Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. Comparative Effectiveness Review No. 227. [Entered Retrospectively]

Project Summary Title and Description

Title
Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. Comparative Effectiveness Review No. 227. [Entered Retrospectively]
Description
Structured Abstract Objectives. We updated the evidence from our 2018 report assessing persistent improvement in outcomes following completion of therapy for noninvasive nonpharmacological treatment for selected chronic pain conditions. Data sources. Electronic databases (Ovid MEDLINE®, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews), through November 2017 (for priorAHRQreport) and from September 2017 through September 2019 (for this update report), reference lists, ClinicalTrials.gov, and our previous report. Review methods. Using predefined criteria, we selected randomized controlled trials (RCTs) 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 reported results for a at least 1 month postintervention. We analyzed effects and assessed strength of evidence (SOE) at short term (1 to <6 months following treatment completion), intermediate term (≥6 to <12 months), and long term (≥12 months).Results. We included 233 RCTs (31 new to this update). Many were small (N<70), and evidence beyond 12 months after treatment completion was sparse. The most common comparison was with usual care. Evidence on harms was limited, with no evidence suggesting increased risk for serious treatment-related harms for any intervention. Effect sizes were generally small for function and pain. Chronic low back pain: Psychological therapies were associated with small improvements compared with usual care or an attention control for both function and pain at short-term, intermediate-term, and long-term followup (SOE: moderate). Function improved over short and/or intermediate term for exercise, low-level laser therapy, spinal manipulation, massage, yoga, acupuncture, and multidisciplinary rehabilitation (SOE moderate at short term for exercise, massage, and yoga; low for all others). Improvements in pain at short term were seen for massage, mindfulness-based stress reduction, acupuncture,and multidisciplinary rehabilitation (SOE: moderate), and exercise, low-level laser therapy, and yoga (SOE: low). At intermediate term, spinal manipulation, yoga, multidisciplinary rehabilitation (SOE: moderate) and exercise and mindfulness-based stress reduction (SOE: low) were associated with improved pain. Compared with exercise, multidisciplinary rehabilitation improved both function and pain at short and intermediate terms (small effects, SOE: moderate.) Chronic neck pain: In the short-term, low-level laser therapy (SOE: moderate) and massage (SOE: low) improved function and pain. Exercise in general improved function long term, and combination exercise improved function and pain both short and long term compared with usual care (SOE: low). Acupuncture improved function short and intermediate term, but there was no pain improvement compared with sham acupuncture (SOE: low). Compared with acetaminophen, Pilates improved both function and pain (SOE: low). Osteoarthritis pain: Exercise resulted in small improvements in function and pain at short-term(SOE: moderate) and long-term, and moderate improvement at intermediate-term (SOE: low) followup for knee osteoarthritis versus nonactive comparators. Small improvements in function and pain with exercise were seen for hip osteoarthritis short term (SOE: low). Functional improvement persisted into intermediate term, but pain improvement did not (SOE: low). Fibromyalgia: Functional improvements were seen with exercise, mind-body practices, multidisciplinary rehabilitation (SOE: low) and acupuncture (SOE: moderate) short term compared with usual care, attention control, or sham treatment. At intermediate term, there was functional improvement with exercise and acupuncture (SOE: moderate), cognitive-behavioral therapy (CBT), mindfulness-basdedstress reduction, myofascial release,and multidisciplinary rehabilitation (SOE: low). LLong term, functional improvements persisted for multidisciplinary rehabilitation without improvement in pain (SOE: low). Compared with exercise, tai chiconferred improvement in function short and intermediate term (SOE: low). Pain was improved with exercise (short and intermediate term, SOE moderate), and for CBT (shortterm),mindfulness practices,and multidisciplinary rehabilitation (MDR) (intermediate term)(SOE lowfor these three). Chronic tension headache: Evidence was sparse and the majority of trials were of poor quality. Spinal manipulation resulted in moderate improvement in pain short term. Conclusions. Trials identified subsequent to the earlier report largely support previous findings, —namely that exercise, multidisciplinary rehabilitation, acupuncture, CBT, mindfulness practices, massage,and mind-body practices most consistently improve function and/or pain beyond the course of therapy for specific chronic pain conditions. Additional research, including comparisons with pharmacological and other active controls, on 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. DOI: https://doi.org/10.23970/AHRQEPCCER227.
