The structure and function of human tissue, such as bone, muscle and tendon, can be improved with targeted exercise training. However, the effects of exercise training on intervertebral disc tissue remain unclear. We aimed to examine the impact of physical loading exposure (exercise training, sport and physical activity) on intervertebral disc (IVD) health compared to non-physical loading (or lower volume of the same physical loading) controls. We conducted a systematic review and meta-analysis. Seven electronic databases (PubMed, CINAHL, SPORTDiscus, EMBASE, CENTRAL, Web of Science and Scopus) and two trial registries (World Health Organization International Clinical Trials Registry Platform and National Institutes of Health) were searched from inception to 3 June, 2025. Forward and backward citation tracking was conducted for included reports. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation criteria (GRADE). Risk of bias was assessed using Cochrane RoB2 and Johanna Briggs Institute critical appraisal checklists. We included randomised controlled trials (n = 2), cohort (n = 9) and cross-sectional studies (n = 28) of any physical loading compared to controls with continuous measurements of IVD health (e.g. T2-relaxation, IVD height) via magnetic resonance imaging and/or categorically graded measures of IVD degeneration (e.g. Pfirrmann grade). Forty-five reports of 39 studies (participants: 4152) were included. The pairwise random-effects meta-analysis estimated the standardised mean difference (Hedges’ g) of continuous outcomes for combined physical loading and independent subgroups and odds ratios (Paule–Mandel estimator) of categorical outcomes for combined physical loading only. A meta-analysis revealed upright bipedal loading (mostly running; Hedges’ g [95

OBJECTIVE:To provide an overview of the effects of exercise for osteoarthritis. DESIGN:Overview. DATA SOURCES:Medline, Embase, Epistemonikos, PEDro, Cochrane and registries from inception to 8 November 2025. ELIGIBILITY CRITERIA:Reviews comparing exercise with placebo, no intervention or other interventions on pain and function for osteoarthritis. Supplementary trials were included to update inconclusive areas. DATA EXTRACTION AND SYNTHESIS:Two independent reviewers extracted data and assessed bias. Data were standardised to a 0-100 scale and reanalysed using random-effects meta-analysis. Certainty was rated using Grading of Recommendations Assessment, Development and Evaluation. RESULTS:Five reviews (κ=100; n=8631) and 28 supplementary trials (knee/hip κ=23, hand κ=3, ankle κ=2; n=4360) were included. Evidence indicated small, short-term effects of exercise versus placebo (mean difference -10.8, 95% CI -19.1 to -2.6) and no-treatment (-12.4, 95% CI -15.6 to -9.2) for knee osteoarthritis pain, but certainty was very low and effects in larger or longer-term trials were smaller. Moderate evidence suggested negligible effects in hip (-6.7 95% CI -9.3 to -4.0) and small effects in hand (-10.0 95% CI -15.5 to -4.5) osteoarthritis. Varying certainty evidence indicated comparable outcomes to education, manual therapy, analgesics, injections and arthroscopy. Single trials in selected populations showed exercise was less effective than knee osteotomy (12.4 95% CI 4.7 to 20.2) and joint replacement (knee 17.1 95% CI 10.4 to 23.8; hip 24.2 95% CI 18.2 to 30.2) at longer term. CONCLUSION AND RELEVANCE:Evidence on exercise for osteoarthritis remains largely inconclusive, suggesting negligible or short-lasting small effects comparable to, or less effective than, other treatments. These findings question its universal promotion and highlight the need to revisit research priorities and clinical discussions around its worthwhileness. REGISTRATION:CRD42023446888.

