Chronic Pain Treatments Evidence
Transcript of Chronic Pain Treatments Evidence
-
8/13/2019 Chronic Pain Treatments Evidence
1/15
ChronicPain
Treatments:
What
is
the
Evidence?
WorkSafeBCEvidenceBasedPracticeGroup
April2010
-
8/13/2019 Chronic Pain Treatments Evidence
2/15
-
8/13/2019 Chronic Pain Treatments Evidence
3/15
-
8/13/2019 Chronic Pain Treatments Evidence
4/15
-
8/13/2019 Chronic Pain Treatments Evidence
5/15
-
8/13/2019 Chronic Pain Treatments Evidence
6/15
ChronicPainTreatments:WhatistheEvidence? 5
WorkSafeBCEvidenceBasedPracticeGroup April2010
www.worksafebc.com/evidence
PainManagementPrograms
Painmanagementprograms
(PMPs)
PMPs,alsoknownasMultimodalRehabilitationPainPrograms,consistofeducationon
painphysiology,painpsychology,healthyfunction,andselfmanagementofpain
problems;guidedpracticeonsettinggoalsandworkingtowardsthem;identifyingand
changingunhelpfulbeliefsandwaysofthinking;relaxation;andchanginghabitswhich
contributeto
disability.
There
is
high
quality
evidence
on
the
effectiveness
of
PMPs
in
reducingpain,returningpeopletowork,andreducingsickleavescomparedtopassive
controlsorseparateinterventions.However,theireffectivenessforneckandshoulder
painamongworkingageadultsisquestionable.Further,forchroniclowbackpain
patients,itisimportanttoinvestigatethecomponentsofaprogrambeforecommittingto
one.
29 (2007),
30(2006),
31(Nov2002),
32(2003)
WorkSafeBCprovides:
Comprehensive
MultidisciplinaryPain
Assessmentinorderto
assistcase
managers
in
adjudicatingdecisionsin
chronicpain;
PainManagement
Program,a
multidisciplinary
treatmentprogram
consistingofa
physiotherapist,
occupationaltherapist,
psychologist,pharmacist
andphysicianwho
assistworkerswho
requireassessment
and/ormanagementof
theircomplexpainissue;
Sympathetically
mediatedPain
RehabilitationServices,a
multidisciplinaryteam
treatinginjuredworkers
diagnosedwithComplex
RegionalPainSyndrome.
Theseservicescanbe
accessedthroughreferral
bytheBoard'sMedical
Advisors.
-
8/13/2019 Chronic Pain Treatments Evidence
7/15
-
8/13/2019 Chronic Pain Treatments Evidence
8/15
-
8/13/2019 Chronic Pain Treatments Evidence
9/15
-
8/13/2019 Chronic Pain Treatments Evidence
10/15
ChronicPainTreatments:WhatistheEvidence? 9
WorkSafeBCEvidenceBasedPracticeGroup April2010
www.worksafebc.com/evidence
ComplementaryandAlternativeMedicine
Touchtherapiesforpain
reliefinadults
Touchtherapies,includingHealingTouch(HT),TherapeuticTouch(TT)andReiki,showed
verysmalleffects(0.83unitsona0to10unitscale)inloweringpainintensitycompared
tounexposedparticipants.
57 (June2008) Notapproved
Neuroreflexotherapy(NRT)
fornonspecificlowback
pain
AlesswidelyusedtechniquefromSpain,NRTshowedshortterm(15to60days)
statisticallysignificantlybetteroutcomesinpain,mobility,disability,medicationuse,
consumptionofresources,andcosts,butnotqualityoflife.
58 (July2009) Notapproved
Massageformechanicalneck
disorders
Neithermassagealonenormassagecombinedwithothertreatmentsshoweda
significantadvantageoverothercomparisongroupsincludingnotreatment,hotpacks,
activerangeofmovementexercises,interferentialcurrent,acupuncture,exercises,sham
laser,TENS,manualtraction,mobilization,education,andpainmedication.
59 (Sept2004) TheBoardprovides
massage,deliveredbya
RegisteredMassage
Therapist,aspartof
rehabilitativetherapyfor
injuredworkerswith
musculoskeletalrelated
injuries.Massageis
providedfor5
consecutiveweekswitha
maximumof3treatments
perweekuntilreturnto
work.Treatmentis
limitedtoone
rehabilitationmassage
perday.
