Therapeutic Writing Interventions for Adults With Chronic Pain: Experiences and Health Effects—A Systematic Review With a Narrative Synthesis

Abstract

Background and Objective: Chronic pain is often associated with heightened psychological stress, which may exacerbate symptoms and impair functioning. Therapeutic writing has been proposed as a low-cost adjunctive strategy. This review evaluated the reported experiences and health effects of writing interventions in adults with non-malignant chronic pain. Databases and Data Treatment: A systematic search of Web of Science, EBSCOhost, ProQuest, Ovid and Scopus (1999–November 5, 2025) identified studies examining health effects and experiences of therapeutic writing. Methodological quality was assessed using Joanna Briggs Institute tools, and certainty of evidence using GRADE and CERQual. Results: Twenty-four studies involving 2477 adults were included. Therapeutic writing supported pain management through emotional processing, cognitive reappraisal and meaning-making. Health effects were modest, context‑dependent and typically short‑term, with small reductions in pain and improvements in psychological well-being but limited physical benefits. Effects varied according to individual characteristics, including negative affect and catastrophizing. Qualitative evidence described increased self‑understanding, empowerment and coping, especially in structured, group-based or cognitive-behavioral contexts, suggesting that benefits may partly reflect the broader therapeutic environment. Certainty of evidence ranged from low to moderate for quantitative outcomes and moderate to high for qualitative findings. Conclusions: Therapeutic writing may offer modest but meaningful psychological benefits for adults with chronic pain, although physical improvements appear fleeting. These findings support its use as a low-intensity adjunct within multidisciplinary pain management. Future research should employ mechanism‑focused, moderator‑sensitive trials and include process-level measures to clarify how writing exerts its effects and to identify the individuals most likely to benefit. Significance Statement: This review clarifies when therapeutic writing may be clinically useful in chronic pain care: as a low-intensity adjunct that can support coping and psychological adjustment in specific contexts and patient groups. By integrating experiential and quantitative evidence, it highlights the importance of delivery structure, emotional pacing and patient characteristics, and identifies targets for better-designed interventions that can be safely incorporated into multidisciplinary pain management.