Objective To examine the efficacy of conservative (non-surgical) treatments, usual care, and no treatment for chronic radicular and non-specific back pain.Design Time course network meta-analysis.Data sources Six electronic databases (Medline, SPORTDiscus, CINAHL, PsycINFO, Embase, and CENTRAL), searched from inception to 24 July 2020, and 302 previous systematic reviews.Eligibility criteria for selecting studies Full peer reviewed publications in English or German of randomised controlled trials, randomised clinical trials, randomised controlled cluster trials, or randomised crossover trials in adults (aged ≥18 years) receiving common conservative treatments for non-specific and radicular chronic low back pain. Treatments examined were acupuncture, education or advice, electrotherapy (including heat and ice electrotherapeutic modalities applied non-invasively), exercise training, manual treatments or manipulation, massage, the McKenzie method, pharmacotherapy, psychological treatments, traction, physical therapy (otherwise not falling into specific treatment combinations), placebo, multidisciplinary pain management, usual care (eg, management by a doctor), and no treatment (true control).Results Back pain intensity, leg pain intensity, disability, and mental health outcomes were reported immediately (<1 day), and at short term (≥1 day and ≤3 months), intermediate term (>3 and <12 months), and long term (≥12 months) time points. 581 reports of 551 studies (71 126 patients) were included. 510 trials included people with non-specific chronic low back pain and 41 trials included those with radicular chronic low back pain. For back pain (0-100 scale), acupuncture (mean difference −20.91, 95% credible interval −24.00 to −11.95), electrotherapy (−18.98, −21.84 to−10.95), exercise (−15.59, −17.51 to −10.05), manual treatment (−19.48, −22.17 to −11.74), massage (−25.61, −30.42 to −10.91), and multidisciplinary pain management (−18.96, −22.26 to −9.58) exceeded the minimal clinically important difference (set at 0.5 standard deviation) in the short term. For disability (0-100 scale), acupuncture (mean difference −10.52, 95% credible intervals −11.84 to −6.59), massage (−9.95, −11.45 to −5.50), and multidisciplinary pain management (−12.56, −13.91 to −8.55) were clinically effective in the short term. In the immediate and intermediate term only, the McKenzie method and massage, respectively, exceeded the minimal clinically important difference. In the long term, although two of the 14 treatments for back pain and nine of 14 treatments for disability had statistically significant benefits compared with no treatment, the effects were not clinically significant. The certainty of the evidence based on the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework was low (1.4%) to very low (98.6%) across interventions and time points. Findings for massage and the McKenzie method were not stable in the sensitivity analyses. Treatment effects for radicular chronic low back pain did not seem to differ from those for non-specific chronic low back pain.Conclusions Some treatments were effective for pain and function in non-specific chronic low back pain, but improvements did not persist long term. Most of the evidence was for non-specific chronic low back pain; the evidence base for radicular chronic low back pain was limited. Although sensitivity analyses did not provide evidence for a different response in radicular chronic low back pain, an evidence gap remains for this subpopulation. Future work should explore strategies to establish the long term efficacy of modifications to lifestyle and behaviour.Systematic review registration PROSPERO CRD42020182039

Introduction Low back pain (LBP) is the leading cause of disability globally and clinical practice guidelines recommend active and conservative management. However, little is known regarding guideline adherence among German healthcare practitioners. Methods We conducted an online, cross-sectional clinical vignette-based survey of 658 German medical doctors, physiotherapists, and sport scientists between May 2022 and March 2023 to assess implementation of diagnostic and treatment recommendations for chronic non-specific LBP, specific LBP (axial spondyloarthritis), and acute lumbar radiculopathy. Guideline implementation was assessed for the survey responses against recommendations from four German national guidelines. Adherence was quantified using a predefined adherence matrix that translated agreement with guideline recommendations into percentage scores. The use of clinical practice guidelines and determinants of guideline adherence were calculated. Multiple regression analyses examined predictors of guideline adherence. Results Among 658 healthcare practitioners, overall guideline adherence was 57.8% (treatment: 59.8%; diagnostic: 50.6%). Adherence was highest for chronic non-specific LBP, while imaging was frequently overused for lumbar radiculopathy (MRI recommended by 84.3% (95% CI 81.1-87.5). Awareness of axial spondyloarthritis was poor, with only 32.7% (95% CI 29.2 to 36.4) correctly identifying the condition. Correct triage across the three vignettes emerged as the strongest predictor of overall guideline adherence. Conclusion Diagnostic and treatment adherence to national guidelines among German healthcare practitioners appears inadequate. Overuse of imaging for acute lumbar radiculopathy, delays in axial spondyloarthritis diagnosis, correct triage for specific LBP, and underutilization of active rehabilitation for chronic non-specific LBP are important areas for optimizing clinical care.

