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ChronicPain

Treatments:

What

is

the

Evidence?

WorkSafeBCEvidenceBasedPracticeGroup

April2010

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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.

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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)

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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

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