Noninvasive, Nonpharmacological Treatment for Chronic Pain: A Systematic Review [Entered Retrospectively]

Project Summary Title and Description

Title
Noninvasive, Nonpharmacological Treatment for Chronic Pain: A Systematic Review [Entered Retrospectively]
Description
Structured Abstract Objectives. Many interventions are available to manage chronic pain; understanding the durability of treatment effects may assist with treatment selection. We sought to assess which noninvasive, nonpharmacological treatment for selected chronic pain conditions are associated with persistent improvement in function and pain outcomes at least 1 month after the completion of treatment. Data sources. Electronic databases (Ovid MEDLINE®, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews), through November 2017, reference lists, and ClinicalTrials.gov. Review methods. Using predefined criteria, we selected randomized controlled trials of noninvasive, nonpharmacological treatments for five common chronic pain conditions (chronic low back pain, chronic neck pain, osteoarthritis of the knee, hip, or hand, fibromyalgia, and tension headache) that addressed efficacy or harms compared with usual care, no treatment, waitlist, placebo, or sham intervention; compared with pharmacological therapy; or compared with exercise. Study quality was assessed, data extracted, and results summarized for function and pain. Only trials reporting results for at least 1 month post-intervention were included. We focused on the persistence of effects at short term (1 to < 6 months following treatment completion), intermediate term (≥6 to <12 months), and long term (≥12 months). Results. 218 publications (202 trials) were included. Many included trials were small. Evidence on outcomes beyond 1 year after treatment completion was sparse. Most trials enrolled patients with moderate baseline pain intensity (e.g., >5 on a 0 to 10 point numeric rating scale) and duration of symptoms ranging from 3 months to >15 years. The most common comparison was against usual care. Chronic low back pain: At short term, massage, yoga, and psychological therapies (primarily cognitive behavioral therapy [CBT]) (Strength of evidence [SOE]: Moderate) and exercise, acupuncture, spinal manipulation, and multidisciplinary rehabilitation (SOE: Low) were associated with slight improvements in function compared with usual care or inactive controls. Except for spinal manipulation, these interventions also improved pain. Effects on intermediate term function were sustained for yoga, spinal manipulation, multidisciplinary rehabilitation (SOE: Low), and psychological therapies (SOE: Moderate). Improvements in pain continued into intermediate term for exercise, massage and yoga (moderate effect, SOE: Low), mindfulness-based stress reduction (small effect, SOE: Low), spinal manipulation, psychological therapies, and multidisciplinary rehabilitation (small effects, SOE: Moderate). For acupuncture, there was no difference in pain at intermediate term, but a slight improvement at long term (SOE: Low). Psychological therapies were associated with slightly greater improvement than usual care or an attention control on both function and pain at short-term, intermediate-term, and long-term followup (SOE: Moderate). At short and intermediate term, multidisciplinary rehabilitation slightly improved pain compared with exercise (SOE: Moderate). High-intensity multidisciplinary rehabilitation (≥20 hours/week or >80 hours total) was not clearly better than nonhigh-intensity programs. Chronic neck pain: At short- and intermediate-terms, acupuncture and Alexander Technique were associated with slightly improved function compared with usual care (both interventions), sham acupuncture, or sham laser (SOE: Low), but no improvement in pain was seen at any time (SOE: Low). Short-term, low-level laser therapy was associated with moderate improvement in function and pain (SOE: Moderate). Combination exercise (any 3 of the following: muscle performance, mobility, muscle re-education, aerobic) demonstrated a slight improvement in pain and function short and long-term (SOE: Low). Osteoarthritis: For knee osteoarthritis, at short-term exercise and ultrasound demonstrated small short-term improvements in function compared with usual care, an attention control or sham procedure (SOE: Moderate for exercise, Low for ultrasound), which persisted into the intermediate term only for exercise (SOE: Low). Exercise was also associated with moderate improvement in pain (SOE: Low). Long term, the small improvement in function seen with exercise persisted, but there was no clear effect on pain (SOE: Low). Evidence was sparse on interventions for hip and hand osteoarthritis. Exercise for hip osteoarthritis was associated with slightly greater function and pain improvement than usual care short term (SOE: Low). The effect on function was sustained intermediate