Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review

Skelly, Andrea C.; Chou, Roger; Dettori, Joseph R; Turner, Judith A.; Friedly, Janna; Rundell, Sean D.; Fu, Rongwei; Brodt, Erika D.; Wasson, Ngoc; Kantner, Shelby; Ferguson, Aaron J.R.

doi:10.23970/ahqrepccer209

Cited by 75 publications

(86 citation statements)

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“…[27][28][29][30][31][32] A recently updated individual patient data meta-analyses including over 20,000 patients with chronic pain showed acupuncture to be significantly better than sham treatment or usual care with only a 15% reduction in treatment effect at 1 year. 33 Acupuncture therapy is supported or recommended as part of comprehensive pain care 12 by the Agency for Healthcare Research and Quality (AHRQ), 34 the American College of Physicians (ACP), 35 and the Joint Commission (TJC). 36,37 Acupuncture therapy has been predominantly studied in the individual setting 17 ; it has been shown to be effective and feasible for low-income, ethnically diverse, chronic pain patients delivered in community health center settings.…”

Section: Introductionmentioning

confidence: 99%

Individual vs. Group Delivery of Acupuncture Therapy for Chronic Musculoskeletal Pain in Urban Primary Care—a Randomized Trial

et al. 2020

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Background Acupuncture has been shown to be effective for the treatment of chronic musculoskeletal back, neck, and osteoarthritis pain. However, access to acupuncture treatment has been limited in medically underserved and low-income populations. Objective Acupuncture therapy delivered in groups could reduce cost and expand access. We compared the effectiveness of group versus individual acupuncture for pain and function among ethnically diverse, low-income primary care patients with chronic musculoskeletal pain. Design This was a randomized comparative effectiveness non-inferiority trial in 6 Bronx primary care community health centers. Participants with chronic (> 3 months) back, neck, or osteoarthritis pain were randomly assigned to individual or group acupuncture therapy for 12 weeks. Participants Seven hundred seventy-nine participants were randomized. Mean age was 54.8 years. 35.3% of participants identified as black and 56.9% identified as Latino. Seventy-six percent were Medicaid insured, 60% reported poor/fair health, and 37% were unable to work due to disability. Interventions Participants received weekly acupuncture treatment in either group or individual setting for 12 weeks. Main Measures Primary outcome was pain interference on the Brief Pain Inventory at 12 weeks; secondary outcomes were pain severity (BPI), physical and mental well-being (PROMIS-10), and opiate use. Outcome measures were collected at baseline, 12 and 24 weeks. Key Results 37.5% of individual arm and 30.3% in group had > 30% improvement in pain interference (d = 7.2%, 95% CI − 0.6%, 15.1%). Non-inferiority of group acupuncture was not demonstrated for the primary outcome assuming a margin of 10%. In the responder analysis of physical well-being, 63.1% of individual participants and 59.5% of group had clinically important improvement at 12 weeks (d = 3.6%, 95% CI − 4.2%, 11.4%). Conclusions Both individual and group acupuncture therapy delivered in primary care settings reduced chronic pain and improved physical function at 12 weeks; non-inferiority of group was not shown. Trial Registration Clinicaltrials.gov # NCT02456727

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Section: Introductionmentioning

confidence: 99%

Individual vs. Group Delivery of Acupuncture Therapy for Chronic Musculoskeletal Pain in Urban Primary Care—a Randomized Trial

et al. 2020

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“…The data were extracted from the PDF of the original report. 9 Tableau uses a relational format for its data input, where each row of data corresponds to a single observation. For this project, we chose to use an Excel (2016) workbook, though numerous other options would have worked as well (MySQL, Microsoft Access, delimited text files, cloud servers, etc.)…”

Section: Resultsmentioning

confidence: 99%

“…Data were extracted from the previously completed report on noninvasive nonpharmacological treatment for chronic pain. 9 Information for all studies was extracted from the forest plots and the summaries for each study in the report. As the original data were not available in an accessible format, all data used in the project were manually extracted and stored in a spreadsheet document employing a relational structure.…”

Section: Methodsmentioning

confidence: 99%

“…Traditional forest plot in a systematic review (reprinted from Skelly et al,9 2018). AC, attention control; CI, confidence interval; MI, minimal intervention; N, number; NE, no exercise; ODI, Oswestry Disability Index; PDI, Pain Disability Index; RDQ, Roland-Morris Disability Questionnaire; SD, standard deviation; SMD, standardized mean difference; UC, usual care; WL, waitlist.…”

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confidence: 99%

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Visual Evidence: Increasing Usability of Systematic Reviews in Health Systems Guidelines Development

2019

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Background Integration of evidence from systematic reviews is an essential step in the development of clinical guidelines. The current practice for reporting uses a static structure that does not allow for dynamic investigation. A need exists for an alternate reporting modality to facilitate dynamic visualization of results to match different end-users' queries. Objectives We developed a dynamic visualization of data from a systematic review using the commercial product Tableau and assessed its potential to permit customized inquiries. Methods Data were selected and extracted from a previously completed systematic review. The resulting dataset was then used to develop an interactive, web-based report designed for use by a guidelines development committee. Results A novel example of combining existing reporting standards for systematic review data and modern reporting tools was developed to investigate potential benefits of a dynamic report. Demonstrations of the report to clinicians sitting on previous and future guideline committees received positive feedback for its potential benefit in guidelines development. The report received a runner-up award during the design challenge at the 2018 Workshop on Visual Analytics in Health Care. Conclusion The use of interactive, accessible data may increase the use of systematic reviews and aid decision makers in developing evidence-based practice changes.

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“…Third, our analysis is limited to pharmacologic therapies, while coverage and reimbursement for nonpharmacologic treatments are also important to consider as part of comprehensive approaches to pain management. 24,25 Fourth, these results are specific to the Medicare population and cannot be easily generalized to other populations among whom the potential for interchangeability across pharmacologic alternatives could differ.…”

Section: Limitationsmentioning

confidence: 98%

Association of Formulary Exclusions and Restrictions for Opioid Alternatives With Opioid Prescribing Among Medicare Beneficiaries

et al. 2020

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IMPORTANCE Although there are many pharmacologic alternatives to opioids, it is unclear whether the structure of Medicare Part D formularies discourages use of the alternatives. OBJECTIVES To quantify the coverage of opioid alternatives and prevalence of prior authorization, step therapy, quantity limits, and tier placement for these drugs, and test whether these formulary exclusions and restrictions are associated with increased opioid prescribing to older adults at the county level. DESIGN, SETTING, AND PARTICIPANTS County fixed-effect models were estimated using a panel of counties across the 50 US states and the District of Columbia over calendar years 2015 and 2016.

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Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review

Cited by 75 publications

References 0 publications

Individual vs. Group Delivery of Acupuncture Therapy for Chronic Musculoskeletal Pain in Urban Primary Care—a Randomized Trial

Individual vs. Group Delivery of Acupuncture Therapy for Chronic Musculoskeletal Pain in Urban Primary Care—a Randomized Trial

Visual Evidence: Increasing Usability of Systematic Reviews in Health Systems Guidelines Development

Association of Formulary Exclusions and Restrictions for Opioid Alternatives With Opioid Prescribing Among Medicare Beneficiaries

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