Meta-analysis of non-medical treatments for chronic pain

Abstract

A meta-analysis was conducted on 109 published studies which assessed the outcome of various non-medical treatments for chronic pain. Of these studies, 48 provided sufficient information to calculate effect sizes. The remainder were examined according to proportion of patients rated as improved. Studies were compared as a function of type of treatment, type of pain, and type of outcome variable. In general, effect sizes were positive and of modest magnitude indicating the short-term efficacy of most treatments for most types of pain. This finding suggests that the effectiveness of treatments may be attributable not to the differences between treatments, but to the features they have in common. Mood and number of subjective symptoms consistently showed greater responses to treatment than did pain intensity, pain duration, or frequency of pain, indicating the importance of using a multidimensional framework for pain assessment. This finding also suggests that the benefit of psychological approaches to pain management may lie in reducing the fear and depression associated with pain, rather than relieving the pain itself. The present study also highlights the advantages of meta-analytic reviews.

A Clinical Ethics Approach to Opioid Treatment of Chronic Noncancer Pain

“…Available treatments for chronic nonmalignant pain have not been shown efficacious by robust data, whether the treatment in question is cognitive behavioral therapy, biofeedback, interventional anesthesia, or ongoing opioid medication [16,42,43]. Combining these treatments in the setting of multidisciplinary treatment programs, on the other hand, has been demonstrated efficacious in more than 60 studies [44], so the negative results may be partly due to studying available treatments in isolation.…”

Pain rehabilitation – outcome of an 8-week rehabilitation program

“…Rehabilitation in a structured program with a multiprofessional team has shown beneficial effects on sick-leave, disability pension and /or return to work. The clinical effectiveness of such programs has also been documented in systematic reviews (Malone, Strube, 1988;Flor et al, 1992;Morley et al, 1999;Karjalainen et al, 2001;Karjalainen et al, 1999;Guzmán et al, 2001;Nielson, Weir, 2001;Marhold et al, 2001;Oliver, 2001;Shonstein et al, 2003; SBU, 2000; SBU, 2006; SBU, 2010).…”

“…Rehabilitation in a structured program with a multiprofessional team has shown beneficial effects on sick-leave, disability pension and /or return to work. The clinical effectiveness of such programs has also been documented in systematic reviews (Malone, Strube, 1988;Flor et al, 1992;Morley et al, 1999;Karjalainen et al, 2001;Karjalainen et al, 1999;Guzmán et al, 2001;Nielson, Weir, 2001;Marhold et al, 2001;Oliver, 2001;Shonstein et al, 2003; SBU, 2000; SBU, 2006; SBU, 2010).The Department of Rehabilitation Medicine at Huddinge University Hospital in Stockholm, Sweden, offered an 8-week multiprofessional work-related rehabilitation program for patients on long-term sickleave suffering from persistent musculoskeletal related pain.The objectives of the clinical rehabilitation program were: 1) return-to-work, 2) increased activity level, and 3) reduced pain intensity.The 8-week medical and work-related multiprofessional rehabilitation program ran 7.5 hours a day and 5 days a week.The program consisted of 2 parts: A 3-week Impairment and Disability Evaluation Analysis (IDEA) and a 5-week work-related program.The idea of the IDEA included the different tools of the multiprofessional team to measure, observe and evaluate the patients' medical, physical, psychological and social functions, ability to work. This, This is an Open Access article distributed under the terms of the Creative Commons Attribution License 2.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.…”

Cognitive self-regulation influences pain-related physiology

“…Psychological interventions such as hypnosis and placebo have long been documented as effective methods of pain control (7), and several cognitive self-regulation techniques have also been documented for their ability to reduce pain (for a review, see (8)), such as use of mental imagery (9,10) and contextual reinterpretation of painful sensations (11,12).…”