Non-surgical chronic pain treatment outcome: a review

Abstract

Meta-analyses (MAs) of non-surgical chronic pain treatment studies were systematically reviewed to determine effectiveness. Twenty-four MAs were found relating to non-surgical, non-malignant, non-headache chronic pain treatment. Two natural groupings, pain facility treatment and specific pain treatments, were created. In addition, a number of the MAs examined the same treatments including pain facility treatments, manipulation, capsaicin, acupuncture, antidepressants, back school, physical therapy, and cognitive behavior treatments. MAs addressing the same treatments were reviewed for replicate variability or reliability of results, thereby allowing some conclusions about the consistency of this type of data. The following treatments were consistently effective demonstrating replicate non-variability or reliability: pain facility treatment, capsaicin, anti-depressants, physical therapy, topical NSAIDs, and cognitive behavioral treatments. Only one MA demonstrated the effectiveness of anticonvulsants and psychoeducational. Potential problems with the reviewed MAs and cost effectiveness of treatment are discussed. Finally, potential future initiatives in this area of research are presented. Although pain facility treatment and a number of specific pain treatments are consistently demonstrated to be effective, at the present time, it is impossible to isolate a set of 'effective treatments' within the pain facility treatment package.