Mantra Meditation for Pain Conditions: A Systematic Review and Meta‐Analysis

Pain is defined by the International Association for the Study of Pain (IASP) as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’ [ 1 ]. Although criticised for oversimplification [ 2 ], pain is usefully categorised into nociceptive, inflammatory and pathological subtypes [ 3 ], and as acute or chronic by duration [ 4 ]. Chronic pain lasts at least 3 months (e.g., endometriosis, cancer‐related pain) [ 5 ], while acute pain involves rapid onset and short duration (e.g., burns, childbirth) [ 4 ]. Shared physiological and psychological mechanisms [ 6 ] support examining both forms together. The biopsychosocial model best captures pain’s complexity, integrating biological, psychological and social influences [ 7 , 8 ]. Individuals with pain frequently experience anxiety, depression, stress, sleep and mood disturbances, impaired function and disrupted relationships [ 9 ], driven by inflammation and psychosocial factors such as poor mental health or limited support [ 10 ]. These erode quality of life (QoL). Global prevalence is 28% across 52 countries ( n  = 199,862) [ 11 ], generating an annual economic burden of $560–635 billion in medical costs, lost productivity and disability support [ 12 ]. Such personal, societal and financial costs demand effective interventions. Pharmacological treatment predominates, beginning with over‐the‐counter analgesics before diagnosis [ 13 , 14 ] and progressing to tailored regimens of opioids [ 13 , 15 ] and NSAIDs [ 15 , 16 ]. Long‐term NSAID use carries cardiovascular and gastrointestinal risks [ 17 ]. Opioids exacerbate dependence, fuel the current crisis [ 18 ] and nearly double all‐cause mortality in older adults compared with NSAIDs [ 19 – 21 ]. Recognising these limitations and pain’s psychosocial burden, the UK National Institute for Health and Care Excellence (NICE) advocates multidisciplinary management [ 22 ]. This emphasises psychotherapeutic interventions delivered by mental health professionals [ 23 – 25 ], sometimes prioritised over pharmacotherapy or surgery [ 26 , 27 ]. Established psychological therapies include cognitive behavioural therapy (CBT) [ 28 ], acceptance and commitment therapy (ACT) [ 28 ], hypnotherapy [ 29 ] and mindfulness meditation [ 30 ]. CBT has the strongest evidence, significantly reducing pain and disability [ 31 – 34 ], as shown in a review of 75 trials ( N  = 9401) [ 34 ]. ACT improves distress and function, particularly in chronic pain [ 35 , 36 ]. Hypnotherapy benefits irritable bowel syndrome and emotional well‐being [ 37 – 40 ]. Mindfulness meditation stands out for its accessibility—no therapist required, fully self‐administered [ 41 ]—and consistent reductions in pain intensity and distress across populations [ 42 – 48 ], aligning with demand for nonpharmacological self‐management. Mantra meditation (MM), a concentrative practice centred on repeated mantras [ 49 , 50 ], is emerging as a promising alternative. While MM improves mental health [ 50 – 52 ] and spiritual well‐being [ 53 ], its role in pain management is still nascent. Rooted in Hinduism, Buddhism [ 54 ] and Zoroastrianism [ 55 ], ‘mantra’ derives from Sanskrit roots denoting mental repetition that ‘saves’ or protects from suffering [ 56 ]. Mantras—sounds, words or phrases—may be breath‐synchronised [ 57 ], chanted aloud or silently [ 58 ] or simply listened to [ 57 ]. Examples include Transcendental Meditation, Kirtan Kriya and Sahaj Samadhi [ 59 – 62 ]. MM uniquely engages linguistic pathways rather than somatic focus [ 63 ], a mechanism paralleled in speech‐language pathology by melodic intonation therapy, where repetitive, rhythmic vocal production recruits dedicated linguistic‐motor networks in speech rehabilitation [ 64 , 65 ], and by neuroscientific evidence that sustained verbal recitation is associated with structural changes in memory‐ and language‐related brain regions [ 66 ]. Traditional science holds that efficacy peaks when mantras are ‘chetan’—transmitted by a perfected teacher [ 57 , 67 – 69 ]. Neuroimaging reveals MM’s mechanisms. One study showed 40%–50% reductions in thalamic, prefrontal and global brain responses to pain, with modest anterior cingulate attenuation, dampening emotional and motivational processing [ 70 ]. Another study ( n  = 16) identified a signature of heightened attention (elevated anterior cingulate and dorsolateral prefrontal flow) paired with reduced arousal (decreased pons and cerebellar activity), confirming low effort and high feasibility [ 71 ]. Global interest is rising [ 51 ]; 1.6% of US adults (3.6 million) practised MM over 12 months, only 0.3% below mindfulness [ 72 ]. Despite this, no systematic review has synthesised MM’s effects on pain. Given the field’s early stage, broad inclusion criteria are recommended to capture available data comprehensively [ 50 , 73 , 74 ]. This review therefore evaluates MM interventions for acute and chronic pain conditions, across adult and paediatric populations, and all controlled study designs. It addresses four research questions: Can MM improve self‐reported pain intensity in individuals with pain conditions? Can MM improve QoL in people with pain conditions? Can MM reduce symptoms of depression, anxiety and stress in people with pain conditions? Can MM enhance mood states, psychological well‐being and sleep quality in people with pain conditions?