Funding Source
Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2015-00009-I. AHRQ Publication No. 20-EHC009-EF. Rockville, MD: Agency for Healthcare Research and Quality

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
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Randomized controlled trial of exercise for chronic whiplash-associated disorders.2007
Qigong and exercise therapy in patients with long-term neck pain: a prospective randomized trial.2007
A randomized controlled intervention trial to relieve and prevent neck/shoulder pain.2008
Randomized trial of therapeutic massage for chronic neck pain2009
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Basic body awareness therapy or exercise therapy for the treatment of chronic whiplash associated disorders: a randomized comparative clinical trial.2016
Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial.2015
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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).1997
One-year followup of patients with osteoarthritis of the knee who participated in a program of supervised fitness walking and supportive patient education.1998
A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee.1999
Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial.2002
Physiotherapy, including quadriceps exercises and patellar taping, for knee osteoarthritis with predominant patello-femoral joint involvement: randomized controlled trial.2003
A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis.2003
Impact of an exercise and walking protocol on quality of life for elderly people with OA of the knee.2003
Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial.2004
Low power laser treatment in patients with knee osteoarthritis.2004
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.2004
Efficacy and safety of a musically modulated electromagnetic field (TAMMEF) in patients affected by knee osteoarthritis2004
Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial.2004
Randomized controlled trial on low level laser therapy (LLLT) in the treatment of osteoarthritis (OA) of the hand.2005
Effect of pulsed short-wave diathermy on pain and function of subjects with osteoarthritis of the knee: a placebo-controlled double-blind clinical trial.2005
Efficacy of physiotherapy management of knee joint osteoarthritis: a randomised, double blind, placebo controlled trial.2005
Six-week high-intensity exercise program for middle-aged patients with knee osteoarthritis: a randomized controlled trial ISRCTN202448582005
The effects of an exercise program for older adults with osteoarthritis of the hip.2005
Treatment of knee osteoarthritis with pulsed electromagnetic fields: a randomized, double-blind, placebo-controlled study.2005
Acupuncture in patients with osteoarthritis of the knee: a randomised trial2005
Use of ultrasound to increase effectiveness of isokinetic exercise for knee osteoarthritis.2005
Preliminary results of integrated therapy for patients with knee osteoarthritis.2005
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Group and home-based tai chi in elderly subjects with knee osteoarthritis: a randomized controlled trial.2007
Laser acupuncture in knee osteoarthritis: a double-blind, randomized controlled study.2007
Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement.2007
A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis.2008
A blinded randomised trial of acupuncture (manual and electroacupuncture) compared with a non-penetrating sham for the symptoms of osteoarthritis of the knee.2008
The effect of low-level laser in knee osteoarthritis: a double-blind, randomized, placebo-controlled trial.2009
Effects of different stretching techniques on the outcomes of isokinetic exercise in patients with knee osteoarthritis.2009
Acupuncture for pain and osteoarthritis of the knee: a pilot study for an open parallel-arm randomised controlled trial2009
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A pragmatic randomized controlled study of the effectiveness and cost consequences of exercise therapy in hip osteoarthritis.2011
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Massage therapy for osteoarthritis of the knee: a randomized dose-finding trial.2012
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Efficacy of exercise intervention as determined by the McKenzie System of Mechanical Diagnosis and Therapy for knee osteoarthritis: a randomized controlled trial.2014
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Limited effects of exercises in people with hand osteoarthritis: results from a randomized controlled trial.2014
Acupuncture for chronic knee pain: a randomized clinical trial.2014
Effectiveness of a cognitive-behavioural group intervention for knee osteoarthritis pain: a randomized controlled trial.2015
Intensive Gait Training for Older Adults with Symptomatic Knee Osteoarthritis.2015
