Efficacy of Internet‐Based Cognitive Behavioural Therapy ( iCBT ) on Pain Symptoms and Sleep Quality Improvement in Chronic Pain Patients: A Meta‐Analysis of Randomised Controlled Trials

ABSTRACT Background Chronic pain is defined as pain that persists or recurs for more than 3 months, involving complex pathological mechanisms and affecting a significant global population. In recent years, Internet‐Based Cognitive Behavioural Therapy (iCBT) has garnered increasing attention as a treatment modality, particularly for alleviating chronic pain and improving sleep quality. Design A systematic review and meta‐analysis. Methods Comprehensive literature searches were conducted in English databases including PubMed, Web of Science (WoS) Core Collection, Cochrane Library, and Embase, as well as Chinese databases including China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform (Wanfang), and VIP Information from their inception to December 2, 2024. Two independent researchers performed the literature search and data extraction. All statistical analyses were performed using RevMan version 5. Results Nine randomised controlled trials were included in the analysis. Following the intervention, iCBT significantly alleviated pain (9 studies, SMD = −0.24, 95% CI = −0.37 to −0.12, I 2 = 33%). Five studies included long‐term follow‐up, and the results indicated no statistically significant differences between the intervention and control groups (5 studies, SMD = 0.05, 95% CI = −0.10 to 0.19, I 2 = 0%). Five studies compared post‐intervention and follow‐up results in the intervention group, showing no statistically significant differences (5 studies, SMD = −0.27, 95% CI = −0.73 to 0.19, I 2 = 88%). Regarding sleep, following the intervention, iCBT significantly enhanced sleep quality (9 studies, SMD = −0.42, 95% CI = −0.71 to −0.14, I 2 = 76%). Subgroup analysis of sleep outcomes revealed that iCBT was effective for both patients with diagnosed sleep disorders and those without a diagnosis of insomnia. iCBT was effective among patients with diagnosed insomnia (2 studies, SMD = −0.61, 95% CI = −1.17 to −0.04, I 2 = 70%) and those without a diagnosis of insomnia (7 studies, SMD = −0.37, 95% CI = −0.66 to −0.07, I 2 = 67%). iCBT was also found to be effective in adults aged ≥ 18 years (6 studies, SMD = −0.71, 95% CI = −0.87 to −0.54, I 2 = 29%). Additionally, subgroup analysis of intervention delivery modes showed hospital web‐based self‐administered (2 studies, SMD = −0.83, 95% CI = −1.17 to −0.50, I 2 = 0%) and synchronous remote interventions (2 studies, SMD = −0.79, 95% CI = −1.01 to −0.57, I 2 = 0%) significantly improved sleep quality. Conclusion iCBT is an effective intervention for the management of chronic pain, significantly alleviating pain and improving sleep quality in patients. It is particularly effective in enhancing sleep quality in adults aged ≥ 18 years. Trial Registration PROSPERO identifier: CRD42025634381