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Nonpharmalogical Modalities for Pain Management

Modality Article Name: Reference (website)*: Putatively effective for: Tai chi 1 ) Tai Chi for Chronic Pain Conditions: A

Systematic Review and Meta-analysis of Randomized Controlled Trials 2) Tai Chi for treating rheumatoid arthritis 3) VA/DOD clinical practice guideline for diagnosis and treatment of low back pain

1)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850460/ 2)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004849/full?highlightAbstract=withdrawn%7Cexercise%7Cpain%7Cexercis 3)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008208.pub5/epdf/full

1)The literature review found that Tai Chi can improve patient’s chronic pain. Specifically, Tai Chi was found to be beneficial for patients with OA, LBP and osteoporosis. It appears that the valid duration of Tai Chi for chronic OA might be at least 6 weeks. On the follow-up effects, there was insufficient evidence for the effects of Tai Chi for suffers of chronic pain conditions. 2)The Cochrane Database of Systematic Reviews (conducted in 2003) found that Tai Chi did not exacerbate symptoms of rheumatoid arthritis. Tai chi was found to have a statistically significant benefits on lower extremity range of motion for people with RA. The studies included in this review did not asses the effects on patient-reported pain. 3)Conclusion – Weak for (strength). “Evidence favored tai chi over no exercise, wait list, and backward walking and jogging, but not swimming, for improvement in chronic LBP.

Yoga 1)2016 An evidence map of yoga for low back pain 2) 2014 Movement therapies for self-management of chronic pain 3) Yoga for chronic non-specific low back pain

4) 2015 Yoga for low back: painPEDro systematic review update.

5) 2013 Yoga for chronic low back pain a meta-analysis of randomized controlled trials.

6)VA/DOD clinical practice guideline for diagnosis and treatment of low back pain

1)https://www.sciencedirect.com/science/article/pii/S0965229916300255?via%3Dihub 2)https://academic.oup.com/painmedicine/article/15/S1/S40/1824046 3)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010671.pub2/full?highlightAbstract=yoga&highlightAbstract=pain 4)https://www.ncbi.nlm.nih.gov/pubmed/25082615 5)https://www.ncbi.nlm.nih.gov/pubmed/23894731

1)The systematic review found good quality evidence suggesting significant effects for short- and long-term pain intensity reduction. There are also long-term effects for back specific disability. However, there doesn’t seem to be significant evidence for health related QOL, well-being, and acute LBP. 2)Most of the yoga studies included in this article were of high quality (dosages between 15 hours over 12 weeks and 72 hours over 24 weeks). Some of the studies found that yoga is more effective than control groups for reducing chronic LBP and pain associated with fibromyalgia. However, some of the yoga studies were

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6)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008208.pub5/epdf/full

found to be of poor quality (1 hour over 1 day to 15 hours over 12 weeks). Of the low-quality studies, it was found that yoga was more effective than no treatment and/or and educational group for patients with OA and chronic LBP. 3)The Cochrane Database of Systematic Reviews (concluded in 2016) found low- to moderate- evidence that yoga, compared to non-exercise controls, provides small to moderate improvements in functioning at 3 and 6 months. Yoga might also have more effect for reducing pain intensity compared to non-exercise controls at 3 and 6 months, but the results weren’t clinically important. Current evidence cannot determine whether yoga is more effective than other exercise modalities at reducing pain intensity and improving function. Yoga is associated with more adverse events than non-exercise controls, but appears to have the same risk of adverse of events as other exercise. 4)The meta-analyses found strong evidence for short-term effects of yoga on pain intensity and back-specific disability compared to controls. There was moderate evidence for pain reduction at long-term follow-up. The analyses did not find short-term or long-term effects on QOL. The short-term effect on disability was of moderate size, but other outcomes were judged to have a small effect. 5)May be effective CLBP; more research needed 6) Conclusion – Weak for (strength). There is inconclusive evidence for yoga compared to usual care. Short-erm pain, disability, and QOL improved in yoga studies compared to an educational intervention. There is low quality evidence recommending yoga over strengthening exercises for pain levels and QOL.

Exercise TX 1)VA/DOD clinical practice guideline for diagnosis and treatment of low back pain 2)Exercises for prevention of recurrences of low-back pain (review)

1)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008208.pub5/epdf/full 2)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006555.pub2/epdf/full

1)Conclusion – Weak for (strength). Clinically directed exercise is favorable for the treatment of chronic LBP. The quality of the evidence is moderate for the effects of exercise compared to a placebo.

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3) Motor control exercise for chronic non-specific low-back pain (Review) 4)Exercise therapy for treatment of non-specific low back pain (Review) 5) Exercise for hand osteoarthritis (Review) 6)Exercise for rheumatoid arthritis of the hand (Review) 7)Exercise for osteoarthritis of the hip (Review) 8)High-intensity versus low-intensity physical activity or exercise in people with hip or knee osteoarthritis 9)Aerobic exercise training for adults with fibromyalgia (Review) 10)Resistance exercise training for fibromyalgia 11)Exercise for treating fibromyalgia syndrome 12)Manual therapy and exercise for rotator cuff disease 13)Physical activity and exercise for chronic pain in adults: an overview of Cochrane reviews 14)Exercise for osteoarthritis of the knee 15)Exercise for people with peripheral neuropathy

3)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012004/epdf/full 4)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000335.pub2/epdf/full 5)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010388.pub2/epdf/full 6)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003832.pub3/epdf/full 7)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007912.pub2/epdf/full 8)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010203.pub2/full?highlightAbstract=withdrawn%7Cexercise%7Cpain%7Cexercis 9)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012700/epdf/full 10)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010884/full?highlightAbstract=withdrawn%7Cexercise%7Cexercis%7Cpain 11)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003786.pub2/full?highlightAbstract=withdrawn%7Cexercise%7Cexercis%7Cpain 12)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012224/full?highlightAbstract=withdrawn%7Cexercise%7Cexercis%7Cpain 13)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011336/full?highlightAbstract=withdrawn%7Cexercise%7Cexercis%7Cpain 14)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004376.pub3/full?highlightAbstract=withdrawn%7Cexercise%7Cexercis%7Cpain 15)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003904.pub2/full?highlightAbstract=withdrawn%7Cexercise%7Cexercis%7Cpain