Should
the
injuredworkernotreturn
toworkafter5weeks,
approvaltocontinue
massagecanbeobtained
afterconsultationwith
theBoard'sMedical
Advisorsforuptoa
maximumof3additional
weeksof
treatment.
Massageforlowbackpain Massagemightbebeneficialforpatientswithsubacuteandchronicnonspecificlowback
pain,especiallywhencombinedwithexercisesandeducation.Thereisatrendtowards
acupressureor
pressure
point
massage
techniques
providing
more
relief
than
classic
(Swedish)massage.
60 (May2008)
-
8/13/2019 Chronic Pain Treatments Evidence
11/15
ChronicPainTreatments:WhatistheEvidence? 10
WorkSafeBCEvidenceBasedPracticeGroup April2010
www.worksafebc.com/evidence
Acupuncturefortension
typeheadache
Thereareclinicallyrelevantshortterm(upto3 months)benefitsofacupunctureover
routinecareforresponse,numberofheadachedays,andpainintensityamongpatients
withacuteheadaches.Noevidenceonlongtermeffects(>3months).
61 (Jan2008) WorkSafeBCdoesnot
generallyaccept
responsibilityforthecost
ofacupuncture. Any
exceptionmustbe
previouslyauthorized,
andwhenauthorized,
treatmentisforashort
periodoftimeandonlyin
conjunctionwitha
comprehensivetreatment
planthatincludes
activationandother
painmanagement
strategies.Upon
approval,injuredworkers
canreceiveuptofive
acupuncturetreatments
overtwoweeks.
Acupunctureanddry
needlingforlowbackpain
Forchroniclowbackpain,acupunctureismoreeffectiveforpainreliefandfunctional
improvementthannotreatmentorshamtreatmentimmediatelyaftertreatmentandin
theshorttermonly.Acupunctureisnotmoreeffectivethanotherconventionaland
"alternative"treatments.Acupunctureanddryneedlingmaybeusefuladjunctstoother
therapiesforchroniclowbackpain.
62 (Feb2003)
Acupunctureforshoulder
pain
Thereisnotenoughevidencetosaywhetheracupunctureworkstotreatshoulderpainor
whetherit
is
harmful.
63 (Dec2003)
Herbaltherapyfortreating
rheumatoidarthritis
Theremaybesomepotentialbenefitfortheuseofgammalinolenicacid(GLA)in
rheumatoidarthritisforreliefofpain,morningstiffness,andjointtenderness.GLAmay
providesupplementaryoralternativetreatmenttoNSAIDsforsomepatients.
64 (2000) Notapplicable
Herbalmedicine
for
low
back
pain
Althoughthere
have
been good
results
with
three
herbal
medicines
(Devil's
Claw
(Harpagophytum Procumbens),WillowBark(SalixAlba),andCayenne(Capsicum
Frutescens)inshorttermtrials,thereisnoevidenceyetthatanyofthesesubstancesare
safeandusefulforlongtermuse.
