A scoping review of nonpharmacologic strategies for use with Mediterranean youth with mixed chronic pain conditions: a culturally adapted approach.

OBJECTIVE: Chronic pain in youth is common, affecting over 20% worldwide. While effective nonpharmacologic interventions are available, including psychological therapies and physical interventions, it is critical to ensure available interventions are culturally relevant. The objective of this scoping review is to understand nonpharmacologic interventional strategies used for youth with chronic pain conditions in Mediterranean countries and rate the quality of the evidence. METHODS: Search terms to identify nonpharmacologic treatments for youth with chronic pain in Mediterranean countries (e.g., Spain, Portugal, France, and Italy) were run in six databases on March 11, 2025, including Medline (PubMed), Embase (Elsevier), SciELO (Web of Science), and PsycInfo (ProQuest). Covidence software was used to screen abstracts and then full texts by two independent reviewers. RESULTS: Of the 6,158 abstracts screened, 35 articles were identified for inclusion in the review. They included (1) psychological/educational interventions (n = 18), (2) physical interventions (n = 9), including pain neuroscience with targeted muscular exercises, (3) dietary interventions (n = 7), including a low FODMAP diet and dietary supplements, and 4) a mixed (cognitive behavioral therapy, diet, and exercise) intervention. CONCLUSIONS: A comprehensive skill-based approach, including psychological strategies (e.g., cognitive behavioral and mindfulness meditation) and healthy lifestyle recommendations (e.g., dietary modification and sleep hygiene), may be a culturally relevant approach to care of Mediterranean youth with chronic pain.