Nonpharmacologic treatment of chronic pain: What works?
Which therapies should you recommend for chronic low back pain, osteoarthritis, or fibromyalgia? This review—with 3 handy tables—summarizes the evidence.
PRACTICE RECOMMENDATIONS
› Recommend tai chi as an exercise modality for patients with osteoarthritis. A
› Recommend mindfulness training for patients with chronic low back pain (LBP). A
› Recommend a trial of either acupuncture or spinal manipulation for patients with chronic LBP. A
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
From The Journal of Family Practice | 2018;67(8):474-477,480-483.
There is a growing body of research demonstrating the benefits and safety of yoga for the treatment of chronic pain. Multiple reviews have evaluated the effectiveness of yoga in the treatment of chronic LBP with fairly consistent results. A 2017 Cochrane review (12 trials; n=1080) found moderate evidence of improvement in functional outcomes, although the magnitude of benefit was small.4 Chou et al found low-quality evidence of improvement in pain and function with yoga compared with usual care, education, and other exercise therapy (14 trials; n=1431).5
Tai chi is a centuries-old system of slow, deliberate, flowing movements based in the Chinese martial arts. The gentle movements make this a particularly appealing treatment for those who may have difficulty with other forms of exercise, such as the elderly and patients with OA. Tai chi is effective for treating a variety of conditions such as back pain, knee pain, and fibromyalgia. Multiple reviews have shown effectiveness in the treatment of OA.6,7
A 2016 randomized controlled trial (RCT) compared a 12-week course of tai chi to standard physical therapy (PT) for knee OA (n=204).8 The authors found that both strategies yielded similar improvement in pain and function, but that the tai chi group had better outcomes in secondary measures of depression and quality of life.8 Chou et al also found tai chi effective for chronic LBP (2 trials; n=480)5 (TABLE 13-5,7,9-13).
Counsel patients seeking to learn tai chi that it takes time to learn all the postures. Beginner classes typically offer the most detailed instruction and are best suited to patients new to the activity.
Mind-body/behavioral therapies: Taking on a greater role
Mind-body therapies are becoming increasingly important in the management of chronic pain syndromes because of an improved understanding of chronic pain pathophysiology. Studies have shown chronic pain can induce changes in the cortex, which can affect pain processing and perpetuate the experience of pain. Mind-body therapies have the potential to directly address brain centers affected by chronic pain.14 In addition, mind-body therapies can improve coexisting psychological symptoms and coping skills.
Continue to: Psychological therapies