To identify patient and intervention factors that moderate the effects of running on intervertebral disc health (IVD) in adults with non‑specific chronic low back pain. Pre‑planned secondary analysis of a 12-week parallel-group (1:1) randomised controlled trial of 40 adults with non-specific CLBP (mean [SD] age: 33 [6] years, female: 50

ABSTRACT Background The intervertebral disc (IVD) is a mechanosensitive structure influenced by physical loading (physical activity/sport/exercise); however, the optimal type and parameters of physical loading for IVD health remain unclear. The Bone Physical Activity Questionnaire is validated to predict bone mineral density from lifetime exposure to physical loading; therefore, we explored the association between lifetime physical loading and IVD health. Methods This cross‐sectional study recruited 40 individuals with chronic low back pain. Outcomes were magnetic resonance imaging‐derived IVD measures reported as both averages and across individual spinal levels T11/T12–L5/S1, including T2 (ms, measure of hydration), height‐to‐vertebral‐body ratio, nucleus‐to‐annulus signal intensity ratio, volume (cm3), and Pfirrmann grade (0–5 points). Multiple linear regression examined lifetime physical loading and IVD health while controlling for significant covariates (age, body mass index, current and past occupational sitting, and physical labour). Results Lifetime bone‐related physical loading was not associated with IVD health across average spine values, except nucleus‐to‐annulus signal intensity ratio, which was negatively associated (β [95% CI]: −0.00 [−0.01, −0.00], p = 0.030). At L5/S1, IVD T2 (−0.30 [−0.56, −0.05], p = 0.022) and nucleus‐to‐annulus signal intensity (−0.02 [−0.03, −0.01], p = 0.007) were negatively associated, and Pfirrmann grade (0.02 [0.01, 0.03], p = 0.006) was positively associated with physical loading. Conclusions Physical activity loading necessary for improved IVD health appears to differ from loading previously reported for optimal bone health. Specifically, lifetime activity levels considered beneficial for bone were associated with less favourable L5/S1 IVD characteristics, highlighting distinct loading requirements across these tissues. Future studies could develop a questionnaire that captures optimal physical loading for IVD health, such as moderate physical loading.

Musculoskeletal pain is associated with alterations across brain, sensory, psychological, motor, and tissue domains, but the relative magnitude of these differences across domains and diagnoses remains unclear. We synthesised evidence comparing people with fibromyalgia, knee osteoarthritis, low back pain, and neck pain with pain-free controls and examined whether multidomain patterns differed by diagnosis. MEDLINE, EMBASE, PsycINFO, CINAHL, and SPORTDiscus were searched from inception to June 2025, supplemented by trial registries and reference lists. We included observational studies and randomised trials contributing baseline data that compared adults with fibromyalgia, knee osteoarthritis, low back pain, or neck pain with pain-free controls. Standardised mean differences (Hedges' g) were pooled using random-effects models with robust variance estimation. Multivariate models jointly estimated domain-level effects while accounting for within-study dependence. Certainty of evidence was assessed using GRADE. Across 118 studies (N = 11,822), psychological (g = 1.08, 95% CI 0.94-1.22; moderate-certainty evidence) and sensory (g = 0.85, 95% CI 0.61-1.08; moderate-certainty evidence) measures showed larger case-control differences than motor (g = 0.66, 95% CI 0.51-0.82; very low-certainty evidence), brain (g = 0.59, 95% CI 0.39-0.78; low-certainty evidence), and tissue measures (g = 0.30, 95% CI 0.05-0.55; very low-certainty evidence). Patterns of effects differed across diagnostic categories, with fibromyalgia showing larger differences across domains than the other conditions. PERSPECTIVE: This review provides an integrated overview of evidence that has often been restricted to single domains or diagnoses. Considering findings across multiple assessment domains may help distinguish musculoskeletal pain states and guide future multidomain research and more targeted treatment approaches. REGISTRATION: This review was prospectively registered on the Open Science Framework (https://osf.io/dy9ek).