65 (July2005) Not
approved
VitaminDforthetreatment
ofchronicpainfulconditions
inadults
ThereisinsufficientevidenceforaneffectofvitaminDinchronicpainconditions. 66 (Sept2009) Notapproved
-
8/13/2019 Chronic Pain Treatments Evidence
12/15
-
8/13/2019 Chronic Pain Treatments Evidence
13/15
http://www.ihe.ca/publications/libraryhttp://www.ihe.ca/publications/libraryhttp://www.ihe.ca/publications/libraryhttp://www.ihe.ca/publications/libraryhttp://www.ihe.ca/publications/libraryhttp://www.ihe.ca/publications/libraryhttp://www.ihe.ca/publications/libraryhttp://www.ihe.ca/publications/libraryhttp://www.cadth.ca/media/cdr/complete/cdr_complete_Tridural_April-17-2008.pdfhttp://www.cadth.ca/media/cdr/complete/cdr_complete_Tridural_April-17-2008.pdfhttp://www.cadth.ca/media/cdr/complete/cdr_complete_Tridural_April-17-2008.pdfhttp://www.cadth.ca/media/cdr/complete/cdr_complete_Tridural_April-17-2008.pdfhttp://www.cadth.ca/media/cdr/complete/cdr_complete_Tridural_April-17-2008.pdfhttp://www.cadth.ca/media/cdr/complete/cdr_complete_Tridural_April-17-2008.pdfhttp://www.cadth.ca/media/cdr/complete/cdr_complete_Tridural_April-17-2008.pdfhttp://www.cadth.ca/media/cdr/complete/cdr_complete_Ralivia_June_25_2008.pdfhttp://www.cadth.ca/media/cdr/complete/cdr_complete_Ralivia_June_25_2008.pdfhttp://www.cadth.ca/media/cdr/complete/cdr_complete_Ralivia_June_25_2008.pdfhttp://www.cadth.ca/media/cdr/complete/cdr_complete_ZytramXL_September-26-2007.pdfhttp://www.cadth.ca/media/cdr/complete/cdr_complete_ZytramXL_September-26-2007.pdfhttp://www.cadth.ca/media/cdr/complete/cdr_complete_ZytramXL_September-26-2007.pdfhttp://www.cadth.ca/media/cdr/complete/cdr_complete_ZytramXL_September-26-2007.pdfhttp://www.cadth.ca/media/cdr/complete/cdr_complete_ZytramXL_September-26-2007.pdfhttp://www.cadth.ca/media/cdr/complete/cdr_complete_ZytramXL_September-26-2007.pdfhttp://www.cadth.ca/media/cdr/complete/cdr_complete_ZytramXL_September-26-2007.pdfhttp://www.cadth.ca/media/cdr/complete/cdr_complete_ZytramXL_September-26-2007.pdf -
8/13/2019 Chronic Pain Treatments Evidence
14/15
-
8/13/2019 Chronic Pain Treatments Evidence
15/15
ChronicPainTreatments:WhatistheEvidence? 14
WorkSafeBCEvidenceBasedPracticeGroup April2010
www.worksafebc.com/evidence
55. YousefiNooraieR,SchonsteinE,HeidariK,RashidianA,PennickV,AkbariKamraniM,etal.Lowlevellasertherapyfornonspecificlowbackpain.Cochrane
DatabaseSystRev.2008(2):CD005107.
56. ChowRT,JohnsonMI,LopesMartinsRA,BjordalJM.Efficacyoflowlevellasertherapyinthemanagementofneckpain:asystematicreviewandmeta
analysisofrandomisedplacebooractivetreatmentcontrolledtrials.Lancet.2009Dec5;374(9705):1897908.
57.
SoPS,
Jiang
Y,
Qin
Y.
Touch
therapies
for
pain
relief
in
adults.
Cochrane
Database
Syst
Rev.
2008(4):CD006535.
58. UrrutiaG,BurtonAK,MorralA,BonfillX,ZanoliG.Neuroreflexotherapyfornonspecificlowbackpain.CochraneDatabaseSystRev.2004(2):CD003009.
59. HaraldssonBG,GrossAR,MyersCD,EzzoJM,MorienA,GoldsmithC,etal.Massageformechanicalneckdisorders.CochraneDatabaseSystRev.
2006;3:CD004871.
60. FurlanAD,ImamuraM,DrydenT,IrvinE.Massageforlowbackpain.CochraneDatabaseSystRev.2008(4):CD001929.
61. LindeK,AllaisG,BrinkhausB,ManheimerE,VickersA,WhiteAR.Acupuncturefortensiontypeheadache.CochraneDatabaseSystRev.2009(1):CD007587.
62. FurlanAD,vanTulderMW,CherkinDC,TsukayamaH,LaoL,KoesBW,etal.Acupunctureanddryneedlingforlowbackpain.CochraneDatabaseSystRev.2005(1):CD001351.
63. GreenS,BuchbinderR,HetrickS.Acupunctureforshoulderpain.CochraneDatabaseSystRev.2005(2):CD005319.
64. LittleC,ParsonsT.Herbaltherapyfortreatingrheumatoidarthritis.CochraneDatabaseSystRev.2001(1):CD002948.
65. GagnierJJ,vanTulderM,BermanB,BombardierC.Herbalmedicineforlowbackpain.CochraneDatabaseSystRev.2006(2):CD004504.
66. StraubeS,DerryS,MooreRA,McQuayHJ.VitaminDforthetreatmentofchronicpainfulconditionsinadults.CochraneDatabaseSystRev.
2010(1):CD007771.