“Comparing clinically recommended exercise compared to usual medical care, patients had moderate short-term improvements in pain, small intermediate and long-term improvements in function, and lower likelihood of work disability at 12 months.” 2) The Cochrane Database of Systematic Reviews (concluded in 2009) found that there is moderate quality evidence suggesting that post-treatment exercise programmes can prevent recurrences of back pain. There is conflicting evidence for exercise during treatment. Future research should examine the validity of measurement of effectiveness and recurrences of back pain after engaging in an exercise treatment programme. 3) The Cochrane Database of Systematic Reviews (concluded in 2015) found that there is low to moderate quality evidence for motor control exercise (MCE) compared with a minimal intervention for chronic LBP. The review found very low to low quality evidence that MCE has a clinically important effect compared with exercise plus electrophysical agents (EPA). The review also found moderate to high quality evidence for MCE compared to manual therapies. MCE was not found to be superior to other forms of exercise. 4)The Cochrane Database of Systematic Reviews (concluded in 2004) found that exercise appears to be slightly effective at decreasing pain and improving function in patients with chronic LBP. Subacute LBP patients engaging in a graded activity program improves absenteeism outcomes. Exercise therapy appears to be as effective as either no treatment or other conservative treatments in acute LBP patients. 5) The Cochrane Database of Systematic Reviews (concluded in 2015) found low-quality evidence with small beneficial effects of exercise on hand pain, function, and finger joint stiffness. It is unclear if the

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effects of exercise represent a clinically important change. 6) The Cochrane Database of Systematic Reviews (concluded in 2017) reports uncertainty about whether exercise improves short-term hand function and/or pain. Exercise appears to slightly improve function, but doesn’t appear to impact pain, at medium and long-term follow-up. Exercise may improve grip and pinch strength in the short term. Patients who received exercise with adherence strategies were more adherent in the medium-term than who did not undergo and exercise program. Engaging in hand exercises are unlikely to lead to adverse events. 7) The Cochrane Database of Systematic Reviews (concluded in 2013) found that land-based therapeutic exercise programmes could reduce pain and improve physical function among patients experiencing hip OA (high quality evidence). 8)The Cochrane Database of Systematic Reviews (concluded in 2014) found very low to low-quality evidence comparing high-intensity compared to low-intensity exercise programs in improving pain and physical function in short-term. The review couldn’t conclude whether high-intensity exercise programs may result in more harmful effects than lower-intensity programs. Future research should examine dose-response relationship in exercise programs. 9)The Cochrane Database of Systematic Reviews (concluded in 2016) found that there is moderate-quality evidence to indicate that patients engaging in aerobic exercise compared to those in a control group had improved HRQL. There is low-quality evidence which suggests that aerobic exercise may decrease pain intensity, may slightly improve physical function, and may lead to little difference in fatigue and stiffness. Although evidence

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on adverse events is scarce, aerobic exercise appears to be well tolerated. 10) The Cochrane Database of Systematic Reviews (concluded in 2013) suggest that the evidence (of low quality) for moderate- and moderate-to high intensity resistance training improves multidimensional function, pain, tenderness, and muscle strength in women with fibromyalgia. Eight weeks of aerobic exercise (evidence was also rated as low quality) was found to be superior to moderate-intensity resistance training for improving pain in women with fibromyalgia. There was low-quality evidence suggesting a 12-week low-intensity resistance training program was more effective than flexibility exercise training to improve pain and multidimensional function. 11)The Cochrane Database of Systematic Review (concluded in 2005) concluded that there is “gold level evidence” for supervised exercising training which improves patient’s physical capacity and reduces fibromyalgia symptoms. Strength training may also have benefits on fibromyalgia symptoms. Research is needed to examine long-term benefits of exercise. 12)The Cochrane Database of Systematic Reviews (concluded in 2015) found one trial of combined manual therapy and exercise reflective of common/current practice to placebo. The study was found to be of high quality and didn’t find clinically significant differences between the groups. 13)The Cochrane Database of Systematic Reviews (concluded in 2013) concluded that there is low to moderate evidence suggesting that aquatic training, compared to control groups, improves wellness, symptoms, and fitness in adults with fibromyalgia. The review also found very low to low quality evidence for aquatic training over land-based exercise, except in muscle strength (very low-quality evidence favoring land). The review did not identify

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any serious adverse events associated with aquatic training. 14) The Cochrane Database of Systematic Reviews (concluded in 2013) determined that there is high-quality evidence that land-based exercise provides short-term benefit which can be sustained for 2 to 6 months after completing formal treatment, as well as moderate-quality evidence showing improvement in physical function. The review concluded that the magnitude of treatment is considered moderate to small, but comparable to non-steroidal anti-inflammatory drugs. 15)The Cochrane Database of Systematic Reviews found that there is inadequate evidence (only 1 study fully met the inclusion criteria) to examine the effect of exercise on functional ability in people with peripheral neuropathy.

Pilates

1)Pilates for low back pain (Review) 2) VA/DOD clinical practice guideline for diagnosis and treatment of low back pain

1)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010265.pub2/epdf/full 2)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008208.pub5/epdf/full

The Cochrane Database of Systematic Reviews (conducted in 2015) did not find any high-quality evidence for the treatment comparison outcomes or follow-up periods investigated. The research suggests low to moderate quality evidence that Pilates is more effective than minimal intervention for pain and disability. When Pilates was compared with other exercises, a small effect was found for function at intermediate-term follow-up. Although there is some evidence for the effectiveness of Pilates for LBP, there is no conclusive evidence that it is superior to other forms of exercise. 2) Conclusion – Weak for (strength). Pilates has been found to be associated with better outcomes of pain, disability, and short-term function compared to interventions and a group of control patients. Evidence is inconclusive about whether providers should recommend Pilates over other types of exercise, massage therapy, and usual care.

Aqua therapy

1)Aquatic exercise training for fibromyalgia 2)Aquatic exercise for treatment of knee and hip osteoarthritis

1)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011336/full?highlightAbstract=withdrawn%7Cexercise%7Cexercis%7Cpain

1)The Cochrane Database of Systematic Reviews (conducted in 2013) found low to moderate evidence related to a control group which suggests that aqua therapy

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2)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005523.pub3/full?highlightAbstract=withdrawn%7Cexercise%7Cpain%7Cexercis

can improve wellness, symptoms, and fitness in patients with fibromyalgia. Very low-quality evidence suggests that there are benefits of aquatic and land-based exercise, except in muscle strength (very low-quality evidence favoring land). Current research hasn’t reported serious adverse effects associated with aqua therapy. 2) The Cochrane Database of Systematic Reviews (conducted in 2015) suggests that patients experiencing knee and hip OA may benefit from aquatic exercise. There is moderate quality evidence that suggests that aquatic exercise may have small, short-term, and clinically relevant effects on patient-reported pain, disability, and QoL.

Injection therapy

1)Injection therapy for subacute and chronic low-back pain 2)Corticosteroid injections for shoulder pain

1)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001824.pub3/full?highlightAbstract=withdrawn%7Cinjection%7Cinject%7Ctherapy%7Ctherapi 2)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004016/full?highlightAbstract=withdrawn%7Cinjection%7Cinject%7Ctherapy%7Ctherapi

1)The Cochrane Database of Systematic Reviews (conducted in 2007) found insufficient evidence to support the use of injection therapy in subacute and chronic LBP. The review indicated that future research should examine if specific subgroups of patients may respond to a specific type of injection therapy. 2) The Cochrane Database of Systematic Reviews (conducted in 2002) found overall there is very little overall evidence to guide treatment due to the RCTs small sample sizes, variable methodological quality, and heterogeneity. Although the effects are small and not well-maintained, there is some evidence that aubacromial corticosteroid injection for rotator cuff disease and intra-articular injection for adhesive capsulitis maybe beneficial. Future research would benefit from 1) further trials investigating the efficacy of corticosteroid injections for shoulder pain, and 2)clarifying whether the accuracy of needle placement, anatomical site, frequency, dose, and type of corticosteroid influences efficacy of this treatment.