term (SOE: Low). Fibromyalgia: In the short term, acupuncture (SOE: Moderate), CBT, tai chi, qigong, and exercise (SOE: Low) were associated with slight improvements in function compared with an attention control, sham, no treatment or usual care. Exercise (SOE: Moderate) and CBT improved pain slightly and tai chi and qigong (SOE: Low) improved pain moderately in the short term. At intermediate term for exercise (SOE: Moderate), acupuncture and CBT (SOE: Low), slight functional improvements persisted and were also seen for myofascial release massage and multidisciplinary rehabilitation (SOE: Low); pain was improved slightly with multidisciplinary rehabilitation in the intermediate-term (SOE: Low). In the long term, small improvements in function continued for multidisciplinary rehabilitation but not for exercise or massage (SOE: Low for all); massage (SOE: Low) improved long-term pain slightly but no clear impact on pain for exercise (SOE: Moderate) or multidisciplinary rehabilitation (SOE: Low) was seen. Short-term CBT was associated with a slight improvement in function but not pain compared with pregabalin. Chronic tension headache: Evidence was sparse and the majority of trials were of poor quality. Spinal manipulation slightly improved function and moderately improved pain short-term versus usual care and laser acupuncture was associated with slight pain improvement short term compared with sham (SOE Low). There was no evidence suggesting increased risk for serious treatment-related harms for any of the interventions, although data on harms were limited. Conclusions. Exercise, multidisciplinary rehabilitation, acupuncture, cognitive behavioral therapy, and mind-body practices were most consistently associated with durable slight to moderate improvements in function and pain for specific chronic pain conditions. Our findings provided some support for clinical strategies that focused on use of nonpharmacological therapies for specific chronic pain conditions. Additional comparative research on sustainability of effects beyond the immediate post-treatment period is needed, particularly for conditions other than low back pain.
Attribution
N/A
Authors of Report
N/A
Methodology description
Using predefined criteria, we selected randomized controlled trials of noninvasive, nonpharmacological treatments for five common chronic pain conditions (chronic low back pain, chronic neck pain, osteoarthritis of the knee, hip, or hand, fibromyalgia, and tension headache) that addressed efficacy or harms compared with usual care, no treatment, waitlist, placebo, or sham intervention; compared with pharmacological therapy; or compared with exercise. Study quality was assessed, data extracted, and results summarized for function and pain. Only trials reporting results for at least 1 month post-intervention were included. We focused on the persistence of effects at short term (1 to < 6 months following treatment completion), intermediate term (≥6 to <12 months), and long term (≥12 months).
PROSPERO
CRD42017067729
DOI
https://doi.org/10.23970/AHRQEPCCER209
Notes
Data was entered retrospectively via the upload of the evidence and quality appendix tables in Word.
Funding Source
Agency for Healthcare Research and Quality. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. HHSA290201500009I.) AHRQ Publication No. XXX.

Key Questions

1. 1. Chronic low back pain
2. 1. Chronic low back pain
3. 2. Chronic neck pain
4. 2. Chronic neck pain
5. 3. Osteoarthritis (knee, hip, hand)
6. 3. Osteoarthritis (knee, hip, hand)
7. 4. Fibromyalgia
8. 4. Fibromyalgia
9. 5. Chronic tension headache
10. 5. Chronic tension headache

Associated Extraction Forms

Associated Studies (each link opens a new tab)

TitleAuthorsYear
The effect of pulsed electromagnetic fields in the treatment of osteoarthritis of the knee and cervical spine. Report of randomized, double blind, placebo controlled trials.
Effects of training on female trapezius Myalgia: An intervention study with a 3-year follow-up period.
Effectiveness of dynamic muscle training, relaxation training, or ordinary activity for chronic neck pain: randomised controlled trial.
Investigation of the effect of GaAs laser therapy on cervical myofascial pain syndrome.
Efficacy of 904 nm gallium arsenide low level laser therapy in the management of chronic myofascial pain in the neck: a double-blind and randomize-controlled trial.
Acupuncture versus placebo for the treatment of chronic mechanical neck pain: a randomized, controlled trial.
The effect of 300 mW, 830 nm laser on chronic neck pain: a double-blind, randomized, placebo-controlled study.
Efficacy and safety of acupuncture for chronic uncomplicated neck pain: a randomised controlled study.
Randomized controlled trial of exercise for chronic whiplash-associated disorders.
Qigong and exercise therapy in patients with long-term neck pain: a prospective randomized trial.