The present review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines [ 75 ]. The review protocol was registered prospectively on the International Prospective Register of Systematic Reviews (PROSPERO) on the 10th of October 2024, with reference number CRD42024598688 [ 76 ]. This project, due to being a review, was exempted from ethics approval. Studies were eligible if they were English‐language, peer‐reviewed, controlled trials (randomised or non‐randomised) involving human participants of any age or sex experiencing acute [ 4 ] or chronic [ 5 ] pain. Interventions had to consist of MM as the primary component, delivered in any format or duration (face‐to‐face or online); adjunctive breathing exercises or brief visualisations were permitted, but MM could not be combined with any other active intervention. Comparators could be any non‐MM control (wait‐list, treatment‐as‐usual or active). Outcomes were self‐reported using validated instruments and included pain intensity (primary), QoL, depression, anxiety, stress, negative mood, psychological well‐being and sleep quality. Studies were excluded if they were grey literature, conference abstracts, uncontrolled or did not evaluate an MM intervention. A comprehensive search was conducted across Medline Complete, APA PsycINFO, CINAHL, Cochrane CENTRAL, EMBASE and Scopus (see Appendix A for sample strategy (see Table A1 )). Reference lists of included studies and relevant reviews were hand‐searched. No date limits were applied; searches were restricted to English‐language publications and completed on 15 October 2024, and updated on 10 th October 2025. Records were imported into Covidence [ 77 ]. Titles and abstracts were screened independently by two reviewers (Yao Coitinho Biurra, Zoe Coitinho Biurra), with conflicts resolved by a third (Anthony Thompson). Full‐text articles were assessed independently by the same two reviewers, with discrepancies resolved by discussion. Data were extracted independently by two reviewers ((Yao Coitinho Biurra, Zoe Coitinho Biurra) into a pre‐piloted Excel spreadsheet (Appendix B), with conflicts resolved by AT. Extracted items included study characteristics (authors, year, country, design, setting), participant details (sample size, age, pain condition), intervention features (MM type, duration, delivery mode, comparator), outcome measures and all means and standard deviations (or standard errors) at every time point. A data extraction checklist is provided in Appendix C (see Table A2 ). Comparable outcomes were synthesised using inverse‐variance random‐effects meta‐analyses in IBM SPSS [ 78 ], following the intention‐to‐treat principle. Postintervention data (first follow‐up after intervention end) were converted to Hedges’ g to accommodate small samples and varying reporting formats, using the George Mason University online effect‐size calculator [ 79 ]. Effect sizes were interpreted as small (g = 0.15), medium (0.40) or large (0.75) [ 80 ]. Heterogeneity was assessed with I 2 (< 25% low, 50% moderate, 75% high) [ 81 ]. Acute and chronic pain studies were pooled because of the limited evidence base [ 50 , 73 , 74 ]. Subgroup analyses by pain type (acute vs chronic) were performed only when ≥ 2 studies were available per category. When multiple measures existed for one outcome, the most appropriate was selected. A narrative synthesis complemented the quantitative results. Risk of bias was assessed independently by two reviewers (Yao Coitinho Biurra, Zoe Coitinho Biurra) using the Cochrane Risk of Bias Tool Version 1 [ 82 ], with disagreements resolved by discussion. The tool evaluates seven domains (random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting and other bias), each rated as low, high or unclear risk.