Nerve block 1) 2016 Comparison of the Effectiveness of Suprascapular Nerve Block With Physical Therapy, Placebo, and Intra-Articular Injection in Management of Chronic Shoulder Pain: A Meta-Analysis of Randomized Controlled Trials.

1)https://www.ncbi.nlm.nih.gov/pubmed/26701762

CER shows suprascapular nerve block is more effective than PT, injections for reduction in pain severity

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Prolotherapy Injection 1)Prolotherapy injections for chronic low-back

pain

1)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004059.pub3/full?highlightAbstract=withdrawn%7Cexercise%7Cexercis%7Cpain

1)The Cochrane Database of Systematic Reviews (conducted in 2006) found conflicting evidence regarding the efficacy of prolotherapy injections for patients with chronic LBP. It does not appear that using prolotherapy alone is effective for chronic LBP. However, when prolotherapy is combined with spinal manipulation, exercise, and other interventions, prolotherapy may improve chronic LBP and disability. Additional studies are needed to make a more definitive conclusion about the effectiveness of prolotherapy due to the clinical heterogeneity among studies and by the presence of co-interventions.

Radiofrequency 1)Radiofrequency denervation for neck and

back pain

2)Radiofrequency denervation for chronic low-back pain

1)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004058/full?highlightAbstract=heat%7Cwithdrawn%7Cpain

2)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008572.pub2/full?highlightAbstract=heat%7Cwithdrawn%7Cpain

1)The Cochrane Database of Systematic Reviews (conducted in 2002) found limited evidence that radiofrequency (RF) denervation offers short-term relief for chronic neck pain of the facet joint and for chronic cervicobrachial pain. There is conflicting evidence on short-term effect of RF lesioning on pain and disability in chronic low back pain of the facet joint, and limited evidence that intradiscal RF thermocoagulation is not effective for chronic discogenic LBP. Future RF research would benefit from: 1) high-quality RCTs with larger patient samples and data on long-term effects of RF, and 2) RCTs on non-spinal indications where RF is currently without any scientific evidence. 2) The Cochrane Database of Systematic Reviews (conducted in 2014) found now high-quality evidence suggesting that RF denervation provides pain relief or increases function for patients with chronic LBP. The current evidence for RF denervation for chronic LBP is very low to moderate in quality. Future research would benefit from high-quality RCTs with larger patients samples and data examining long-term effects.

Radiation therapy

1)2017 systematic review: Nonpharmacologic Pain Interventions: A Review of Evidence-Based Practices for Reducing Chronic Cancer Pain

1)https://cjon.ons.org/cjon/21/3/supplement/nonpharmacologic-pain-interventions-review-evidence-based-practices-reducing

1.Based on results from a meta analysis and RCTs, radiation therapy appears to be effective in reducing pain from metastatic bone cancer, lung, breast, prostate cancer. Additional research is necessary to better understand the safety, tolerability, and

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efficacy of radiation therapy in specific cancer diagnoses.

TMS/rTMS 1)2014 Non-invasive brain stimulation techniques for chronic pain. Cochrane systematic review

2)Non-invasive brain stimulation in chronic orofacial pain: A systematic review

3)Non-invasive brain stimulation techniques for chronic pain (review) 4)The efficacy of transcranial magnetic stimulation on migraine: A meta-analysis of randomized controlled trials

1)https://www.ncbi.nlm.nih.gov/pubmed/24729198/ 2)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6078189/pdf/jpr-11-1445.pdf 3)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008208.pub5/epdf/full 4)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5567575/

1)This article is an updated version of the original Cochrane review published in 2010. Single doses of high-frequency rTMS of the motor cortex appear to have small short-term effects on chronic pain. However, there are multiple sources of bias that may exaggerate this observed effect. The effects of rTMS do not appear to meet the predetermined threshold of minimal clinical significance and multiple-dose studies do not consistently demonstrate effectiveness in the treatment of chronic pain. The broad conclusions for rTMS and CES haven’t change substantially since the original review, however, with the application of the GRADE system has modified the conclusion regarding the effectiveness of rTDS. There is a need for larger rigorously designed studies, particularly of longer courses of stimulation. 2) This systematic review concludes that TMS and tDCS appear to be safe and promising techniques to reduce pain intensity in different chronic oral facial pain disorders. The authors conclude that additional research is needed to reduce bias, improve quality, and characterize optimal brain stimulation parameters to promote efficacy of these treatments. 3) The Cochrane Database of Systematic Reviews (concluded in 2017) found very low-quality evidence that single doses of high-frequency rTMS of the motor cortex and tDCS may have short-term effects on chronic pain and QOL. Multiple sources of bias may exist and they may have influenced the observed effects. The review did not find evidence that low-frequency rTMS, rTMS applied to the dorsolateral prefrontal cortex, and CES are effective for reducing pain intensity in chronic pain. The overarching conclusions of this review haven’t changed. There remains a need for substantially larger,

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rigorously designed studies, particularly of longer course of stimulation. 4)The systematic review evaluated 4 RCTs examining the effects of TMS on chronic migraine. Statistical heterogeneity was detected. The efficacy of TMS on chronic migraine was not significant. Statistically significant effect of group (TMS group vs a control group) was found by analyzing the RCTs.

Transcranial direct current stimulation (tDCS)

1)Transcranial direct current stimulation in neuropathic pain

2)Non-invasive brain stimulation in chronic orofacial pain: A systematic review

3)Non-pharmacological interventions for chronic pain in people with spinal cord injury

1)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193292/pdf/nihms473986.pdf

2)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6078189/pdf/jpr-11-1445.pdf

3)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009177.pub2/full?highlightAbstract=transcrani%7Ccurrent%7Ctranscranial%7Cdirect%7Cwithdrawn%7Cstimul%7Cstimulation

1)The systematic review suggest that tDCS may reduce neuropathic pain short-term (2-4 weeks after treatment). No severe adverse effects were found. Large clinical trials are needed. 2)Patients experiencing oral facial pain were found to experience a reduction in pain associated tDCS and/or TMS treatment. Future research is needed to reduce bias, improve quality, and characterize optimal brain stimulation to promote the efficacy of the treatments. 3)The Cochrane Database of Systematic Reviews (concluded in 2011) concluded that there wasn’t enough evidence to suggest that non-pharmacological treatments (tDCS, CES, rTMS, exercise, acupuncture, self-hypnosis, TENS) are effective in reducing chronic pain in people living with spinal cord injury. Future research should investigate RCTs with adequate sample size and study methodology.