A randomized controlled intervention trial to relieve and prevent neck/shoulder pain.
Randomized trial of therapeutic massage for chronic neck pain
Efficacy of acupunture in patients with chronic neck pain--a randomised, sham controlled trial.
Assessment of a traditional acupuncture therapy for chronic neck pain: a pilot randomised controlled study
Effects of three different conservative treatments on pain, disability, quality of life, and mood in patients with cervical spondylosis.
A randomized controlled trial on the efficacy of intermittent cervical traction for patients with chronic neck pain.
Acupuncture with non-steroidal anti-inflammatory drugs (NSAIDs) versus acupuncture or NSAIDs alone for the treatment of chronic neck pain: an assessor-blinded randomised controlled pilot study.
Long-term efficacy of electroacupuncture for chronic neck pain: a randomised controlled trial
Effects of neck coordination exercise on sensorimotor function in chronic neck pain: a randomized controlled trial.
Basic body awareness therapy or exercise therapy for the treatment of chronic whiplash associated disorders: a randomized comparative clinical trial.
Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial.
The Effects of Tai Chi and Neck Exercises in the Treatment of Chronic Nonspecific Neck Pain: A Randomized Controlled Trial.
Comparison of the effectiveness of resistance training in women with chronic computer-related neck pain: a randomized controlled study.
Efficacy of abdominal acupuncture for neck pain: A randomized controlled trial.
A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST).
One-year followup of patients with osteoarthritis of the knee who participated in a program of supervised fitness walking and supportive patient education.
A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee.
Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial.
Physiotherapy, including quadriceps exercises and patellar taping, for knee osteoarthritis with predominant patello-femoral joint involvement: randomized controlled trial.
A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis.
Impact of an exercise and walking protocol on quality of life for elderly people with OA of the knee.
Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial.
Low power laser treatment in patients with knee osteoarthritis.
Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: a randomized clinical trial.
Pilot study of the effects of a heat-retaining knee sleeve on joint pain, stiffness, and function in patients with knee osteoarthritis.
Efficacy and safety of a musically modulated electromagnetic field (TAMMEF) in patients affected by knee osteoarthritis
Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial.
Randomized controlled trial on low level laser therapy (LLLT) in the treatment of osteoarthritis (OA) of the hand.
Effect of pulsed short-wave diathermy on pain and function of subjects with osteoarthritis of the knee: a placebo-controlled double-blind clinical trial.
Efficacy of physiotherapy management of knee joint osteoarthritis: a randomised, double blind, placebo controlled trial.
Six-week high-intensity exercise program for middle-aged patients with knee osteoarthritis: a randomized controlled trial ISRCTN20244858
The effects of an exercise program for older adults with osteoarthritis of the hip.
Treatment of knee osteoarthritis with pulsed electromagnetic fields: a randomized, double-blind, placebo-controlled study.
Acupuncture in patients with osteoarthritis of the knee: a randomised trial
Use of ultrasound to increase effectiveness of isokinetic exercise for knee osteoarthritis.
Preliminary results of integrated therapy for patients with knee osteoarthritis.
Brace treatment for osteoarthritis of the knee: a prospective randomized multi-centre trial.
Group and home-based tai chi in elderly subjects with knee osteoarthritis: a randomized controlled trial.
Laser acupuncture in knee osteoarthritis: a double-blind, randomized controlled study.
Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement.
A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis.
A blinded randomised trial of acupuncture (manual and electroacupuncture) compared with a non-penetrating sham for the symptoms of osteoarthritis of the knee.
The effect of low-level laser in knee osteoarthritis: a double-blind, randomized, placebo-controlled trial.
Effects of different stretching techniques on the outcomes of isokinetic exercise in patients with knee osteoarthritis.
Acupuncture for pain and osteoarthritis of the knee: a pilot study for an open parallel-arm randomised controlled trial
Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial.
A randomized controlled trial of acupuncture for osteoarthritis of the knee: effects of patient-provider communication.
A pragmatic randomized controlled study of the effectiveness and cost consequences of exercise therapy in hip osteoarthritis.
Localized hyperthermia induced by microwave diathermy in osteoarthritis of the knee: a randomized placebo-controlled double-blind clinical trial.
The effectiveness of pulsed electrical stimulation in the management of osteoarthritis of the knee: results of a double-blind, randomized, placebo-controlled, repeated-measures trial.
