CRD42021293938.