Intradiscal electrothermal therapy (IDET)

Only found trials on cochrane library

Spinal Cord Stimulation 1)Spinal cord stimulation for cancer-related

pain in adults

2)Spinal Cord stimulation for chronic pain

3)Present and potential use of spinal cord stimulation to control chronic pain

4)A review of spinal cord stimulation systems for chronic pain

1)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009389.pub3/full?highlightAbstract=cord%7Cwithdrawn%7Cstimulator%7Cspinal%7Cstimul

2)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003783.pub3/full?highlightAbstract=cord%7Cwithdrawn%7Cstimulator%7Cspinal%7Cstimul

1)The Cochrane Database of Systematic Reviews (concluded in 2014) concluded that there is insufficient evidence to determine whether SCS is effective to treat cancer-related pain.

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https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003783.pub3/epdf/full

3)https://www.painphysicianjournal.com/current/pdf?article=MjA5OQ%3D%3D&journal=82

4)https://www.dovepress.com/a-review-of-spinal-cord-stimulation-systems-for-chronic-pain-peer-reviewed-fulltext-article-JPR

2)The review has been withdrawn from publication. The review was out of date and it will not be updated. 3)SCS has been found to be effective for the approved indication. SCS has been reported to be more effective than conservative medical management and reoperation for patients with failed back surgery. Some clinical benefit has been found for patients experiencing CRPS, critical limb ischemia, and refractory angina pectoris. Large RCTs showing clear clinical benefit are needed to gain support for their use. 4)The review found high-level evidence for the safety, efficacy, and cost effectiveness of SCS for chronic refractory LBP and predominant limb pain. SCS has been found to be associated with a reduction in pain intensity. Future research is needed to examine newer SCS treatments.

Physical therapy 1)Physiotherapy for pain and disability in adults

with complex regional pain syndrome (CRPS) types I and II

2)Manual therapy and exercise for adhesive capsulitis (frozen shoulder)

1)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010853.pub2/full?highlightAbstract=withdrawn%7Cexercise%7Cexercis%7Cpain

2)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011275/full?highlightAbstract=withdrawn%7Cexercise%7Cexercis%7Cpain

1)The Cochrane Database of Systematic Reviews (conducted in 2015) suggests that graded motor imagery and mirror therapy may provide improvements in pain and functioning in people with CRPS I. However, the quality of the supporting evidence is very low. Currently there is very limited research examining the effectiveness of multimodal physiotherapy, electrotherapy, and manual lymphatic drainage. Large scale and high quality RCTs are necessary to test the effectiveness of physiotherapy based interventions to treat pain and disability among patients experiencing CRPS I and II. 2) The Cochrane Database of Systematic Review (concluded in 2013) suggests that manual therapy may not be as effective as glucocorticoid therapy in the short-term. Current research suggest it is unknown whether a combination of manual therapy, exercise and electrotherapy is an effective adjunct glucocorticoid injection or oral NSAID. “Following arthrographic joint distension with glucocorticoid and saline, manual therapy and exercise may confer effects similar to those of sham ultrasound in terms of overall pain, function and

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quality of life, but may provide greater patient-reported treatment success and active range of motion.” The review suggests that high-quality RCTs are needed to better understand the benefits and harms of manual therapy and exercise interventions that reflect actual practice, compared with placebo and/or no intervention.

TENS 1) 2015 Systematic review of efficacy of TENS for management of central pain in people with multiple sclerosis

2) 2017 Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain 3) 2018 Literature Review and Meta-Analysis of Transcutaneous Electrical Nerve Stimulation in Treating Chronic Back Pain

4)Electrotherapy for neck pain

1)https://www.ncbi.nlm.nih.gov/pubmed/26008938 2)https://www.cochrane.org/CD011976/SYMPT_transcutaneous-electrical-nerve-stimulation-tens-neuropathic-pain https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011976.pub2/media/CDSR/CD011976/CD011976_standard.pdf 3)https://journals.lww.com/rapm/Fulltext/2018/05000/Literature_Review_and_Meta_Analysis_of.13.aspx 4)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004251.pub5/full?highlightAbstract=withdrawn%7Cpain%7Cultrasound

1) The systematic review found medium sized effect of TENS for management of chronic pain in people with MS. The frequency of TENS or outcome used to measure pain had no effect on the results. 2) This review examined the use of TENS and sham TENS. There is very low quality of evidence which means that the authors couldn’t state whether TENS is able to manage neuropathic pain. 3) The review found that the efficacy of TENS was similar to that of a control treatment proving pain relief. Other nerve stimulation therapies were found to be more effective than TENS. TENS, however, was more effective at improving functional disability with follow-up of less than 6 weeks than a control group. 4)The Cochrane Database of Systematic Reviews (concluded in 2012) was unable to definitively determine the usefulness of electrotherapy due to the low or very low quality of evidence. Future research is needed to change the estimate of effect and confidence in the results.

Heat tx 1)Superficial heat or cold for low back pain

1)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004750.pub2/full?highlightAbstract=withdrawn%7Cexercise%7Cpain%7Cexercis

1)The Cochrane Database of Systematic Reviews (conducted in 2005) suggests that there is moderate evidence in a small number of trials that heat wrap therapy can provide short-term reduction in pain and disability in patients with acute and sub-acute low-back pain. They conclude there is a need for future higher-quality randomized control trials.

Cryotherapy (cold therapy)

1) Superficial heat or cold for low back pain

1)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004750.pub2/full?highlightAbstract=withdrawn%7Cexercise%7Cpain%7Cexercis

1)The Cochrane Database of Systematic Reviews (conducted in 2005) suggests that there is a limited evidence base to support the common practice of the use of cryotherapy for low back pain. Only 3 poor

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quality studies were identified. No conclusions could be drawn about the use of cold for low-back pain. They conclude there is a need for future higher-quality randomized control trials.