All stages of screening are presented in the PRISMA flow diagram below [ 75 ] (see Figure 1 ). A total of 2588 studies were selected for potential inclusion, and 369 duplicates were removed. A further 2194 records were excluded after screening titles and abstracts against the selection criteria. The remaining 25 full‐text records were further assessed for eligibility, and another 18 were excluded, mostly due to the wrong study design or population. Discrepancies between reviewers were resolved through discussion. The remaining seven studies met the selection criteria and were included in the final meta‐analyses. PRISMA diagram of study selection [ 75 ]. Table 1 summarises the key characteristics of the studies included in this review. Seven RCTs were included, with sample sizes ranging from 22 [ 86 ] to 99 [ 85 ]. Four studies were conducted in the United States [ 60 , 83 , 84 , 86 ], one in Germany [ 85 ], one in India [ 59 ] and one in the Netherlands [ 87 ]. Summary characteristics of included randomised controlled trials. Note : STDV, standard deviation; QWB, Quality of Well‐Being survey; LHFQ: Minnesota Living with Heart Failure Questionnaire, 6‐MWT: six‐minute walk test, SF‐36: 36‐Item Short Form Health Survey, CES‐D: Center for Epidemiologic Studies Depression Scale, NPAD: Neck Pain and Disability Index, CPS: Cohen Perceived Stress Scale, KOOS: Knee Injury and Osteoarthritis Outcome Score. Acute/chronic classification follows ICHD‐3 convention for migraine (episodic attacks vs. ≥ 15 headache days/month for > 3 months) [ 5 ], and Bone and Joint Decade Task Force criteria for neck pain ( 3 months) [ 88 ]. Abbreviations: BNP, brain natriuretic peptide; CSI, Children Somatisation Inventory; PMS, Profile of Mood States; PCQ, Pain Coping Questionnaire; PSQI, Pittsburgh Sleep Quality Index; PSS, Perceived Stress Scale; PWBS, Psychological Well‐Being Scale; RCADS, Revised Children’s Anxiety and Depression Scale; STAI, State‐Trait Anxiety Inventory; TAI, Trait Anxiety Inventory; USA, United States of America. There were a total of 374 participants across 7 studies, with 188 participants in the intervention conditions and 186 in the control conditions. Mean ages ranged from 13.39 (STDV = 2.61) [ 87 ] to 64.14 (STDV = 9.13) [ 83 ] years. Six studies included adult populations, while only one [ 87 ] included a paediatric population ( n  = 78). While six studies included female‐dominant samples (74.38% females vs 25.62% males), only one was male‐dominant (53%) [ 59 ]. Further participant characteristics are presented in Table 1 . Two studies [ 83 , 87 ] implemented Transcendental Meditation, two [ 84 , 86 ] applied a general MM, one [ 84 ] used ‘spiritual’ mantras, one [ 60 ] employed Kirtan Kriya, one [ 59 ] utilised Yogic Sound Resonance, and one [ 85 ] investigated Jyoti Meditation. The intervention delivery methods varied: three studies [ 83 , 84 , 87 ] provided group‐based in‐person training, where the intervention itself was later self‐directed by participants at home, based on what they learned during training. Three studies [ 59 , 60 , 86 ] followed a similar delivery format, but included additional pre‐recorded audios for guided at‐home sessions. Lastly, one study [ 85 ] provided the intervention via in‐person group sessions, but also allowed for at‐home practice. Intervention durations ranged from 1.5 weeks [ 59 ] to 12 weeks [ 60 , 83 , 87 ], while follow‐up timeframes ranged from 3 weeks [ 59 ] to 9 months [ 87 ] (see Table 1 for further details). As presented in Table 1 , all the studies employed parallel controlled group designs, with all but one study [ 59 ] using an active control. Active control interventions differed across studies: Three studies [ 84 , 85 , 87 ] compared the intervention to progressive muscle relaxation (PMR), two [ 60 , 86 ] used music listening, and one [ 83 ] used health education, while the nonactive control study [ 59 ] employed nonguided supine rest. All included studies measured both physiological and psychological outcomes (see Table 1 for further details). The measures used for the meta‐analyses were as follows: The PSS was used for stress, the PMS for mood, PWBS for psychological well‐being, CES‐D and RCADS for symptoms of depression, STAI and RCADS for symptoms of anxiety, SF‐36 for physical and mental QoL and the PSQI for sleep quality; meanwhile, NRS, VAS and SF‐36 (bodily pain subscale) were used for pain intensity. The results of the risk‐of‐bias appraisals for the included studies are presented in Table 2 . Across the studies, the risk‐of‐bias domains that were appraised as having a high or unclear risk of bias were the blinding of participants (performance bias) and blinding of outcome assessment (detection bias), as well as in the ‘other sources of bias’ category, mostly due to small sample sizes [ 83 , 86 ] or lack of symmetry in the control treatment [ 85 ]. All other domains were appraised as having a low or mixed (low, high, or unclear across different domains) risk of bias. Risk‐of‐bias appraisal for included studies. Six out of seven studies ( N  = 296) [ 59 , 60 , 83 – 86 ] provided a measure of pain intensity. To ensure consistency in interpreting the results across the variety of measures used (which interpreted results in opposing directions), effect sizes underwent a directional adjustment by multiplying the NRS and VAS results by −1. This adjustment was necessary because the SF‐36 pain subscale scores increased with reducing pain intensity, while VAS and NRS scores decreased with reducing pain intensity. This modification allowed for a uniform directionality of effect sizes, facilitating the accurate interpretation of the meta‐analysis. Overall, no significant difference in pain intensity was observed between the MM and control groups posttreatment, g = 0.07 [‐0.18,0.33], Z  = 0.57, p = 0.57 (Figure 2 ). Heterogeneity was low, I 2  = 18%. Forest plot of MM versus control groups for the outcome of pain intensity postintervention. Positive values favour MM. Three out of seven studies ( N  = 171) [ 60 , 85 , 86 ] measured physical QoL using the SF‐36 physical component. Overall, no significant difference in physical QoL was observed between the MM and control groups posttreatment, g = 0.10 [−0.2, 0.39], Z  = 0.63, p = 0.53 (Figure 3 ). Heterogeneity was extremely low, I 2  = 0%. Forest plot of MM versus control groups for the outcome of physical QoL postintervention. Three out of seven studies ( N  = 171) [ 60 , 85 , 86 ] measured mental QoL using the SF‐36 mental component. A significant increase in mental QoL postintervention was found for participants in the MM versus control groups, indicative of a moderate effect [ 80 ], g = 0.38 [0.08, 0.68], Z  = 2.48, p = 0.01 (Figure 4 ). Heterogeneity was extremely low, I 2  = 0%. Forest plot of MM versus control groups for the outcome of mental QoL postintervention. Four out of seven studies ( N  = 232) [ 83 – 85 ] measured symptoms of depression using the RCADS [ 87 ] and the CES‐D. Overall, no significant difference in depression was observed between the MM and control groups posttreatment, g = −0.11 (−0.57, 0.35), Z  = −0.46 and p = 0.64 (Figure 5 ). Heterogeneity was high, I 2  = 65%. Forest plot of MM versus control groups for the outcome of depression postintervention. Further subgroup analysis was performed, where only studies utilising participants with chronic conditions were included ( N  = 112) [ 83 , 85 ]. A significant reduction in depression was found for participants in the MM versus control groups posttreatment, indicative of a moderate effect [ 80 ], g = −0.46 [−0.91, −0.02], Z  = −2.04 and p = 0.04 (Figure 5 ). Heterogeneity was low, I 2  = 18%. Two out of seven studies ( N  = 149) [ 59 , 85 ] measured state anxiety using the STAI. No significant difference in state anxiety was observed between the MM and control groups posttreatment, g = −0.56 [−1.124, 0.001], Z  = −1.96 and p = 0.05 (Figure 6 ). Heterogeneity was high, I 2  = 65%. Given the small number of studies (2), these results should be read with caution. Forest plot of MM versus control groups for the outcome of state anxiety postintervention. Two out of seven studies ( N  = 131) [ 84 , 85 ] measured trait anxiety using the STAI. No significant difference in trait anxiety was observed between the MM and control groups posttreatment, g = −0.13 [−0.47, 0.21], Z  = −0.74 and p = 0.46 (Figure 7 ). Heterogeneity was low, − = 0%. Given the small number of studies (2), these results should be read with caution. Forest plot of MM versus control groups for the outcome of trait anxiety postintervention. Two out of seven studies ( N  = 82) [ 60 , 86 ] measured results for (negative) mood states using the PMS. A significant reduction in mood states was found for participants in the MM versus control groups posttreatment, indicative of a moderate effect [ 80 ], g = −0.55 [−0.98, −0.11], Z  = −2.48 and p = 0.01 (Figure 8 ). Heterogeneity was low, I 2  = 0%. Given the small number of studies (2), these results should be read with caution. Forest plot of MM versus control groups for the outcome of mood states postintervention. Two out of seven studies ( N  = 82) [ 60 , 86 ] reported results for psychological well‐being using the PWBS. No significant difference in psychological well‐being was observed between the MM and control groups posttreatment, g = 0.43 [−0.004, 0.856], Z  = 1.94, p = 0.05 (Figure 9 ). Heterogeneity was low, I 2  = 0%. Given the small number of studies (2), these results should be read with caution. Forest plot of MM