Pulsed shortwave treatment in women with knee osteoarthritis: a multicenter, randomized, placebo-controlled clinical trial.
Massage therapy for osteoarthritis of the knee: a randomized dose-finding trial.
Pain coping skills training and lifestyle behavioral weight management in patients with knee osteoarthritis: a randomized controlled study.
Efficacy of paraffin bath therapy in hand osteoarthritis: a single-blinded randomized controlled trial.
Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee: a randomized controlled trial. 1: clinical effectiveness.
No evidence for the effectiveness of a multidisciplinary group based treatment program in patients with osteoarthritis of hands on the short term; results of a randomized controlled trial.
Efficacy of therapeutic ultrasound for the management of knee osteoarthritis: a randomized, controlled, and double-blind study.
Efficacy of low-level laser therapy applied at acupuncture points in knee osteoarthritis: a randomised double-blind comparative trial.
Efficacy of exercise intervention as determined by the McKenzie System of Mechanical Diagnosis and Therapy for knee osteoarthritis: a randomized controlled trial.
The efficacy of shock wave therapy in patients with knee osteoarthritis and popliteal cyamella.
Limited effects of exercises in people with hand osteoarthritis: results from a randomized controlled trial.
Acupuncture for chronic knee pain: a randomized clinical trial.
Effectiveness of a cognitive-behavioural group intervention for knee osteoarthritis pain: a randomized controlled trial.
Intensive Gait Training for Older Adults with Symptomatic Knee Osteoarthritis.
Effectiveness of exercise therapy added to general practitioner care in patients with hip osteoarthritis: a pragmatic randomized controlled trial.
Physical Therapist-Delivered Pain Coping Skills Training and Exercise for Knee Osteoarthritis: Randomized Controlled Trial.
The effectiveness of ultrasound treatment for the management of knee osteoarthritis: a randomized, placebo-controlled, double-blind study.
Effects of aerobic exercise versus stress management treatment in fibromyalgia. A 4.5 year prospective study.
Biofeedback/relaxation training and exercise interventions for fibromyalgia: a prospective trial.
Static magnetic fields for treatment of fibromyalgia: a randomized controlled trial.
Glucosamine and chondroitin sulfate for the treatment of osteoarthritis: comment on the article by Akama and Saito.
A randomized clinical trial comparing fitness and biofeedback training versus basic treatment in patients with fibromyalgia.
Improving physical functional status in patients with fibromyalgia: a brief cognitive behavioral intervention.
The effects of exercise and education, individually or combined, in women with fibromyalgia.
Fibromyalgia: a randomised, controlled trial of a treatment programme based on self management.
Long-term efficacy of therapy in patients with fibromyalgia: a physical exercise-based program and a cognitive-behavioral approach.
A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia.
A randomized clinical trial of an individualized home-based exercise programme for women with fibromyalgia.
Exercise in waist-high warm water decreases pain and improves health-related quality of life and strength in the lower extremities in women with fibromyalgia.
Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial.
Psychological pain treatment in fibromyalgia syndrome: efficacy of operant behavioural and cognitive behavioural treatments.
Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: results of a randomized clinical trial.
Eight months of physical training in warm water improves physical and mental health in women with fibromyalgia: a randomized controlled trial.
Pool exercise for patients with fibromyalgia or chronic widespread pain: a randomized controlled trial and subgroup analyses.
Effect of pilates training on people with fibromyalgia syndrome: a pilot study.
Cognitive-behavioral therapy attenuates nociceptive responding in patients with fibromyalgia: a pilot study.
Effects of lifestyle physical activity on perceived symptoms and physical function in adults with fibromyalgia: results of a randomized trial.
Neurofeedback intervention in fibromyalgia syndrome; a randomized, controlled, rater blind clinical trial.
A randomized trial of tai chi for fibromyalgia.
Aerobic exercise versus combined exercise therapy in women with fibromyalgia syndrome: a randomized controlled trial.
Treating fibromyalgia with mindfulness-based stress reduction: results from a 3-armed randomized controlled trial.
Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia
Effectiveness of physical activity in reducing pain in patients with fibromyalgia: a blinded randomized clinical trial.
Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: a randomized controlled trial.
Effectiveness of cognitive behaviour therapy for the treatment of catastrophisation in patients with fibromyalgia: a randomised controlled trial.
