Effects of booster sessions on self-management interventions for chronic musculoskeletal pain: a systematic review and meta-analysis of randomised controlled trials.

When people finish a self-management programme for long-term musculoskeletal pain, the benefits do not always stick, so some programmes add later 'booster' sessions to try to maintain behaviour change. This review pooled 14 randomised trials with a total of 1695 patients to see whether adding booster sessions after the main intervention helped more than the intervention without them. For the main outcomes the researchers cared about, physical function, pain-related disability, and confidence in managing pain, there was no evidence that booster sessions made a difference. One secondary outcome, pain catastrophising (negative thinking about pain), showed a statistically significant reduction, though this does not necessarily translate into less pain or better function.

Pain intensity, mood, coping, and adherence showed no clear effect either. The main limitation is that every included study was rated high risk of bias with very low quality evidence, and the trials varied considerably, so these findings should be read as uncertain rather than conclusive.

If you have ever finished a pain self-management programme, such as one teaching pacing, coping skills, or exercise, you may have been offered occasional 'booster' follow-up sessions meant to help the changes last. This review looked at 14 studies with over 1,600 patients combined to see whether those booster sessions actually helped people stay better over time. The short answer is that the evidence does not currently show a clear benefit.

Physical function, how much pain limited daily activities, and people's confidence in managing their pain did not show a clear improvement when booster sessions were added. One thing did show a statistically significant change: people reported less pain catastrophising, meaning less negative or worried thinking about their pain, though that is a different thing from pain itself easing.

Importantly, the studies behind these findings were rated as low quality with a high risk of bias, so this isn't a final answer, just an honest look at what the evidence shows so far.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This review addresses a practical question many clinicians face: once a patient completes a self-management programme for chronic musculoskeletal pain, do periodic booster sessions help sustain the gains, or do effects fade regardless? Pooling 14 randomised controlled trials (1695 patients), the authors found no evidence of effect on the primary patient-reported outcomes of physical function, pain-related disability, or pain self-efficacy when booster sessions were added after the index intervention. Among secondary outcomes, booster sessions were associated with a statistically significant reduction in pain catastrophising, but no effect was detected for pain intensity, depression, coping, or treatment adherence. Because catastrophising was a secondary outcome and the overall body of evidence carries high heterogeneity, this isolated significant result should be interpreted cautiously rather than as confirmation that boosters meaningfully alter the clinical course. Critically, every included study was judged at high risk of bias, and the overall certainty of evidence was rated very low.

The abstract does not report on adverse events. This means the findings do not establish that booster sessions are ineffective, only that current trial-level evidence does not support their routine inclusion for maintaining behaviour change, and more rigorous trials would be needed to clarify their role.