OBJECTIVES: We compared topical manual pain therapy (TMPT), a myofascial manual therapy using patient-guided pressure techniques, with exercise training, in adults with chronic nonspecific neck pain. METHODS: In this parallel (1:1) randomized controlled trial, 91 participants (68 women, 23 men) with neck pain ≥3 months were allocated to 3 weeks of TMPT ( n = 51) or exercise training ( n = 40). TMPT included six therapist-guided myofascial massage sessions; exercise training involved resistance-based neck and shoulder exercises. The primary outcome was pain intensity (100-point visual analogue scale) at 6 months. Secondary outcomes included disability, Global Rating of Change, sleep, psychological health, and adverse events. RESULTS: At the primary endpoint (6 months), there was no significant between-group difference in current pain intensity mean difference (MD; MD = 0.05 [−7.80, 7.97], P = .990) between TMPT and exercise. TMPT yielded greater short-term improvements in current pain (MD = 14.58 [−21.18, −7.98]), average pain (MD = 7.67 [−14.43, −0.91]), and disability (MD = 3.4 [−6.54, −0.42]), but these differences did not persist. No between-group differences were observed for maximal pain. Patterns were similar for disability and Global Rating of Change. No serious adverse events occurred. CONCLUSION: TMPT did not offer greater long-term benefits compared to exercise. Although short-term between-group differences favored TMPT, these did not exceed the predefined minimal clinically important difference (15 points on the visual analogue scale) and were not sustained. Future studies should explore blinded delivery, booster sessions, and combined approaches. JOSPT Open 2026;4(1):101-110. Epub 3 December 2025. doi:10.2519/josptopen.2025.0182

BACKGROUND:Exercise is a well-established treatment for chronic low back pain (LBP), yet its effects on inflammation remain unclear. OBJECTIVE:Examine the effects of running on inflammatory markers in chronic LBP and its associations with pain intensity, and mental health as an a priori secondary analysis. METHODS:An a priori secondary analysis of a 12-week, two-arm, parallel-group randomised controlled trial was conducted. Forty adults with chronic LBP were randomised to a run-walk program or waitlist control. The intervention was a digitally delivered, remotely supervised run-walk program, prescribed three times per week for 30 min. Outcomes assessed included systemic inflammatory markers (C-reactive protein [CRP], interleukin-8 [IL-8], and tumour necrosis factor alpha [TNF-α] as well as pain intensity (Visual Analogue Scale), and mental health (21-item Depression, Anxiety, and Stress Scale). RESULTS:No significant between-group differences were observed in CRP (ß [95% CI] = 0.34 [-0.07, 0.74] (log-transformed scale), p = 0.109), TNF-α (-1.29 [-6.15, 3.58] pg/mL, p = 0.595), or IL-8 (-0.36 [-1.30, 0.58] (log-transformed scale), p = 0.443) over the 12 weeks. The associations between changes in inflammatory markers and pain intensity or mental health were not different between groups (all p > 0.05). CONCLUSIONS:A 12-week run-walk training did not alter systemic CRP, TNF-α, or IL-8 in adults with chronic LBP. Improvements in pain intensity were not associated with changes in these inflammatory markers. Clinically, this intervention offers a low-cost and accessible approach that provides meaningful improvements in chronic LBP without observed changes in systemic CRP, IL-8, and TNF-α.

OBJECTIVE:Network meta-analyses (NMAs) frequently inform recommendations for osteoarthritis (OA), but methodological flaws may introduce bias and yield misleading results. This methodological study aimed to evaluate the risk of bias in a restricted sample of systematic reviews incorporating NMAs of health care interventions for knee and hip OA. METHOD:We searched PubMed to identify NMAs published in 22 leading general/internal medical and specialty journals ('Rheumatology/Orthopedics', 'Rehabilitation/Sports Sciences') that evaluated pharmacological or non-pharmacological interventions for knee or hip OA pain or physical function. Risk of bias was assessed independently by two reviewers using the ROBIS tool in combination with the Risk of Bias in Network Meta-Analysis (RoB NMA) tool. RESULTS:A total of 21 NMAs were included. Of these, 11 (52%) evaluated pharmacological interventions, 7 (33%) non-pharmacological interventions, and 3 (14%) a combination. Most NMAs (13; 62%) were rated high risk of bias, four (19%) raised some concerns, and four (19%) were low risk. Risk of bias was most frequently related to intervention grouping and assessment of transitivity, including limited consideration of effect modifiers and statistical consistency. Assessments took a median of 45 minutes (range: 20-110 minutes), with 67-71% inter-rater agreement and slight to fair agreement statistics. CONCLUSION:Knee and hip OA NMAs published in leading journals frequently exhibit limitations in intervention grouping and assessment of transitivity, potentially affecting their validity. Future OA NMAs should implement transparent node-making and assess transitivity a priori by examining key clinical and methodological study characteristics to determine whether valid statistical synthesis is feasible.

