• Michele Marelli, Matteo Cioeta, Leonardo Pellicciari, Fabio Rossi, Stefania Guida, and Silvia Bargeri.
• Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
• Pain Med. 2025 Jan 12.

ObjectiveTo assess the effectiveness of cognitive functional therapy (CFT) in reducing disability and pain compared to other interventions in chronic spinal pain patients.MethodsFive databases were queried to October 2023 for retrieving randomized controlled trials (RCTs), including patients with chronic spinal pain and administering CFT. Primary outcomes were disability and pain. Secondary outcomes included psychological factors, quality-of-life, patient satisfaction and adverse events. Two independent reviewers performed study selection, data extraction, risk of bias assessment (Cochrane RoB 2.0), and evidence certainty (GRADE approach). Random-effect models were used for meta-analyses. Clinical relevance was assessed with the Smallest Worthwhile Effect.ResultsEight RCTs (N = 1228) for chronic low back pain (CLBP), one (N = 72) for chronic neck pain (CNP) were included. Compared to other conservative interventions, CFT may reduce disability (MD: -9.41; 95%CI: -12.56, -6.27) and pain (MD: -1.59; 95%CI: -2.33, -0.85 for CLBP) at short-term follow-up with probable to possible clinical relevance in CLBP and with low and very low evidence certainty, respectively. Similar results, with larger effect sizes, were observed for CFT compared to any unstructured or unsupervised minimal care treatments. Efficacy persisted in longer-term follow-ups, except for comparison with other conservative interventions. The CNP study showed positive results for CFT. Evidence certainty was low to very low. Sparse evidence was found for secondary outcomes.ConclusionCFT may offer clinically relevant benefits for CLBP, although the evidence remains mainly of low to very low certainty. Well-conducted studies, particularly in CNP and other spinal pain conditions are needed to strengthen these findings.RegistrationPROSPERO CRD42023482667.© The Author(s) 2025. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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