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Reprioritization of Certain Chronic Pain Conditions

March 2019

scale, P=0.329), compared with sham in one fair-quality trial (SOE: low). Short-
term function was not reported.
1. Note: MCID for FIQ is a 14% change
ii. There was insufficient evidence to determine the effects of myofascial release
therapy on short-term pain (1 poor-quality trial) and intermediate-term pain (1
fair-quality and 1 poor-quality trial) compared with sham; there were
inconsistencies in effect estimates between the intermediate-term trials (SOE:
insufficient).
iii. Data were insufficient for harms

HERC staff summary of evidence for non-pharmacologic interventions


1) Tai chi: small but clinically significant benefit in pain and function in the short term but not
intermediate or long term (SOE: low)
2) Yoga: inconsistent evidence (SOE: low)
3) Exercise: short term non-clinically significant improvement in pain and function (SOE: low to
moderate); intermediate term non-clinically significant improvement in function (SOE: moderate);
no long term impact on pain (SOE: moderate)
4) Acupuncture: small, short to intermediate term, non-clinically significant improvement in function
(SOE: moderate); no improvement in pain (SOE: low)
5) Interdisciplinary rehabilitation: clinically meaningful improvement in function in the short,
intermediate, and long term based on one poor quality study (SOE: low). No clinically meaningful
impact on pain (SOE: low)
6) Mindfulness: no clear improvement in function or pain (SOE: moderate)
7) Massage/PT with myofascial release: small, non-clinically significant impact on short term
function (SOE: low); insufficient evidence of impact on pain
8) Cognitive behavioral therapy: small, non-clinically significant effects on pain, function and mood
immediately post-treatment that is not sustained in the intermediate or long term (SOE: low)
9) Pain education: no improvement in pain or disability (SOE: low)

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Reprioritization of Certain Chronic Pain Conditions
March 2019

Summary of evidence for non-pharmacological treatments for fibromyalgia from AHRQ review article
(2018) compared with usual care, placebo, sham, attention control, or waitlist:

Function Function Function Pain Pain Pain


Short-Term Intermediate Long-Term Short-Term Intermediate- Long-Term
- Term Term

Effect Size Effect Effect Size Effect Size Effect Size Effect Size
SOE Size SOE SOE SOE SOE SOE
slight slight none slight none none
Exercise
+ ++ + ++ ++ ++
Psychological slight slight insufficient slight none insufficient
Therapies: CBT + + evidence + + evidence
Psychological
Therapies: insufficient insufficient insufficient insufficient insufficient insufficient
Biofeedback, evidence evidence evidence evidence evidence evidence
Imagery
Physical
insufficient none insufficient none
Modalities: no evidence no evidence
evidence + evidence +
Magnetic Pads
Manual Therapies:
Massage slight insufficient insufficient slight
no evidence none
(Myofascial + evidence evidence +
+
Release)
Mindfulness none none
no evidence no evidence no evidence no evidence
Practices: MBSR ++ ++
Mind-Body moderate
slight
Practices: Qigong, no evidence no evidence no evidence no evidence
+ +
Tai Chi

Acupuncture slight slight none none


no evidence no evidence
++ ++ + +
Multidisciplinary
slight slight slight none slight none
Rehabilitation + +
+ + + +

Short-Term: 1 to <6 months; Intermediate-Term: ≥6 to <12 months; Long-Term: ≥12 months


Effect Size: none, slight/small, moderate, or large improvement
Strength of Evidence: + = low, ++ = moderate, +++ = high
CBT = cognitive-behavioral therapy; MBSR = mindfulness-based stress reduction; none = no effect/no
statistically significant effect; SOE = strength of evidence

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Reprioritization of Certain Chronic Pain Conditions
March 2019

Summary of Evidence for Non-Pharmacologic Therapies for Back and Neck Pain
Treatment Strength of Evidence Magnitude of Benefit

Spinal manipulation Good Small to moderate short


term benefit
Yoga (viniyoga) Fair Moderate benefit
Acupuncture Fair Moderate benefit
Cognitive behavioral therapy Good Moderate benefit
Exercise therapy Good Moderate benefit
Intensive interdisciplinary rehabilitation Good Moderate benefit
Massage therapy Fair Moderate benefit
Progressive relaxation Fair Moderate benefit
Note: This evidence table was previously reviewed by the HERC when considering coverage for back
pain. The back pain interventions summarized above are abstracted from Chou 2007 and may not be
directly comparable to the same treatment summarized by HERC staff above for chronic pain conditions

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