Multicomponent cognitive-behavioral group therapy with hypnosis for the treatment of fibromyalgia: long-term outcome.
Effects of exercise training and detraining in patients with fibromyalgia syndrome: a 3-yr longitudinal study.
Cognitive Behavioral Therapy increases pain-evoked activation of the prefrontal cortex in patients with fibromyalgia.
A randomized controlled trial of qigong for fibromyalgia.
Efficacy of a multidisciplinary fibromyalgia treatment adapted for women with low educational levels: a randomized controlled trial.
Effectiveness of dance in patients with fibromyalgia: a randomized, single-blind, controlled study
Six-and 12-month follow-up of an interdisciplinary fibromyalgia treatment programme: results of a randomised trial
Guided imagery in people with fibromyalgia: a randomized controlled trial of effects on pain, functional status and self-efficacy.
Medium-/long-term effects of a specific exercise protocol combined with patient education on spine mobility, chronic fatigue, pain, aerobic fitness and level of disability in fibromyalgia
Interdisciplinary rehabilitation of patients with chronic widespread pain: primary endpoint of the randomized, nonblinded, parallel-group IMPROvE trial.
Effect of a fibromyalgia rehabilitation programme in warm versus cold climate: a randomized controlled study.
MMPI-2 profiles and illness perception in fibromyalgia syndrome: The role of therapeutic exercise as adapted physical activity.
Vagal modulation and symptomatology following a 6-month aerobic exercise program for women with fibromyalgia
Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia--a randomized controlled trial
Acupuncture for fibromyalgia in primary care: a randomised controlled trial.
The effects of long- and short-term interdisciplinary treatment approaches in women with fibromyalgia: a randomized controlled trial.
Efficacy of extremely low-frequency magnetic field in fibromyalgia pain: A pilot study.
Resonance Fluorescence of an InGaAs Quantum Dot in a Planar Cavity Using Orthogonal Excitation and Detection2017
Traditional Chinese acupuncture in tension-type headache: a controlled study.
A comparison of pharmacological (amitriptyline HCL) and nonpharmacological (cognitive-behavioral) therapies for chronic tension headaches.
Placebo-controlled evaluation of abbreviated progressive muscle relaxation and of relaxation combined with cognitive therapy in the treatment of tension headache.
Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial
Pressure pain threshold and needle acupuncture in chronic tension-type headache--a double-blind placebo-controlled study.
Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial.
The effects of laser acupuncture on chronic tension headache--a randomised controlled trial.
Effectiveness of manual therapy for chronic tension-type headache: a pragmatic, randomised, clinical trial.
The influence of ictal cutaneous allodynia on the response to occipital transcutaneous electrical stimulation in chronic migraine and chronic tension-type headache: a randomized, sham-controlled study.
Controlled trial of Japanese acupuncture for chronic myofascial neck pain: assessment of specific and nonspecific effects of treatment.
Spouse-assisted training in pain coping skills and the outcome of multidisciplinary pain management for chronic low back pain treatment: a 1-year randomized controlled trial
Effectiveness of myofascial release in the management of chronic low back pain in nursing professionals
Effectiveness of mindfulness meditation on pain and quality of life of patients with chronic low back pain
Laser therapy: a randomized, controlled trial of the effects of low-intensity Nd:YAG laser irradiation on musculoskeletal back pain
A prospective, randomized 5-year follow-up study of functional restoration in chronic low back pain patients
Comparison of three intensive programs for chronic low back pain patients: a prospective, randomized, observer-blinded study with one-year follow-up
Active treatment programs for patients with chronic low back pain: a prospective, randomized, observer-blinded study
Multidisciplinary intensive treatment for chronic low back pain: a randomized, prospective study
Functional restoration versus outpatient physical training in chronic low back pain: a randomized comparative study
Efficacy of traction for nonspecific low back pain. 12-week and 6-month results of a randomized clinical trial
Qigong versus exercise therapy for chronic low back pain in adults--a randomized controlled non-inferiority trial
Acupuncture in patients with chronic low back pain: a randomized controlled trial
Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial
Acupuncture for chronic low back pain: a randomized placebo-controlled study with long-term follow-up
Two-Year Follow-up of a Randomized Clinical Trial of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care for Chronic Low Back Pain
Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain
A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain
Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial.
