One of the greatest obstacles in the treatment of chronic pain is not the efficacy of psychological interventions — widely demonstrated by the literature — but access to them. The cognitive-behavioral gold-standard treatment for chronic pain involves 6 to 12 in-person sessions, which represents an economic, logistic, and temporal barrier for most patients, especially in middle- and low-income countries. In this scenario, single-session interventions (SSIs) emerge as an accessible alternative: a single consultation or brief session delivers the central elements of a behavioral intervention and starts the change process.
A systematic review and meta-analysis led by Ziadni MS et al. — a Stanford University group specialized in pain treatment — and published in the Journal of Pain (March 2026) reviewed 17 randomized clinical trials and demonstrated that SSIs produce statistically significant improvements in pain intensity, functional interference, pain catastrophizing, anxiety, and depression in adults with chronic pain.
The problem of access to chronic pain treatment
It is estimated that chronic pain affects 1 in 5 adults in high-income countries and up to 1 in 3 in contexts of greater socioeconomic vulnerability. Despite the established efficacy of cognitive-behavioral therapy (CBT), acceptance and commitment therapy (ACT), and other psychological interventions, only a fraction of patients gain access to multi-session treatments. Barriers include:
Main barriers to access to psychological treatment for chronic pain
- Cost: pain-specialized psychology can be expensive out of pocket; a complete CBT course (8-12 sessions) is inaccessible for a large part of the population in many countries
- Time: chronic pain patients frequently have functional limitation and difficulty attending multiple in-person consultations
- Scarcity of professionals: psychologists specialized in chronic pain are concentrated in large urban centers and university hospitals
- Stigma: some patients are reluctant to start psychological treatment for fear of interpretation of pain as "psychological" or "imaginary"
SSIs address at least the first three barriers: they are cheaper, require only one encounter, and can be delivered in a hybrid manner (in person, telehealth, or even via app).
Methodology: 17 randomized clinical trials, multiple types of intervention
The review by Ziadni MS et al. (PROSPERO CRD42023447224) searched seven electronic databases through November 2024. Seventeen RCTs with adults with chronic pain diagnosis (any type) submitted to psychological interventions of maximum one-session duration were included. Outcomes measured included: pain intensity, pain interference with daily activities, pain catastrophizing, anxiety, and depression — all by validated instruments. Methodologic quality was evaluated by the NIH Quality Assessment Tool.
SINGLE-SESSION INTERVENTIONS FOR CHRONIC PAIN — STUDY DATA
Results: small but significant effects on all outcomes
All five primary outcomes demonstrated statistically significant improvements compared with control conditions. The effects are classified as small (SMD < 0.2) to small-moderate (SMD ≈ 0.3-0.4), which is consistent with what is expected from a single brief session versus multi-session treatments.
SSI EFFECTS — EFFECT SIZES BY OUTCOME
The outcome with the greatest response was pain catastrophizing (SMD = 0.37) — the cluster of negative thoughts, amplification, and helplessness in the face of pain. This suggests that brief interventions are especially effective at modifying dysfunctional beliefs and cognitive patterns, even without multiple work sessions. The result for depression was SMD = 0.25, also significant.
Frequently Asked Questions
Yes, according to this meta-analysis. The effects are small but consistent and statistically significant on five outcomes. The magnitude is similar to that of many first-line pharmacologic interventions for pain — for example, the gain in pain intensity (SMD = 0.17) is modest, but comparable in magnitude to that reported for some first-line pharmacologic interventions in chronic pain (direct comparison of effect size between heterogeneous modalities should be interpreted with caution). In addition, SSIs may serve as a gateway to more intensive interventions or potentiate the effect of other treatments (acupuncture, exercise) by modifying catastrophizing beliefs that limit adherence.
Pain catastrophizing is a cluster of negative cognitions and emotional responses to pain, composed of three dimensions: rumination (thinking excessively about pain), magnification (interpreting pain as threatening), and helplessness (feeling that nothing will help). Evaluated by the Pain Catastrophizing Scale (PCS), it is one of the most robust predictors of clinical outcome in chronic pain — more so than pain intensity itself. Patients with high catastrophizing have worse results in surgery, physical therapy, and pharmacotherapy, and greater risk of pain becoming chronic.
Yes, and many already do so intuitively. Explaining to the patient that chronic pain involves central sensitization (and not necessarily active injury), validating the painful experience without reinforcing catastrophism, and offering simple coping strategies are elements of psychoeducation that can be delivered in 10-15 minutes of consultation. Pain neuroscience education programs (PNE) have growing evidence as effective brief intervention.
Yes, and the combination is promising. While acupuncture acts on neurobiologic components of pain (modulation of neurotransmitters, descending pain inhibition circuits), SSIs address the cognitive and behavioral components (catastrophizing, kinesiophobia, avoidance). In clinical practice, medical acupuncturists can offer brief psychoeducation in the same encounter as acupuncture treatment — a form of SSI naturally integrated into the therapeutic plan.
Public health systems with integrative-medicine programs and primary-care psychology infrastructure offer natural settings for the delivery of brief interventions in mental health and pain. Primary-care psychologists can be trained in SSI techniques and integrate them into shared consultations. In addition, SSIs have potential for digital delivery (apps, telehealth platforms), expanding the reach in regions with lower density of specialized professionals.
Sources consulted
- Ziadni MS, Dildine TC, Edwards KA, Herrick A, You DS, Darnall BD. Single Session Behavioral Interventions for Chronic Pain: A Systematic Review and Meta Analysis of Randomized Controlled Trials. J Pain. 2026;27(3):106220. DOI: 10.1016/j.jpain.2026.106220.
- Darnall BD, Roy A, Chen AL, et al. Comparison of a Single-Session Pain Psychology Class to an 8-Session Cognitive Behavioral Therapy Program for Chronic Pain. J Pain. 2021.
- Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: development and validation. Psychol Assess. 1995.
- Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011.
- Williams AC, Fisher E, Hearn L, Eccleston C. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2020.
Fonte Original
The Journal of Pain(em inglês)Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).