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Physical Therapist-Delivered Pain Coping Skills Training and Exercise for Knee Osteoarthritis: Randomized Controlled Trial.2016
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Fibromyalgia: a randomised, controlled trial of a treatment programme based on self management.2004
Long-term efficacy of therapy in patients with fibromyalgia: a physical exercise-based program and a cognitive-behavioral approach.2004
A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia.2005
A randomized clinical trial of an individualized home-based exercise programme for women with fibromyalgia.2005
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.2006
Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial.2006
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Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: results of a randomized clinical trial.2007
Eight months of physical training in warm water improves physical and mental health in women with fibromyalgia: a randomized controlled trial.2008
Pool exercise for patients with fibromyalgia or chronic widespread pain: a randomized controlled trial and subgroup analyses.2009
Effect of pilates training on people with fibromyalgia syndrome: a pilot study.2009
Cognitive-behavioral therapy attenuates nociceptive responding in patients with fibromyalgia: a pilot study.2010
Effects of lifestyle physical activity on perceived symptoms and physical function in adults with fibromyalgia: results of a randomized trial.2010
Neurofeedback intervention in fibromyalgia syndrome; a randomized, controlled, rater blind clinical trial.2010
A randomized trial of tai chi for fibromyalgia.2010
Aerobic exercise versus combined exercise therapy in women with fibromyalgia syndrome: a randomized controlled trial.2010
Treating fibromyalgia with mindfulness-based stress reduction: results from a 3-armed randomized controlled trial.2011
Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia2011
Effectiveness of physical activity in reducing pain in patients with fibromyalgia: a blinded randomized clinical trial.2012
Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: a randomized controlled trial.2011
Effectiveness of cognitive behaviour therapy for the treatment of catastrophisation in patients with fibromyalgia: a randomised controlled trial.2011
Multicomponent cognitive-behavioral group therapy with hypnosis for the treatment of fibromyalgia: long-term outcome.2012
Effects of exercise training and detraining in patients with fibromyalgia syndrome: a 3-yr longitudinal study.2012
Cognitive Behavioral Therapy increases pain-evoked activation of the prefrontal cortex in patients with fibromyalgia.2012
A randomized controlled trial of qigong for fibromyalgia.2012
Efficacy of a multidisciplinary fibromyalgia treatment adapted for women with low educational levels: a randomized controlled trial.2013
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 trial2012
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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 fibromyalgia2014
Interdisciplinary rehabilitation of patients with chronic widespread pain: primary endpoint of the randomized, nonblinded, parallel-group IMPROvE trial.2014
Effect of a fibromyalgia rehabilitation programme in warm versus cold climate: a randomized controlled study.2014
MMPI-2 profiles and illness perception in fibromyalgia syndrome: The role of therapeutic exercise as adapted physical activity.2015
Vagal modulation and symptomatology following a 6-month aerobic exercise program for women with fibromyalgia2015
Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia--a randomized controlled trial2015
Acupuncture for fibromyalgia in primary care: a randomised controlled trial.2016
The effects of long- and short-term interdisciplinary treatment approaches in women with fibromyalgia: a randomized controlled trial.2016
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2004
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Placebo-controlled evaluation of abbreviated progressive muscle relaxation and of relaxation combined with cognitive therapy in the treatment of tension headache.1990
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Pressure pain threshold and needle acupuncture in chronic tension-type headache--a double-blind placebo-controlled study.2000
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.2005
Effectiveness of manual therapy for chronic tension-type headache: a pragmatic, randomised, clinical trial.2011
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.2015
Controlled trial of Japanese acupuncture for chronic myofascial neck pain: assessment of specific and nonspecific effects of treatment.1998
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 trial2012
Effectiveness of myofascial release in the management of chronic low back pain in nursing professionals2014
Effectiveness of mindfulness meditation on pain and quality of life of patients with chronic low back pain2015
