Psychologically based interventions aim to improve pain-related functioning by targeting pain-related fears, cognitions and behaviors. Mediation and moderation analyses permit further examination of the effect of treatment on an outcome. This systematic review and meta-analysis aims to synthetize the evidence of specific mediators and moderators (i.e., treatment targets) of psychologically based treatment effects on pain and disability. A total of 28 mediation and 11 moderation analyses were included. Thirteen mediation studies were included in a meta-analysis, and the rest was narratively synthetized. Reductions in pain-related fear (indirect effect [IE]: −0.07; 95% confidence interval [CI]: −0.11, −0.04) and catastrophizing (IE: -0.07; 95%CI: −0.14, −0.00), as well as increases in self-efficacy (IE: -0.07; 95%CI: −0.11, −0.04), mediated effects of cognitive behavioral therapy on disability but not on pain intensity, when compared to control treatments. Enhancing pain acceptance (IE: -0.17; 95%CI: −0.31, −0.03) and psychological flexibility (IE: -0.30; 95%CI: −0.41, −0.18) mediated acceptance and commitment therapy effects on disability. The narrative synthesis showed conflicting evidence, which did not support a robust moderated effect for any of the examined constructs. Overall, the methodological quality regarding mediation was low, and some key pitfalls are highlighted alongside recommendations to provide a platform for future research.

基于心理学的干预措施旨在通过针对与疼痛相关的恐惧、认知和行为来改善与疼痛相关的功能。中介和调节分析允许进一步检查治疗对结果的影响。这项系统回顾和荟萃分析旨在综合基于心理的疼痛和残疾治疗效果的特定中介因素和调节因素（即治疗目标）的证据。总共包括 28 项中介分析和 11 项调节分析。荟萃分析中纳入了十三项中介研究，其余的则进行了叙述性综合。与疼痛相关的恐惧（间接效应[IE]：-0.07；95%置信区间[CI]：-0.11，-0.04）和灾难化（IE：-0.07；95%CI：-0.14，-0.00）减少，如与对照治疗相比，认知行为疗法对残疾有中介作用，但对疼痛强度没有影响。增强疼痛接受度（IE：-0.17；95%CI：-0.31，-0.03）和心理灵活性（IE：-0.30；95%CI：-0.41，-0.18）介导接受和承诺治疗对残疾的影响。叙述综合显示出相互矛盾的证据，不支持任何所检查的结构具有强大的调节效应。总体而言，有关调解的方法论质量较低，并强调了一些关键陷阱，并提出了为未来研究提供平台的建议。