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Non-Pharmacologic Interventions by Type of Non-Malignant Chronic Pain

Non-Pharmacologic Interventions by Type of Non-Malignant Chronic Pain - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Pain and Sedation, Related


Excerpt from the UW Health Management of Non-Malignant Chronic Pain in Primary Care – Adult – Ambulatory
Guideline Reference full document for additional details.
Figure 1. Suggested Non-Pharmacologic Interventions by Pain Type1-8
Note: Patients with osteoarthritis pain should be managed using the recommendations within the
UW Health Osteoarthritis of the Knee and Hip – Adult – Ambulatory Clinical Practice Guideline.
Copyright © 2017 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org

Table 1. Non-pharmacologic Interventions for Chronic Non-Malignant Pain1-10
Treatment Efficacy/Impact Safety Considerations Evidence Grade
Exercise
Reduces pain relative to usual
care or attention control,
improves physical functioning
and self-efficacy.
No reported safety issues Strongly consider in chronic low back pain, fibromyalgia and older adults with persistent
pain
UW Health Moderate quality
evidence, strong recommendation
Aquatic therapy May improve physical function
and pain
No reported safety issues May be beneficial for individuals with comorbidities that cannot tolerate weight-bearing
exercise (e.g. low back pain); beneficial for fibromyalgia patients with depression or anxiety
UW Health Low quality evidence,
weak/conditional recommendation
Tai chi
Studies suggest effective
treatment in improving physical
functioning
No serious adverse
events, minor adverse
events include muscle
soreness and increased
joint pain
Low-impact exercise that may help individuals with joint problems, arthritis, low back pain
and fibromyalgia
Consider in older patients with persistent pain, if delivered appropriately
UW Health Low quality evidence,
weak/conditional recommendation
Qi-gong May improve sleep and physical
function
No reported safety issues May help fibromyalgia patients UW Health Low quality evidence, weak/conditional recommendation
Yoga
May help improve sleep, reduce
stress and anxiety and improve
strength and flexibility
No serious adverse events
May help fibromyalgia patients
May improve pain and function in low back pain patients compared to usual care however
mixed results when compared to exercise/stretching
Consider in older patients with persistent pain
UW Health Low quality evidence,
weak/conditional recommendation
Cognitive- behavioral
Therapy (CBT)
May help reduce pain and
disability /improve how patients
think and cope with pain
No serious adverse events
May help fibromyalgia patients in reducing pain and disability with sustained long term
results
May help older patients if delivered by professional
UW Health Moderate quality
evidence, weak/conditional
recommendation
Biofeedback Can include relaxation training No serious adverse events
Limited to no evidence can improve sleep or fatigue in fibromyalgia patients
May be used in multi-disciplinary pain management program
UW Health Low quality evidence,
weak/conditional recommendation
Acupuncture
Can reduce pain and functional
disability relative to sham
controls
No serious adverse
events; minor events
include bruising, bleeding
at needle insertion sites
May consider as adjunctive therapy in older patients
May improve pain and function in low back pain patients compared to usual care
May not be effective for fibromyalgia symptoms treatment
UW Health Low quality evidence,
weak/conditional recommendation
Mindfulness meditation Can be used to supplement CBT No serious adverse events
May help improve pain in fibromyalgia patients versus usual care ; limited to evidence may
help older patients with persistent pain
UW Health Low quality evidence,
weak/conditional recommendation
Massage May reduce pain and improve
functioning
No serious adverse events May consider as adjunct therapy in an older adult; modest pain improvement demonstrated
for low back pain patients at 10 weeks but not sustained at 52 weeks
UW Health Low quality evidence,
weak/conditional recommendation
Self-management
education
program/support group
May reduce pain and improve
functioning
No serious adverse events May enhance benefits from exercise in fibromyalgia patients; consider in older patients with
persistent pain
UW Health Low quality evidence,
weak/conditional recommendation
Transcutaneous electric
nerve stimulation
(TENS)
Percutaneous electrical
nerve stimulation (PENS)
May improve pain quality and
functioning
May be a complex
intervention due to
complex pattern of usage
and multiple direct/indirect
outcomes
May reduce in chronic pain patients when used as complementary treatment to other
treatments (e.g. medications)
PENS may reduce pain and improve sleep for painful diabetic neuropathy
UW Health Low quality evidence,
weak/conditional recommendation
Copyright © 2017 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org

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Copyright © 2017 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org