versus control groups for the outcome of psychological well‐being postintervention. Four out of seven studies ( N  = 194) [ 60 , 83 , 85 , 86 ] measured stress, using the PSS. No significant difference in stress was observed between the MM and control groups posttreatment, g = −0.19 [−0.47, 0.09], Z  = −1.34 and p = 0.18 (Figure 10 ). Heterogeneity was low, I 2  = 0%. Forest plot of MM versus control groups for the outcome of stress postintervention. Two out of seven studies ( N  = 82) [ 60 , 86 ] reported results for sleep quality, using the SQI. No significant difference in sleep quality was observed between the MM and control groups posttreatment, g = −0.38 [−1.21, 0.45], Z  = −0.91, p = 0.36 (Figure 11 ). Heterogeneity was substantial, I 2  = 66%. Given the small number of studies (2), these results should be read with caution. Forest plot of MM versus control groups for the outcome of sleep quality.

This meta‐analysis is the first to synthesise the evidence for MM in improving biopsychosocial outcomes among individuals with acute and chronic pain. MM is defined as the focused repetition of a specific word, sound, or phrase—silently or aloud—engaging a distinct linguistic pathway rather than bodily sensations or external objects [ 63 ]. Neuroimaging studies have demonstrated that MM produces unique patterns of brain activity, significantly attenuates emotional and motivational responses to pain (40%–50% reduction in thalamic, prefrontal and global responses) and operates with minimal cognitive effort, supporting its feasibility as a scalable intervention [ 70 , 71 ]. Given the embryonic stage of MM research, broad inclusion criteria were deliberately adopted [ 50 , 73 , 74 ]. The review therefore encompassed both acute and chronic pain conditions, adult and paediatric populations and a wide range of self‐reported biopsychosocial outcomes: pain intensity (primary), mental and physical QoL, psychological well‐being, negative mood states, state and trait anxiety, depression and sleep quality. Overall, the findings provide preliminary but encouraging evidence that MM can improve selected biopsychosocial domains in pain populations. A statistically significant improvement emerged for mental QoL, consistent with a large systematic review ( k  = 51) demonstrating small‐to‐moderate gains in general‐population mental health [ 51 ]. Negative mood states were also significantly reduced postintervention, extending the limited narrative evidence from an earlier review ( k  = 37) [ 50 ]. For depression, the overall pooled effect was nonsignificant; however, subgroup analysis restricted to chronic pain revealed a significant reduction. This pattern is plausible given the markedly higher prevalence and severity of depressive symptoms in chronic versus acute pain [ 89 – 91 ], affording greater scope for therapeutic change [ 46 , 92 ]. The result aligns with two prior meta‐analyses confirming MM’s benefits for depression in nonclinical samples [ 50 , 51 ]. In contrast, MM produced no significant effect on pain intensity—the first meta‐analytic evaluation of this outcome. Heterogeneity in pain measures and diagnostic categories (e.g., headache versus osteoarthritis) likely contributed to an underpowered analysis. Pain’s inherently biopsychosocial nature further complicates detection of specific intervention effects. Similarly, no significant improvement occurred in physical QoL, an unsurprising finding given its strong correlation with pain intensity [ 93 ] and the absence of pain reduction. Previous reviews reported benefits of MM for sleep quality [ 51 ], psychological well‐being [ 94 , 95 ] and both state and trait anxiety [ 50 ]. The present analyses, however, yielded null results for stress, anxiety, psychological well‐being and sleep. Each of these outcomes rested on only two small studies, several with substantial heterogeneity, rendering the meta‐analyses underpowered. Likewise, although earlier general‐population reviews ( k  = 51 and k  = 37) found stress reduction [ 50 , 51 ], the current null finding may reflect the review’s focus on individuals with clinical pain rather than healthy adults; stress in pain populations is inextricably linked to physiological burden, potentially requiring more targeted or intensive intervention [ 46 , 92 ]. Considerable heterogeneity existed across MM protocols. Most employed Sanskrit mantras, but several used English [ 84 – 86 ]; session durations ranged from 1.5 to 12 weeks; and one protocol involved multiple sequential mantras [ 59 ]. Delivery modes were largely consistent (in‐person or home‐based), yet few studies explicitly followed traditional ‘chetan’ transmission—impartation by a perfected teacher—which mantra theory posits is essential for maximal efficacy [ 57 , 67 – 69 ]. These variations preclude firm conclusions about optimal parameters and highlight the urgent need for standardised, evidence‐based protocols. Strengths include prospective registration on PROSPERO [ 76 ], strict adherence to PRISMA guidelines [ 75 ] and dual independent review at every stage of screening, data extraction and quality appraisal, with third‐reviewer resolution of discrepancies. The broad yet clearly justified scope enabled the first biopsychosocial evaluation of MM applied to a physical health condition, distinguishing this work from prior mental‐health‐only reviews. Limitations are nevertheless important. Only seven studies met inclusion criteria, each with modest sample sizes; not all outcomes were reported in every trial, further reducing statistical power. Pooling paediatric and adult samples alongside acute and chronic pain conditions introduced clinical heterogeneity. Intervention variability (type, duration, language, number of mantras) and the absence of traditional mantra impartation likely attenuated observable effects. Adherence to home practice and adverse events were rarely reported, limiting safety and feasibility conclusions. Most studies used active but nonspecific controls (e.g., PMR, rest, education) that failed to match MM’s core components or benchmark against gold‐standard psychotherapies such as CBT or ACT. Risk‐of‐bias ratings were generally moderate, driven primarily by inadequate blinding and small samples. Collectively, these factors necessitate cautious interpretation. Future trials should employ active controls that closely replicate MM’s attentional and repetitive elements (e.g., mindfulness meditation or music‐assisted relaxation [ 60 , 86 ]) to maintain blinding and isolate specific effects. Inclusion of gold‐standard comparators (CBT, ACT) is also recommended. Traditional mantra transmission should be incorporated, readily achievable through pre‐recorded sessions delivered by expert practitioners. Studies must be adequately powered, use homogeneous protocols and outcome measures, monitor adherence rigorously, report safety data and include extended follow‐up. Once the evidence base expands, subsequent systematic reviews should conduct subgroup analyses by pain type (nociceptive, neuropathic, inflammatory), age group and MM characteristics (session length, delivery mode, mantra language, syllable count) to identify dose–response relationships and optimal protocols [ 53 ]. Separate meta‐analyses for acute versus chronic pain and paediatric versus adult populations will further refine clinical recommendations. A related but mechanistically distinct paradigm—group or synchronous chanting, which engages social entrainment through joint vocalisation rather than the solitary, linguistic–attentional focus characteristic of individual MM practice—represents a promising avenue for future pain research [ 96 , 97 ]. Current NICE guidelines advocate multidisciplinary pain management that prioritises psychotherapeutic interventions, sometimes over pharmacotherapy or surgery [ 22 – 27 ]. Although MM did not reduce pain intensity, it produced meaningful gains in mental QoL and negative mood states—outcomes that are highly valued by patients and strongly associated with improved functioning and treatment adherence. MM is brief to learn, low‐burden, portable, equipment‐free and adaptable to any cultural or religious context. It can be delivered in‐person or via scalable pre‐recorded formats, offering cost‐effective access. These attributes position MM as a practical adjunct within existing pain services, either as a standalone self‐management tool or integrated with conventional care, thereby advancing truly holistic, patient‐centred pain management.

This first meta‐analysis of MM for pain indicates preliminary benefits for mental QoL, negative mood and (in chronic pain) depression, despite no effect on pain intensity itself. The small number of modest‐quality studies precludes definitive conclusions. Nevertheless, MM’s accessibility and feasibility suggest it may serve as a valuable low‐intensity adjunct in multidisciplinary pain programmes. High‐quality, adequately powered randomised trials using standardised protocols, appropriate controls and rigorous reporting are now urgently required to clarify its role and optimise its application.

This study did not receive any specific funding from public, commercial or not‐for‐profit agencies. Open access publishing facilitated by Deakin University, as part of the Wiley‐Deakin University agreement via the Council of Australasian University Librarians.

The present manuscript was made available as a preprint at [ 98 ] https://www.researchsquare.com/article/rs-9536601/v1 .

The authors declare no conflicts of interest.