Laser therapy: a randomized, controlled trial of the effects of low-intensity Nd:YAG laser irradiation on musculoskeletal back pain1999
A prospective, randomized 5-year follow-up study of functional restoration in chronic low back pain patients1998
Comparison of three intensive programs for chronic low back pain patients: a prospective, randomized, observer-blinded study with one-year follow-up1997
Active treatment programs for patients with chronic low back pain: a prospective, randomized, observer-blinded study1995
Multidisciplinary intensive treatment for chronic low back pain: a randomized, prospective study1996
Functional restoration versus outpatient physical training in chronic low back pain: a randomized comparative study2000
Efficacy of traction for nonspecific low back pain. 12-week and 6-month results of a randomized clinical trial1997
Qigong versus exercise therapy for chronic low back pain in adults--a randomized controlled non-inferiority trial2015
Acupuncture in patients with chronic low back pain: a randomized controlled trial2006
Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial2011
Acupuncture for chronic low back pain: a randomized placebo-controlled study with long-term follow-up2001
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 Pain2017
Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain2001
A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain2009
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.2016
A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial2011
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 trial2009
In chronic low back pain, low level laser therapy combined with exercise is more beneficial than exercise alone in the long term: a randomised trial2007
The effect of continuous ultrasound on chronic non-specific low back pain: a single blind placebo-controlled randomized trial2012
Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: A randomized trial2007
Controlled comparison of short-wave diathermy treatment with osteopathic treatment in non-specific low back pain1985
A randomized controlled trial investigating the efficiency of musculoskeletal physiotherapy on chronic low back disorder2006
Yoga for Military Veterans with Chronic Low Back Pain: A Randomized Clinical Trial2017
A randomized clinical trial and subgroup analysis to compare flexion-distraction with active exercise for chronic low back pain2006
German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups2007
Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial2014
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Cost-effectiveness of Mindfulness-based Stress Reduction Versus Cognitive Behavioral Therapy or Usual Care Among Adults With Chronic Low Back Pain2017
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 pain2009
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Acupuncture in the management of chronic low back pain: a blinded randomized controlled trial2003
Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis2010
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Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial2013
Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain2008
Efficacy of the addition of modified Pilates exercises to a minimal intervention in patients with chronic low back pain: a randomized controlled trial2013
A multidisciplinary rehabilitation programme improves disability, kinesiophobia and walking ability in subjects with chronic low back pain: results of a randomised controlled pilot study2014
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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 study2009
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Pilates improves pain, function and quality of life in patients with chronic low back pain: a randomized controlled trial2015
Operant-behavioural and cognitive-behavioural treatment for chronic low back pain1991
Comparison of cognitive-behavioral group treatment and an alternative non-psychological treatment for chronic low back pain1992
A randomised controlled study of reflexology for the management of chronic low back pain2007
Reflexology in the management of low back pain: a pilot randomised controlled trial2008
Comparison of a functional restoration program with active individual physical therapy for patients with chronic low back pain: a randomized controlled trial2007
Multidisciplinary intensive functional restoration versus outpatient active physiotherapy in chronic low back pain: a randomized controlled trial2011
Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial2017
No effect of traction in patients with low back pain: a single centre, single blind, randomized controlled trial of Intervertebral Differential Dynamics Therapy2009
Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?2011
Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial2005
A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain2011
The impact of physical function and pain on work status at 1-year follow-up in patients with back pain2001
