Non-pharmacological therapy in chronic musculoskeletal pain

Abstract

BACKGROUND: Despite enormous progress in the field of pain management over the recent years, pain continues to be a highly prevalent medical condition worldwide. Non-pharmacological therapies, as relaxation and exercise, may have specific benefits in reducing the severity of chronic non-cancer pain improving functioning. Although there is low evidence of their effectiveness, they are usually included as a first approach in consensus guidelines on chronic pain. The aim of this study was to investigate whether standard non-pharmacological therapies are effective in relieving chronic non-cancer pain and improving its disabling consequences in real world. METHODS: Pain Unit ambulatory patients, chronically treated with opioids, were included between 2012 and 2017, in four different non-pharmacological therapies: Jacobson progressive muscular relaxation (N.=58), occupational therapy (N.=43), physiotherapy (N.=34) and relaxing yoga (N.=41) sessions. Pain intensity (Visual Analogue Scale), sleep (Medical Outcomes Study Sleep), functionality (Barthel Index and International Physical Activity Questionnaire) and adherence, were evaluated pre- and postinterventions. Hospital Ethics Committee approved the study and data was analyzed with GraphPad Prism v. 5.02 software (GraphPad Inc., La Jolla, CA, USA) and R. 3.2.4 (R Foundation for Statistical Computing, Vienna, Austria). RESULT S: A total of 147 patients (55±13 years old; 69% female) were included mostly with moderate to severe chronic low back pain (89%, VAS 68±22.7 mm) and under long-term use of opioids. Results showed a lower pain intensity postintervention in all group treatments, especially in patients with severe pain intensity and upon physiotherapy. Pain relief was associated with an improvement on quantity and quality of sleep. All interventions had no adverse events and a high self-rated adherence to the recommended exercise training. CONCLUSIONS: Findings support the effectiveness, tolerability, and acceptability of non-pharmacological interventions for reducing pain perception and improve sleep with minimal therapist time, especially physiotherapy for chronic non-cancer pain.