Massage therapy 1)2016 The Impact of Massage Therapy on

Function in Pain Populations—A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part I, Patients Experiencing Pain in the General Population

2) 2015 Meta-analysis on massage therapy on cancer patients 3)2015 Efficacy of traditional Thai massage for treatment of chronic pain 4) 2014 Massage therapy for fibromyalgia 5)Massage for low-back pain 6)Massage for mechanical neck disorders

1)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4925170/ 2)http://journals.sagepub.com/doi/full/10.1177/1534735415572885#_i3 3)https://www.sciencedirect.com/science/article/pii/S1744388115000080?via%3Dihub 4)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/ 5)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001929.pub3/full?highlightAbstract=withdrawn%7Cexercise%7Cexercis%7Cpain 6)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004871.pub4/full?highlightAbstract=withdrawn%7Cmassage%7Cmassag

1)This systematic review examines massage therapy compared to no treatment. The results suggest that massage therapy is weakly recommended for reducing pain, improving mood and health related quality of life compared to other sham or active comparators. 2) This meta-analysis suggests that massage provides short-term relief for patients experiencing cancer pain. 3)TTM appears to provide a reduction in pain severity for up to 15 weeks. Research is still needed to identify moderators and mediators to determine the long-term benefits of TTM relative to control conditions. 4)This metanalysis found that patients diagnosed with fibromyalgia and undergo massage therapy for 5 weeks or longer experienced an immediate improvement in pain, anxiety, and depression. Based on the literature review, the authors recommend that massage should be one of the viable complementary and alternative treatments for fibromyalgia. However, large-scale randomized controlled studies with long-term follow-up is necessary to better understand the benefits of massage therapy. 5)The Cochrane Database of Systematic Reviews (conducted in 2015). Results suggest limited confidence that massage is an effective treatment for LBP. The review found that patients experiencing acute, sub-acute and chronic LBP had some short-term improvements in pain outcomes. Some short-term functional improvements were observed in participants experiencing sub-acute and chronic LBP when compared with inactive controls. There were only minor adverse effects with massage.

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6) The Cochrane Database of Systematic Reviews (conducted in 2012) concluded that no recommendation for practice could be made at the time of publication due to the effectiveness of massage for neck pain remains uncertain. Massage, as a stand-alone treatment, was found to provide an immediate and/or short-term effectiveness for both pain and tenderness. Future research would benefit from assessing long-term effects of massage treatment and treatment provided on more than one occasion.

Ultrasound 1.2014 Cochrane review for low back pain: Therapeutic ultrasound for chronic low-back pain 2)Therapeutic ultrasound for osteoarthritis of the knee or hip

1)https://www.cochrane.org/CD009169/BACK_therapeutic-ultrasound-for-chronic-low-back-pain 2)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003132.pub2/full?highlightAbstract=withdrawn%7Cpain%7Cultrasound

1. The Cochrane Review (published in 2014) found no evidence of effectiveness for low back pain or quality of life. Small effect on improving low back pain in the short term, but the findings aren’t clinically important. Future large trials with valid methodology may impact the confidence of effect of ultrasound. 2)The Cochrane Database of Systematic Reviews (concluded in 2009) found that therapeutic ultrasound may be beneficial for patients with OA of the knee. Due to the low quality of evidence, Cochrane was unsure about the magnitude of the effects on pain relief and function. The review did note that therapeutic ultrasound is widely used for its potential benefits on both knee pain and function. Future research would benefit from trials that are adequately powered.

Dry Needling 1)Acupuncture and dry-needling for low back pain 2)Is dry needling effective for low back pain? A systematic review and PRISMA-compliant meta-analysis

1)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001351.pub2/full?highlightAbstract=withdrawn%7Cdri%7Cdry%7Cneedl%7Cneedling 2)https://www.ncbi.nlm.nih.gov/pubmed/29952980

1)The Cochrane Database of Systematic Reviews (concluded in 2003) found that acupuncture and dry-needling could be helpful adjunctive therapies to treat chronic LBP. However, most of the studies were of low methodological quality and thus, high quality trials are needed. 2)Dry needling, compared to acupuncture and sham needling, appears to reduce a patient’s pain and disability postintervention in LBP. Dry needling appears to be as effective as acupuncture at reducing pain and disability at follow-up. Current research cannot answer the question whether dry needling is more effective than other treatments. Current

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evidence is not robust enough to draw a firm conclusion regarding efficacy and safety of dry needling for LBP.

Pelvic Floor Physical Therapy

1)Physical therapy treatment of pelvic pain

1)https://reader.elsevier.com/reader/sd/pii/S1047965117300256?token=7FCADBE8CEFC3FE1A64298AA96FDF072CC2BDF22A6A0D5A034100E5153CE6196EB6999B602A55D16AFBAF7FB6ED1F22A

1) The review article found that pelvic floor physical therapy can be beneficial for conditions associated with chronic pelvic pain. Some evidence for pelvic floor physical therapy includes: 1) “50% improvement with reduced pelvic pain in patients receiving intravaginal manual treatment as well as patients receiving levator ani muscle trigger point injections,” ) “men and women experienced 57% improvement in the myofascial pelvic floor physical therapy group compared with only 21% improvement in those receiving global massage,” 3) “62% mean improvement in average pain ratings with addition of pelvic floor physical therapy to traditional medical interventions with treatment, including relaxation, perineal bulges, diaphragm.” breathing, posture corrections, and use of dilators and a therapy wand as part of the home program of self-management

Acupuncture

1) Summary of systematic reviews VA 2) 2013 Effectiveness of acupuncture for nonspecific chronic low back pain 3) Effectiveness of acupuncture for cancer pain 4) Acupuncture for chronic pain: An individual patient data meta-analysis 5) Acupuncture for chronic pain: more than an effective placebo? 6) Acupuncture for treating fibromyalgia 7) Systematic review and meta-analysis of acupuncture to reduce cancer pain 8)VA/DOD clinical practice guideline for diagnosis and treatment of low back pain 9)Acupuncture for shoulder pain

1)https://www.ncbi.nlm.nih.gov/books/NBK185071/ 2)https://www.ncbi.nlm.nih.gov/pubmed/24026151 3)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778333/ 4)https://www.ncbi.nlm.nih.gov/books/NBK409498/#s2-3 5)https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1533-2500.2009.00337.x 6)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007070.pub2/full?highlightAbstract=withdrawn%7Cacupunture%7Cfibromyalgi%7Cfibromyalgia%7Cacupuntur

1) positive effect-Headache, migraine, chronic pain: (potential effect-FM, postoperative pain, back pain, neck pain, shoulder pain, rheumatoid arthritis, shoulder pain), knee osteoarthritis, migraine, tension headache, post-operative pain, chronic low back pain 2) This systematic review found that acupuncture has a clinically significant effect on self-reported pain intensity and functional limitations when compared to sham or control group. There were significant, but not clinically meaningful differences, when comparing acupuncture to medications and usual care. 3) Insufficient evidence 4) The meta-analysis results suggest that acupuncture was found to be statistically superior to control and sham groups. The effect sizes were similar across pain conditions after excluding outlier studies. The effect size was of clinical relevance. Results suggest that acupuncture is more

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10)Acupuncture for the prevention of tension-type headache 11)Acupuncture for peripheral joint osteoarthritis

