Chronic pain of any origin is a leading cause of disability and it affects physical and mental functioning, quality of life, and family relationships over a period of time. Therefore all measures to curtail it should be employed for benefit of the patient. Agency for Healthcare Research and Quality, the US conducted a Meta-Analyses to find out various effective noninvasive nonpharmacological treatment modalities for Chronic Pain and to ascertain which was most effective in which condition.
The Purpose of Review was to assess which noninvasive nonpharmacological treatments for common chronic pain conditions improve function and pain for at least 1 month after treatment. The researchers searched Electronic databases (Ovid MEDLINE®, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews) through November 2017, reference lists, and ClinicalTrials.gov.Out of Various Noninvasive Nonpharmacological options available for Treating Chronic Pain, they sought to assess which noninvasive nonpharmacological treatments for selected chronic pain conditions are associated with persistent improvement in function and pain outcomes at least 1 month after the completion of treatment.
They selected randomized controlled trials of noninvasive nonpharmacological treatments for five common chronic pain conditions Using predefined criteria.The conditions included chronic low back pain; chronic neck pain; osteoarthritis of the knee, hip, or hand; fibromyalgia; and tension headache. Only trials reporting results for at least 1-month post-intervention were included. Their focus was on the persistence of effects at short-term (1 to <6 months following treatment completion), intermediate term (≥6 to <12 months), and long-term (≥12 months).
Key Messages of Study are-
- Interventions that improved function and/or pain for at least 1 month when used for—
- Chronic low back pain: Exercise, psychological therapies (primarily cognitive behavioral therapy [CBT]), spinal manipulation, low-level laser therapy, massage, mindfulness-based stress reduction, yoga, acupuncture, multidisciplinary rehabilitation (MDR).
- Chronic neck pain: Exercise, low-level laser, Alexander Technique, acupuncture.
- Knee osteoarthritis: Exercise, ultrasound.
- Hip osteoarthritis: Exercise, manual therapies.
- Fibromyalgia: Exercise, CBT, myofascial release massage, tai chi, qigong, acupuncture, MDR.
- Chronic tension headache: Spinal manipulation.
- Most effects were small. Long-term evidence was sparse.
- There was no evidence suggesting serious harms from any of the interventions studied; data on harms were limited.
Exercise, multidisciplinary rehabilitation, acupuncture, CBT, and mind-body practices were most consistently associated with durable slight to moderate improvements in function and pain for specific chronic pain conditions. Additional comparative research on the sustainability of effects beyond the immediate post-treatment period is needed, particularly for conditions other than low back pain.
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Dr. Kamal Kant Kohli
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