A randomized study of back school in women with chronic low back pain: quality of life at three, six, and twelve months follow-up2008
Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain2006
Yoga for chronic low back pain: a randomized trial2011
Effectiveness of behavioral therapy for chronic low back pain: a component analysis1990
United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care2004
Intensive group training protocol versus guideline physiotherapy for patients with chronic low back pain: a randomised controlled trial2008
A trial of an activating intervention for chronic back pain in primary care and physical therapy settings2005
Evaluation of the effectiveness and efficacy of Iyengar yoga therapy on chronic low back pain2009
Effect of Iyengar yoga therapy for chronic low back pain2005
Mindfulness meditation alleviates fibromyalgia symptoms in women: results of a randomized clinical trial.2015
Body mass index and response to a multidisciplinary treatment of fibromyalgia.2015
Cognitive behavioral therapy for the treatment of fibromyalgia syndrome: a randomized controlled trial2008
Effect of a randomized, controlled trial of exercise on mood and physical function in individuals with fibromyalgia.2001
Effect of integrated care for sick listed patients with chronic low back pain: economic evaluation alongside a randomised controlled trial.2010
Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis.2001
Exercise and depressive symptoms: a comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology.2002
Obese, older adults with knee osteoarthritis: weight loss, exercise, and quality of life.2002
Functional status, physical activity level, and exercise regularity in patients with fibromyalgia after Multidisciplinary treatment: retrospective analysis of a randomized controlled trial.2017
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A randomized controlled trial on the long-term effects of proprioceptive neuromuscular facilitation training, on pain-related outcomes and back muscle activity, in patients with chronic low back pain.2017
The effect of acupressure on fatigue among female nurses with chronic back pain.2017
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The effects of selective Pilates versus extension-based exercises on rehabilitation of low back pain.2018
An economic evaluation of Alexander Technique lessons or acupuncture sessions for patients with chronic neck pain: A randomized trial (ATLAS).2017
Effectiveness and Cost-Effectiveness of Tuina for Chronic Neck Pain: A Randomized Controlled Trial Comparing Tuina with a No-Intervention Waiting List.2018
Effectiveness of the Pilates Method in the Treatment of Chronic Mechanical Neck Pain: A Randomized Controlled Trial.2018
The effect of instruction in analgesic use compared with neuromuscular exercise on knee-joint load in patients with knee osteoarthritis: a randomized, single-blind, controlled trial.2017
Efficacy of Tailored Exercise Therapy on Physical Functioning in Patients With Knee Osteoarthritis and Comorbidity: A Randomized Controlled Trial.2017
Physical therapy vs internet-based exercise training for patients with knee osteoarthritis: results of a randomized controlled trial.2018
The Effect of Therapeutic Ultrasound on Pain and Physical Function in Patients with Knee Osteoarthritis.2017
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Efficacy of focused low-intensity pulsed ultrasound therapy for the management of knee osteoarthritis: a randomized, double blind, placebo-controlled trial.2016
One year effectiveness of neuromuscular exercise compared with instruction in analgesic use on knee function in patients with early knee osteoarthritis: the EXERPHARMA randomized trial.2018
A randomized trial of a motivational interviewing intervention to increase lifestyle physical activity and improve self-reported function in adults with arthritis.2018
Benefits of 24-Week Exergame Intervention on Health-Related Quality of Life and Pain in Women with Fibromyalgia: A Single-Blind, Randomized Controlled Trial.2019
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Electromyogram Biofeedback in Patients with Fibromyalgia: A Randomized Controlled Trial.-- Not Found --
Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial.2017
Meditation awareness training for the treatment of fibromyalgia syndrome: A randomized controlled trial.2017
Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial.2018
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Cognitive behaviour therapy in women with fibromyalgia: A randomized clinical trial.2015
Effects of Acupuncture Treatment on Fibromyalgia Symptoms, Serotonin, and Substance P Levels: A Randomized Sham and Placebo-Controlled Clinical Trial.2018
Efficacy of Combined Cognitive-Behavioral Therapy for Insomnia and Pain in Patients with Fibromyalgia: a Randomized Controlled Trial2017

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