7)https://onlinelibrary.wiley.com/doi/full/10.1111/ecc.12457 8)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008208.pub5/epdf/full 9)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005319/full?highlightAbstract=withdrawn%7Cexercise%7Cexercis%7Cpain 10)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007587.pub2/full?highlightAbstract=withdrawn%7Cexercise%7Cexercis%7Cpain 11)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001977.pub2/full?highlightAbstract=withdrawn%7Cexercise%7Cpain%7Cexercis

than a placebo. Only high-quality studies were included in this metanalysis

5) The Systematic review found that acupuncture is more than a placebo for common pain conditions. Short-term outcomes suggest that acupuncture is more effective than a sham treatment for back pain, knee pain, and headache. Long-term outcomes (6 to 12 months) suggests that acupuncture is more effective for knee pain and tension-type headache. Effect sizes were found to be relatively small. 6)The Cochrane Database of Systematic Reviews (concluded in 2012) found low to moderate level evidence that acupuncture improves pain intensity and stiffness compared to no treatment and/or standard treatment. There is moderate level evidence that suggests that acupuncture and sham does not differ in reducing pain, fatigue, sleep, or global well-being. Effects of acupuncture may last up to one month, but effects aren’t maintained six months follow-up. 7) This systematic review and meta-analysis found that acupuncture is effective for cancer pain (both malignancy -related and surgery-induced pain). This study did examine heterogeneity, publication bias, and risk of bias associated. 8) Conclusion – Weak for (strength). Based on two trials, there is moderate quality evidence for long-term (three to 6 months) improvements in disability and perceived impact of pain associated with chronic LBP. Data was inconclusive regarding QOL and adverse events. 9)The Cochrane Database of Systematic Reviews (concluded in 2003) found that the authors of this review couldn’t make any conclusions about acupuncture based on the small number of clinical studies/diverse methodological trials. However, there maybe some short-term benefit with respect to a reduction in pain intensity and increase in function.

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10)The Cochrane Database of Systematic Reviews (concluded in 2016) found that acupuncture is an effective treatment for frequent episodic and/or chronic tension-type headaches. Future research should compare acupuncture with other treatments. 11)The Cochrane Database of Systematic Reviews (concluded in 2007) found that acupuncture, compared to a sham trial showed statistically significant benefits. However, the benefits do not meet the predefined threshold for clinical relevance, potentially because of placebo effects from incomplete blinding. Waiting list-controlled trials of acupuncture suggest clinically relevant benefits, which could be due to expectation or placebo effects.

Chiropractor 1)Combined chiropractic interventions for low-back pain 2)Spinal manipulative therapy for chronic low-back pain 3) VA/DOD clinical practice guideline for diagnosis and treatment of low back pain

1)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005427.pub2/full?highlightAbstract=withdrawn%7Cexercise%7Cpain%7Cexercis 2)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008112.pub2/full?highlightAbstract=withdrawn%7Cexercise%7Cpain%7Cexercis 3)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008208.pub5/epdf/full

1)The Cochrane Database of Systematic Reviews (concluded in 2009) found that chiropractic interventions improved short-term (pain intensity and disability) and medium-term (pain intensity) outcomes for acute and subacute LBP. No evidence supports or refutes that chiropractic interventions provide a clinically meaningful difference for pain intensity or disability in people with LBP when compared to other interventions. Future research is needed to better understand the effects and confidence in chiropractic interventions. 2)The Cochrane Database of Systematic Reviews (concluded in 2009) found no clinically relevant differences between spinal manipulation (SMT) and other interventions for reducing pain intensity and improving function in chronic LBP patients (high quality evidence). Cost-effectiveness research is important. 3)Conclusion – Weak for (strength). CPG found that spinal manipulation does not provide improvements for chronic LBP pain patients compared to sham interventions. There is low quality evidence that spinal mobilization in addition with other treatments provide long-term benefits in perceived improvement, satisfaction with care, and lower medication use. When

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comparing spinal mobilization compared to other conservative intervention, there doesn’t seem to be a clear advantage of one form of treatment over another. Spinal manipulation demonstrates small effect sizes for acute pain in short-term function.

Elect magn 1)Neuromuscular electrical stimulation (NMES) for patellofemoral pain syndrome

1)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011289.pub2/full?highlightAbstract=withdrawn%7Cexercise%7Cpain%7Cexercis

1)The Cochrane Database of Systematic Reviews (conducted in 2017) found insufficient and inconclusive evidence from RCT to inform the role of neuromuscular electrical stimulation (NMES) for treating people with patellofemoral pain (PFP). Low-quality evidence for multiple-session programs of NMES combined with exercise. High-quality RCTs are needed to inform on the use of NMES for people with PFP.

CBT 1)Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research

2)VA/DOD clinical practice guideline for diagnosis and treatment of low back pain

3)Cognitive-behavioural treatment for subacute and chronic neck pain (review)

4)Psychological therapies for the management of chronic pain (excluding headache) in adults

5)Psychological therapies for the management of chronic neuropathic pain in adults (Review)

6)Cognitive behavioural therapies for fibromyalgia (Review)

7)Efficacy of cognitive-behavioral therapies in fibromyalgia syndrome – a systematic review and metaanalysis of randomized controlled trials

8)Meta-analysis of psychological interventions for chronic low back pain

1)https://psycnet.apa.org/fulltext/2014-04960-005.html

2)https://www.healthquality.va.gov/guidelines/Pain/lbp/VADoDLBPCPG092917.pdf

3)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010664.pub2/epdf/full

4)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007407.pub3/epdf/full

5)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011259.pub2/epdf/full

6)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009796.pub2/epdf/full

7)http://www.jrheum.org/content/jrheum/37/10/1991.full.pdf

8)https://psycnet.apa.org/fulltext/2006-23340-001.pdf

1)CBT is considered the “gold standard” of psychological treatments for chronic pain patients. Previous systematic reviews and meta-analyses have found that CBT efficacious for reducing pain, distress, pain interference with activities, and disability. Average effects sizes are small to moderate across pain outcomes. CBT lacks risks associated with chronic pain medications, surgeries, and interventional procedures. CBT could be beneficial for comorbid health conditions. 2) Conclusion – Strong for (strength). CBT received a “strong for” recommendation due to the moderate confidence in the quality of evidence. The report indicates that patients undergoing CBT identify and change cognitions and behaviors that perpetuate pain as well as relaxation and exposure techniques to reduce symptoms of distress. Evaluation of long-term benefits (greater than 1 year) is insufficient. 3) The Cochrane Database of Systematic Reviews (conducted in 2014) found that CBT was more effective for short-term pain reduction compared to no treatment, but effects weren’t considered clinically meaningful. CBT was found to be more effective than other interventions for subacute neck pain at reducing pain at short-term follow-up. However, no differences were found for disability and

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9)A systematic review of Randomized controlled trials examining psychological interventions for needle-related procedural pain and distress in children and adolescents: An Abbreviated Cochrane Review

10) Psychosocial interventions for the management of chronic orofacial pain

11)CBT techniques for distress and pain in breast cancer patients: A meta-analysis

12)The influence of CBT on pain, QOL, and depression in patients receiving physical therapy for chronic LBP: A systematic review

13)CBT and pain coping skills training for osteoarthritis knee pain management: A systematic review

14)Internet interventions for chronic pain including headache: A systematic Review