A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial
Acupuncture for chronic low back pain: a multicenter, randomized, patient-assessor blind, sham-controlled clinical trial
Motor control exercise for chronic low back pain: a randomized placebo-controlled trial
In chronic low back pain, low level laser therapy combined with exercise is more beneficial than exercise alone in the long term: a randomised trial
The effect of continuous ultrasound on chronic non-specific low back pain: a single blind placebo-controlled randomized trial
Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: A randomized trial
Controlled comparison of short-wave diathermy treatment with osteopathic treatment in non-specific low back pain
A randomized controlled trial investigating the efficiency of musculoskeletal physiotherapy on chronic low back disorder
Yoga for Military Veterans with Chronic Low Back Pain: A Randomized Clinical Trial
A randomized clinical trial and subgroup analysis to compare flexion-distraction with active exercise for chronic low back pain
German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups
Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial
A controlled study on the outcome of inpatient and outpatient treatment of low back pain. Part I. Pain, disability, compliance, and reported treatment benefits three months after treatment
Cost-effectiveness of Mindfulness-based Stress Reduction Versus Cognitive Behavioral Therapy or Usual Care Among Adults With Chronic Low Back Pain
A randomized controlled trial comparing 2 types of spinal manipulation and minimal conservative medical care for adults 55 years and older with subacute or chronic low back pain
Active exercise, education, and cognitive behavioral therapy for persistent disabling low back pain: a randomized controlled trial
Effects of functional restoration versus 3 hours per week physical therapy: a randomized controlled study
The efficacy of active rehabilitation in chronic low back pain. Effect on pain intensity, self-experienced disability, and lumbar fatigability
Acupuncture in the management of chronic low back pain: a blinded randomized controlled trial
Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis
Group cognitive behavioural interventions for low back pain in primary care: extended follow-up of the Back Skills Training Trial (ISRCTN54717854)
Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life
Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial
Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain
Efficacy of the addition of modified Pilates exercises to a minimal intervention in patients with chronic low back pain: a randomized controlled trial
A multidisciplinary rehabilitation programme improves disability, kinesiophobia and walking ability in subjects with chronic low back pain: results of a randomised controlled pilot study
Effect of a long-lasting multidisciplinary program on disability and fear-avoidance behaviors in patients with chronic low back pain: results of a randomized controlled trial
A Mind-Body Program for Older Adults With Chronic Low Back Pain: A Randomized Clinical Trial
A mind-body program for older adults with chronic low back pain: results of a pilot study
Changes in pain intensity and health related quality of life with Iyengar yoga in nonspecific chronic low back pain: A randomized controlled study
Evaluation of a randomized controlled trial in the management of chronic lower back pain in a French automotive industry: an observational study
Pilates improves pain, function and quality of life in patients with chronic low back pain: a randomized controlled trial
Operant-behavioural and cognitive-behavioural treatment for chronic low back pain
Comparison of cognitive-behavioral group treatment and an alternative non-psychological treatment for chronic low back pain
A randomised controlled study of reflexology for the management of chronic low back pain
Reflexology in the management of low back pain: a pilot randomised controlled trial
Comparison of a functional restoration program with active individual physical therapy for patients with chronic low back pain: a randomized controlled trial
Multidisciplinary intensive functional restoration versus outpatient active physiotherapy in chronic low back pain: a randomized controlled trial
Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial
No effect of traction in patients with low back pain: a single centre, single blind, randomized controlled trial of Intervertebral Differential Dynamics Therapy
Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?
Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial
A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain
The impact of physical function and pain on work status at 1-year follow-up in patients with back pain
A randomized study of back school in women with chronic low back pain: quality of life at three, six, and twelve months follow-up
Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain
Yoga for chronic low back pain: a randomized trial
Effectiveness of behavioral therapy for chronic low back pain: a component analysis
United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care
Intensive group training protocol versus guideline physiotherapy for patients with chronic low back pain: a randomised controlled trial
A trial of an activating intervention for chronic back pain in primary care and physical therapy settings
Evaluation of the effectiveness and efficacy of Iyengar yoga therapy on chronic low back pain
Effect of Iyengar yoga therapy for chronic low back pain
Mindfulness Meditation and Cognitive Behavioral Therapy Intervention Reduces Pain Severity and Sensitivity in Opioid-Treated Chronic Low Back Pain: Pilot Findings from a Randomized Controlled Trial

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