Growing evidence highlights the high prevalence of body image (BI) and body awareness (BA) disturbances in individuals with chronic pain. Moreover, these constructs appear to play a significant role in pain experience. Despite a growing number of interventions targeting BI and BA in chronic pain populations, no systematic review has synthesized their effects. This systematic review was conducted in accordance with PRISMA guidelines and included 24 randomized controlled trials (RCTs). Studies were identified through four databases (PubMed, APA PsycNET, Scopus, and Web of Science), searched on November 14, 2022, and updated on February 26, 2025. Inclusion criteria were: (1) adults (≥18 years) with chronic pain; (2) BI or BA-based interventions; (3) RCTs; and (4) outcomes assessing BI, BA, pain intensity, disability, interference, catastrophizing, kinesiophobia, or emotional distress. Quality assessment was carried out with The Panacea Project Quality Assessment Tool for Quantitative Studies and the results were synthesized narratively. Most studies involved female participants (20 out of 24 RCTs). The most studied conditions were fibromyalgia (N=8) and chronic low back pain (N=4). Interventions including physical activity (N=4) (e.g. aerobic exercise, dance, Pilates) consistently showed positive effects on BI and pain intensity. Evidence on kinesiophobia, catastrophizing, and emotional distress was limited and heterogeneous. Overall, while BI appears to be a relevant therapeutic target in chronic pain, the evidence remains modest. In contrast, BA-focused interventions yielded more robust effects. Taken together, these findings highlight the effects of interventions targeting body image and body awareness and support their integration into multidisciplinary chronic pain management.
Keywords: body perceptions; catastrophization; kinesiophobia; rehabilitation.
This review looked at whether treatments that focus on the body can help people living with chronic pain. Often, people with chronic pain feel uncomfortable, disconnected, frustrated or even distrustful toward their bodies. This can make pain harder to manage. However, it has not been clear whether treatments that focus on body image or body awareness can reduce pain or improve daily life. We reviewed 24 high-quality studies that tested different types of treatments. These included movement-based activities such as yoga, Pilates, tai chi, dance, and aerobic exercise, as well as approaches using virtual reality or positive psychology. Programs that included physical activity often helped people feel better about their bodies and reduced pain levels. However, the number of studies was small. Treatments that focused on body awareness, such as gentle movement, balance, and breathing exercises, were studied more often. These treatments showed benefits both shortly after treatment and over time. In summary, helping people feel more positive about their bodies may be useful, but more research is needed. Treatments that improve body awareness seem to offer more consistent benefits. These findings suggest that combining body image and body awareness approaches may improve care for people living with chronic pain.
© 2026 Navarro-Moreno et al.