15)A systematic review of CBT for the management of headaches and migraines in adults

9)https://academic.oup.com/jpepsy/article/33/8/842/925315

10)https://www.ncbi.nlm.nih.gov/pubmed/22071849

11)https://www.ncbi.nlm.nih.gov/pubmed/16400532

12)https://www.ncbi.nlm.nih.gov/pubmed/30266349

13)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890238/

14)https://www.ncbi.nlm.nih.gov/pubmed/30135787

15)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4616982/

kinesiophobia. Recommends long-term benefits and risks of CBT for neck pain. 4) The Cochrane Database of Systematic Reviews (conducted in 2011) found that CBT was more effect that treatment as usual/waitlist control groups. CBT was found to have weak effects in improving pain immediately post-treatment. CBT was also found to impact mood and catastrophizing outcomes with maintenance at 6-months post treatment. 5) The Cochrane Database of Systematic Reviews (conducted in 2015) found that there is insufficient evidence of efficacy of psychological interventions for chronic neuropathic pain. At the time of this review, the two available studies didn’t show benefit of treatment over waitlist or control groups. 6)The Cochrane Database of Systematic Reviews (conducted in 2013) found that CBT had a small benefit over control groups in reducing pain, negative mood and disability at the end of treatment and at long-term follow-up. Dropout rates didn’t differ between CBTs and control. 7)The metanalysis found that CBT reduces depressed mood and improve self-efficacy of pain at posttreatment. No evidence of efficacy of CBT to reduce pain, fatigue, sleep disturbances, and limitations of health related QOL at posttreatment. 8)This metanalysis found positive effects of psychological interventions compared to control groups as measured by pain intensity, pain-related interference, health-related QOL, and depression. CBT and self-regulatory treatments are efficacious. Multidisciplinary pain management approaches that included a psychological component (compared to control conditions) were found to have positive short-term effects on pain interference and long-term effects on return to work.

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9) This metanalysis examines psychological interventions for procedure pain and distress in children. The result found sufficient evidence to support the efficacy of “(a)combined CBT for observer-reported distress and behavioral measures of distress, (b) distraction for self-reported pain, (c) distraction + suggestion for self-reported pain, (d) hypnosis for self-reported pain, self-reported distress, and behavioral measures of distress, (e)providing information/preparation for observer-reported pain and improving pulse rates, (f)nurse coaching + distraction for behavioral measures of distress, and (g) parent positioning + distraction for observer-reported distress.” 10) The Cochrane Database of Systematic Reviews found that there is weak evidence to support the use of psychosocial interventions for chronic orofacial pain. Significant effects were observed for outcome measures where pooling was possible, however, there were a limited number of studies and high risk of bias. Given the non-invasive nature of the interventions, they should be used in preference to other invasive and irreversible treatments which also have limited efficacy. 11) Twenty studies used CBT techniques and effect sizes were calculated to determine – 1)whether CBT techniques have a significant impact on distress and pain, 2) whether individual or group treatment is more effective, 3)whether severity of cancer diagnosis impacts distress and pain outcomes, 4)and whether there is a relationship between CBT technique efficacy for distress and pain. The results suggest that the use of CBT techniques administered individually help manage distress and pain. 12)The review examined whether adding CBT to routine PT has an effect on pain and depression reduction, improvement in QOL, and enhanced function in patients with chronic LBP. Adding CBT to PT appears to reduce pain and disability and

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enhances functional capacity and quality of life. CBT effects on depression cannot be teased out from the effects of PT. 13)The review examined the effectiveness of CBT and pain coping skills training (PCST) on pain level in adults with osteoarthritis of the knee (KOA) in comparison with usual care. Three studies reported clinical improvement in KOA pain perception after 12-months follow-up. 14) The goal of the systematic review was to evaluate internet-based interventions for persons with chronic pain. Findings suggest that internet-based treatments based on CBT are efficacious measured with different outcome variables. Results are in line with trials in clinical settings. Meta-analytic statistics were calculated for interference/disability, pain intensity, catastrophizing and mood ratings. 15)The systematic review aimed to establish whether CBT can reduce the physical symptoms of chronic headache and migraines in adults. Findings were mixed, with some studies providing evidence that people with headaches and migraines can benefit from CBT, and CBT can reduce the physical symptoms of headaches and migraines. However, methodology inadequacies in the evidence base make it difficult to draw meaningful conclusions and/or make recommendations.

Mindfulness Stress reduction

1)2015 Mindfulness-based stress reduction (MBSR) as sole intervention for non-somatisation chronic non-cancer pain (CNCP): protocol for a systematic review and meta-analysis of randomised controlled trials

2) 2015 Group based MBSR and CBT for chronic pain disorders 3) 2017 MBSR for treating low back pain 4) 2015 Acceptance and MBSR interventions for treatment of chronic pain

1)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442214/ 2)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230908/ 3)http://annals.org/aim/fullarticle/2622873/mindfulness-based-stress-reduction-treating-low-back-pain-systematic-review 4)https://www.tandfonline.com/doi/full/10.1080/16506073.2015.1098724 5)https://www.sciencedirect.com/science/article/pii/S0022399913003760?via%3Dihub

1)Effective for non-cancer pain 2)MBSR maybe effective to reduce pain severity and reduce psychological distress. It is unclear how MBSR compares to CBT in the treatment of chronic pan disorders. Gaps in evidence still remain. 3)MBSR appears to be associated with short-term effects on pain intensity and physical functioning. Long-term RCTs are still needed to compare MBSR versus active treatment in order to understand the role of MBSR in the management of LBP.

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5) 2013 A systematic review and meta-analysis of mindfulness-based stress reduction for the fibromyalgia syndrome

6) 2016 Mindfulness and headache: A "new" old treatment, with new findings.

7)VA/DOD clinical practice guideline for diagnosis and treatment of low back pain

6)https://www.ncbi.nlm.nih.gov/pubmed/27694139 7)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008208.pub5/epdf/full

4)The meta-analytic review compared acceptance- and mindfulness-based interventions to waitlist, treatment-as-usual, and/or education/support groups. Effect sizes ranged from small (all outcome measures except anxiety and pain interference) to moderate (anxiety and pain interference) at post-treatment. Effect sizes ranged from small (pain intensity and disability) to large (pain interference) at follow-up. ACT treatment had higher effects on depression and anxiety than MBSR and MBCT. Research suggests that acceptance- and mindfulness-based interventions are not superior to CBT, but they can be good alternatives. 5)The meta-analysis found low quality evidence/small effects of MBSR on QOL and pain intensity in patients with fibromyalgia syndrome compared to usual care groups or active control groups. Effects were not robust against bias and data safety were not reported in the studies. 6)Mindfulness approaches appear to enhance the usual care for headache management. Mindfulness alone may be as beneficial as medication alone for patients experiencing chronic migraine. 7) Conclusion – Weak for (strength). The guidelines found that there is intermediate and long-term benefit of MBSR for pain and functioning compared to usual care. Research suggests equivalence of MBSR to CBT for outcomes such as pain, functioning, and QOL. MBSR may have benefit on comorbid health conditions associated with chronic LBP. Evaluation of long-term benefits (greater than 1 year) is insufficient.

