Addressing health inequities in treating neuropathic pain: a scoping review of cognitive behavioral therapies, mindfulness, and meditation-based interventions

Chronic pain is the leading cause of disability worldwide and chronic neuropathic pain (NP) disproportionately affects individuals with unmet health care needs, especially those facing health inequities. This scoping review addresses 3 research questions: (1) What are the characteristics and outcomes of cognitive behavioral therapy (CBT), mindfulness, and meditation-based intervention studies designed to manage NP? (2) Do these intervention studies include participants from populations experiencing health inequities? (3) Are the interventions customized to meet the needs of people experiencing health inequities? Ten databases were searched for studies focused on the search terms "cognitive behavioral therapy," "CBT," "mindfulness meditation," "and neuropathic pain." In total, 1732 abstracts were screened and a total of 24 articles from 22 original studies were included. The primary characteristics of the studies showed that 99% of participants had NP attributable to diabetes, cancer, or spinal cord injury. Outcomes were consistent with previous reviews, demonstrating promise for CBT, mindfulness, and meditation-based therapies in relieving NP. However, demographics were poorly reported, and there was little diversity among participants. Individuals from groups experiencing health inequities were largely unrepresented. Although 55% of studies tailored intervention materials and provided content to support long-term practice, few included long-term follow-up to evaluate sustained impact. In general, research on this topic has fallen short in including and addressing the needs of people experiencing health inequities. Future research should prioritize broader participant inclusion criteria, involve individuals with lived experience in intervention design and delivery, and conduct long-term follow-up to enhance the accessibility, relevance, and sustainability of NP interventions.