Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review

Comparative Effectiveness Review
Number 209

June 11, 2018

Prepared for:
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services

Prepared by:
Pacific Northwest Evidence-based Practice Center

Purpose of Review

To assess which noninvasive nonpharmacological treatments for common chronic pain conditions improve function and pain for at least 1 month after treatment.

Key Messages—

  • Interventions that improved function and/or pain for at least 1 month when used for
    • Chronic low back pain: Exercise, psychological therapies (primarily cognitive behavioral therapy [CBT]), spinal manipulation, low-level laser therapy, massage, mindfulness-based stress reduction, yoga, acupuncture, multidisciplinary rehabilitation (MDR)
    • Chronic neck pain: Exercise, low-level laser, Alexander Technique, acupuncture
    • Knee osteoarthritis: Exercise, ultrasound
    • Hip osteoarthritis: Exercise, manual therapies
    • Fibromyalgia: Exercise, CBT, myofascial release massage, tai chi, qigong, acupuncture, MDR
    • Chronic tension headache: Spinal manipulation.
  • Most effects were small.  Long-term evidence was sparse.
  • There was no evidence suggesting serious harms from any of the interventions studied; data on harms were limited.