Biofeedback 1)Efficacy of biofeedback in chronic back pain: A meta-analysis

1)https://link.springer.com/article/10.1007%2Fs12529-016-9572-9

1)Meta-analytic results suggest significant small-to-medium effect size for pain intensity reduction which was maintained with a significant small-to-large effect sized over an average follow-up of 8 months. Biofeedback also appeared to reduce

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2)Efficacy of biofeedback in chronic back pain: A meta-analysis 3)Biofeedback as psychological treatment option for chronic back pain 4)Efficacy of biofeedback for migraine: A meta-analysis 5)Meta-analysis of biofeedback for tension-type headache: Efficacy, specificity, and treatment moderators

2)https://link.springer.com/content/pdf/10.1007/s12529-016-9572-9.pdf 3)https://www.futuremedicine.com/doi/full/10.2217/pmt-2016-0040?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed& 4)https://ovidsp.tx.ovid.com/sp-3.33.0b/ovidweb.cgi?QS2=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 5)https://psycnet.apa.org/fulltext/2008-06469-003.pdf

depression sxs, disability, muscle tension, and improved cognitive coping strategies. These effects remained comparable at follow-up compared to controlled studies. Longer biofeedback treatments appear to be more effective for reducing disability and depression. 2)The meta-analysis found significant small-to-medium effect size for pain intensity reduction that appeared stable with significant small-to-large effect sizes over an average follow-up phase of 8 months. Biofeedback (BFB) was effective in reducing depression, disability, reduction of muscle tension, and improving cognitive coping skills. The effects remained stable at follow-up for controlled studies only. Moderator analyses found that longer BFB treatment was more effective at reducing disability and depression. 3)The Meta-analysis found psychological treatments enhanced with biofeedback elements lead to greater improvements on most core pain-related outcomes outlined by IMMPACT. The study found clinically significant improvements for pain intensity was more common at post-treatment and follow-up therapies with biofeedback elements. The results concluded that EMG biofeedback “may be a superior treatment for chronic musculoskeletal pain.” 4)A medium effect size resulted for all biofeedback (BFB) interventions and proved stable over an average follow-up phase of 17 months. BFB was more effective than control conditions. Outcomes – frequency of migraine attacks and perceived self-efficacy demonstrated the strongest improvements. Moderate analyses of BFB in combination with home training was found to be more effective than therapies without home training. Results proved to be robust across different methods of effect size calculation. An intention-to-treat analysis showed that the treatment effects remained stable, even when considering drop-outs.

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6)Effectiveness of autogenic training on headache: A systematic review 7)Mind and body therapy for fibromyalgia 8)Efficacy of EMG- and EEG-biofeedback in fibromyalgia Syndrome: A meta-analysis and a systematic review of randomized controlled trials 9)The effectiveness of self-management interventions in adults with chronic orofacial pain: A systematic review, meta-analysis and meta-regression 10)Biofeedback for pain management during labour

6)https://www.sciencedirect.com/science/article/pii/S0965229917306854?via%3Dihub 7)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001980.pub3/full?highlightAbstract=biofeedback%7Cwithdrawn 8)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776543/ 9)https://onlinelibrary.wiley.com/doi/full/10.1002/ejp.1358 10)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006168.pub2/full?highlightAbstract=biofeedback%7Cwithdrawn

5)Meta-analysis results suggest a significant medium-to-large effect size that remained stable over an average follow-up period of 15 months. Biofeedback (BFB) was found to be more effective than headache monitoring, placebo, and relaxation therapy. The most significant improvement was the reduction in frequency of headache episodes. Other significant effects included reduction of muscle tension, increase in self-efficacy, reduction in symptoms of anxiety and depression, and reduction in analgesic medications. Moderator analyses revealed biofeedback in combination with relaxation was found to be the most effective treatment modality, effects were particularly large in children and adolescents. 6)This review examined autogenic training (AT) only to biofeedback-assisted AT. Results suggest a statistically significant reduction in headache. However, there were a significant number of limitations associated with the RCTs included in the review. Limitations include – small number of studies, high risk of systematic bias due to lack of blinding participants and personnel, small group sample sizes, variations in AT techniques, and differed headache measures. 7)The Cochrane Database of Systematic Reviews (concluded in 2013) found that there is very low quality evidence that biofeedback compared to controls had an effect on physical functioning, pain, and mood post-intervention. Cochrane concluded that they couldn’t make

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definitive conclusions about the effectiveness of biofeedback. No adverse events were reported. 8)Meta-analysis found that compared to control groups, biofeedback (BFB) significantly reduce pain intensity with a large effect size. EMG-BFB and not EEG-BFB significantly reduced pain intensity in comparison to the control groups. BFB did not reduce sleep problems, depression, fatigue, or health QOL in comparison to a control group. 9)A meta-analysis examined long-term outcome measures of pain and depression for those patients who did and didn’t undergo biofeedback treatment. Showed some benefit for long-term pain and depression. Statistically significant differences occurred between self-care CBT and combined biofeedback and CBT tx. Both self-care CBT and CBT/biofeedback showed statistically significant benefits over usual care with regards to depression and pain. 10) The Cochrane Database of Systematic Reviews (completed in 2011) found that there is no significant evidence of a difference between biofeedback and control groups in terms of assisted vaginal birth, caesarean section, augmentation of labour and the use of pharmacological pain relief.

Hypnosis 1)2009 Hypnotherapy for managing chronic pain. 2)2005 Hypnotherapy for treating symptoms in terminally ill cancer patients 3) 2014 Hypnotic approaches to chronic pain management

1)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752362/ 2)http://journals.sagepub.com/doi/pdf/10.1191/0269216305pm1030oa 3)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465776/

1) one or two small studies only for each of the following- all reported to show decrease in pain: cancer pain, low back pain, SCD, arthritis, fibromyalgia, temporomandibular pain. lack of standardization across studies 2) This systematic review examined the use of hypnotherapy to treat pain, anxiety, and depression. There appears to be a lack of evidence to support the use of hypnotherapy. Due to the poor quality studies and heterogeneity of the study population limited the authors conclusions. 3) The review concludes that hypnosis is effective for reducing chronic pain

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4) 2014 Hypnosis for chronic pain problems: comparison between hypnosis, standard care, and psychological interventions

4)https://www.ncbi.nlm.nih.gov/pubmed/24256477

intensity, however, the review also found substantial individual variation. Hypnosis appears to have limited negative side effects. 4) This meta-analysis found moderate treatment benefit for a nonheadache chronic pain group compared to other psychological interventions. The heterogeneity of the study population suggests additional research should be conducted.