Impairments in lumbar sensory perception, including reduced tactile acuity, occur in patients with nonspecific low back pain (LBP). Tactile acuity is linked to primary somatosensory cortex (S1) activity and structure, but neural markers of lumbar-specific tactile acuity tests remain unvalidated. This cross-sectional study investigated associations between lumbar two-point discrimination (TPD) and estimation (TPE) with functional and structural properties of S1, as well as S1-thalamic connectivity. Resting-state functional MRI and diffusion-weighted MRI assessed S1-thalamic functional connectivity (FC) and structural connectivity, as well as regional homogeneity (ReHo) and mean diffusivity (MD) of S1 grey matter in 78 LBP patients and 39 pain-free controls. Participants with LBP were subdivided into 2 groups: 1 with pain (LBP+, n = 39) and 1 without pain (LBP−, n = 39) on the day of assessment. Higher TPD (ie, worse tactile acuity) was associated with higher contralateral S1-thalamic FC (β = 19.97 mm, 95% CI = 8.47-31.46 mm) and lower contralateral S1-MD (β = −76.98 mm, 95% CI = −142.83 to −11.13 mm). Higher TPE was associated with higher S1-ReHo (β = 19.67 mm, 95% CI = 0.35-39 mm). Two-point discrimination and two-point estimation were positively correlated (r = 0.25, P < 0.001). No between-group differences were found for the MRI variables or TPE, but the LBP+ group showed higher TPD thresholds than pain-free controls (MDiff. = 6.05 mm, P adj. = 0.023). Our findings question the validity of TPE as a measure of tactile acuity. Both neural markers of TPD may not explain tactile acuity impairments in LBP but instead reflect a baseline indicator of tactile performance capability, suggesting poor validity as an LBP-specific marker of neuroplasticity.

The stigma that running is unsafe for people with chronic low back pain (LBP) persists, despite recent studies showing that running training is feasible and beneficial in chronic LBP. We examined the beliefs about running in adults with chronic LBP. Forty adults (20 female, mean [SD] age 33 [6] years) with non-specific chronic LBP were randomised to a 12 week digitally-delivered run-walk interval training intervention or waitlist control (ACTRN12622001276741). Participants completed the activity specific beliefs questionnaire (4-point Likert scale) and recorded pain intensity at baseline and 12 weeks. Running intervention participants (n = 19) completed semi-structured qualitative interviews at 12 weeks. Prior to randomisation, 10 participants (25

We compared domain-specific cognitive function between adults with chronic low back pain (CLBP) and pain-free controls. PubMed, CINAHL, PsycINFO, EMBASE, and CENTRAL were searched from inception to 21 February 2025. Pairwise random-effects meta-analysis estimated standardised mean difference (Hedges' g). Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach assessed certainty of evidence. JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies assessed risk of bias. Twenty-six studies (participants: 5572) were included. Compared to pain-free controls, adults with CLBP performed worse on tests of executive function (g [95%CI]: 0.50 [0.27, 0.74], P<0.001, GRADE: very low), global cognition (-0.23 [-0.43, -0.04], P=0.018, GRADE: low), memory (-0.65 [-0.90, -0.41], P<0.001, GRADE: very low), motor skills (0.44 [0.25, 0.64], P<0.001, GRADE: very low), and processing speed (0.27 [0.03, 0.51], P=0.027, GRADE: very low), yet not attention (-0.32 [-1.29, 1.68], P=0.363, GRADE: very low), language (-0.57 [-4.27, 3.13], P=0.302, GRADE: very low), and perception (-0.19 [-1.43, 1.05], P=0.584, GRADE: very low). CLBP may be associated with slightly worse global cognition. CLBP may also be associated with worse executive function, memory, motor skills, and processing speed, but the evidence is very uncertain. While there is a lack of evidence regarding causal mechanisms, assessing cognitive function among adults with CLBP appears warranted. Registration: PROSPERO (CRD42022356396). PERSPECTIVE: This systematic review and meta-analysis compared domain-specific cognitive function between adults with chronic low back pain and pain-free controls. While there is a lack of evidence regarding causal mechanisms, assessing cognitive function among adults with chronic low back pain appears warranted.

OBJECTIVES:This pre-planned secondary analysis examined the effects of a running intervention on mental health symptoms and pain catastrophising in adults with chronic low back pain. DESIGN:Two-arm parallel individual randomised (1:1) controlled trial. METHODS:This study randomised 40 adults (mean [standard deviation] age: 33 [6] years, female: 50 %) with non-specific chronic low back pain to a 12-week running (progressive run-walk interval exercise training) intervention (n = 20) or waitlist control (n = 20). Outcomes were mental health symptoms (21-item Depression, Anxiety, and Stress Scale) and pain catastrophising (Pain Catastrophising Scale). Data were collected at baseline, six, and 12 weeks post-baseline. Separate linear mixed models with random effects (participants) evaluated within- and between-group changes. RESULTS:At 12 weeks post-baseline, running improved overall mental health symptoms (estimated marginal mean net difference [95 % confidence interval] points: -4.35 [-7.73, -0.97], P = 0.012), depression symptoms (-1.75 [-3.42, -0.08], P = 0.040), stress symptoms (-1.65 [-3.01, -0.29], P = 0.017), and pain catastrophising (-7.85 [-11.98, -3.72], P < 0.001), yet not anxiety symptoms (-0.95 [-2.16, 0.26], P = 0.122), compared with control. CONCLUSIONS:Running improved mental health symptoms and pain catastrophising among adults with non-specific chronic low back pain when compared to waitlist control. Differences in pain catastrophising, yet not mental health symptoms, were clinically meaningful. Running appears to be an efficacious treatment for psychological comorbidities common among adults with non-specific chronic low back pain.

Background:Low back pain (LBP) is a major cause of disability worldwide. To tackle issues such as long wait times and limited access to conventional care, telemedicine is emerging as a viable alternative. It offers benefits such as reduced travel and increased flexibility, with evidence showing comparable effectiveness to in-person care. However, usability remains a key challenge, impacting patient compliance. objectives:In a 3-arm randomized controlled trial, our preplanned secondary analysis aimed to assess the usability and patient perceptions toward an autonomous app-based intervention ("NOLA") for LBP to improve clinical practice of telemedicine interventions. Objectives included evaluating app usability, assessing perceptions toward telemedicine, and exploring app usage, adherence, and motivation. Methods:Patients with LBP were recruited from May to August 2022 and randomized into App, Physio+App, or Physio groups. App and Physio+App groups were included in this subanalysis. Intervention duration was 6 weeks. Data on baseline characteristics, System Usability Scale, Telemedicine Perception Questionnaire, app usage, adherence, and motivation were collected via web-based questionnaires. Results:A total of 64 participants were randomized to use the app with available data for 38 participants. The mean age of participants who completed was 49.9 (SD 13.6) years, with 78% (29/38) experiencing LBP for more than 2 years. Usability scores (0-100) were good (Physio+App: median 78, IQR 58-92, app: median 86, IQR 65-91). Positive telemedicine perceptions were noted, with 84% (15/20) rating it an adequate addition to usual care. App usage varied, with 43% (16/35) using it 3 to 5 days per week, and 64% (21/33) reported motivation to use the app. The dropout rates (App: 14/32, 44%; Physio+App: 12/32, 38%; Physio: 11/29, 38%) were similar, but participants who dropped out had statistically significantly less pain (completers: mean 3.9, SD 2.0; dropouts: mean 3.0, SD 2.0; P=.02). Reasons for dropout were mostly not reported. Conclusions:The app "NOLA" demonstrated good usability, and participants expressed positive perceptions toward telemedicine in those who completed the intervention. Despite concerns about the lack of physical contact, the majority considered telemedicine a convenient form of health care delivery. App usage and motivation were favorable, emphasizing the potential of app-based interventions in managing LBP.

Chronic pain and comorbid sleep difficulties impact many children and adolescents. This study aimed to evaluate the efficacy of psychological interventions on sleep in children and adolescents with chronic pain. Five databases (PubMed, CINAHL, APA PsychInfo, Embase, CENTRAL) were searched from inception to April 17, 2023, for randomized controlled trials examining the effects of psychological interventions on sleep in participants aged ≤ 19 years with pain persisting for ≥ 12 weeks. Six studies (participants, n = 686; 78.43 Systematic Review Registration: Registry: PROSPERO; Name: Efficacy of Psychological Interventions for Sleep in Children and Adolescents with Chronic Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials; URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023454620 ; Identifier: CRD42023454620. Thwaite TL, Craige EA, Mundell N, et al. Efficacy of psychological interventions on sleep in children and adolescents with chronic pain: a systematic review with meta-analysis of randomized controlled trials. J Clin Sleep Med. 2025;21(8):1445–1461.