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Which is the best treatment for pain relief?

women biking, doing exercise

An Overview of Exercise and Other Treatment Approaches for Musculoskeletal Pain.

When dealing with a problem like low back, shoulder, knee, or neck pain, there are many options for treatment. While there is a lot of research on treatments for these types of pain, there are a lot of different opinions about what is the best treatment for pain relief. Even well-educated experts often disagree on the best approaches to solutions for musculoskeletal pain in multiple regions. Recently, an article was published in the online PLOS ONE journal with an aim to summarize current best evidence on treatment options for the five most common types of musculoskeletal pain presentations (back, neck, shoulder, knee, and multi-site pain) (Babatunde, 2017). Here, we will discuss some important takeaway points from this important study and how it might (or should) influence our approaches to musculoskeletal pain.

Exercise and Psychosocial Interventions Appear to Have the Best Results

Using metrics to measure the quality of the evidence available and the effect sizes measured from the interventions, exercise treatment appears to be the leader among the interventions studied. Psychosocial interventions were not far behind. Exercise helps, most people would acknowledge that they knew this before this study came out. The important finding of this study is the superiority that exercise demonstrates over other types of treatments. While exercise is commonly included in treatment for different types of pain, psychosocial intervention is not often included. This does not mean that other treatments, especially when matched to the proper patient, are not effective or not necessary. This means that, in general, exercise and psychosocial interventions (especially because of their safety and low cost) should be included in most plans to treat musculoskeletal pain.
hierarchy of evidence for pain treatments

What Does this Article Say About Regenerative Medicine?

The authors of this study examined the strength of evidence for pharmacological injections. These studies were mostly focused on corticosteroids. There was no mention in this article about regenerative medicine (such as Platelet Rich Plasma). One reason for this, I suspect, is that regenerative medicine research is so new that there is very limited synthesized data, which is where this overview had focused its attention.  A smart friend in the fitness industry once told me, “Most Olympic and professional athletes are training about 5-6 years ahead of the research.” Being on the cutting edge of research means finding smaller studies like some of those demonstrating the benefits of regenerative medicine treatment and working to be part of a growing movement to provide the best possible care options for musculoskeletal pain. In five years, there should be a body of evidence on regenerative medicine treatments large enough to be included in an overview like this.

How Does a Combination of Treatments Work?

This study does not address this questions specifically, however, they do state that much of the research is performed with a combination of treatment modalities. While many studies on non-pharmacological treatments use education, or “usual care” to compare their studied treatment against, they often apply the part of those treatments to both (or more) groups. There is a brief mention in this article that combined treatments appear to work better than treatments in isolation. They do, however, recommend that far more research is needed to understand what combinations work for which patients.

What Does this Article Recommend For Future Research Directions?

This article illustrates the exciting moment where we are at right now in research on pain treatments. There is a large volume of research on many (but not all) possible treatments for pain. While we know that some treatments help, there are two big recommendations from the authors of this study. The first recommendation is that our research in areas like exercise on psychosocial interventions for pain become more focused on the method of delivery for each treatment. This means that we must start asking more questions about how long a treatment should last, how often it should take place, and what types of stepwise processes lead to best outcomes for patients. The second recommendation is regarding populations that are going to respond best to treatments. This type of research exists but is in its infancy. A problem with studying problems like back or shoulder pain is something called heterogeneity. This means that within the group of people being studied, although their pain may be in the same location, there are differing characteristics that may affect the outcomes from the treatment. Studies that attempt to stratify or subgroup patients based on how well we expect them to respond to care already exist. This study recommends that a larger pool of these studies are required for an overview like this to make a conclusive statement on who responds well to which treatments.

As always, we ask. What do we do with this Information?

The work done by the authors of this study is incredibly valuable. If you didn’t already know that exercise was an excellent option for your pain, make sure that you make an appointment with a professional who can help you create an exercise plan for your particular problem (the authors of this paper did find that a specific design of exercises for a region gave better results than general exercise). If you are already doing some exercise to treat your condition, consider some of the other things that are mentioned in this study. If you feel that you have been dealing with a problem for some time after several types of treatment, ask a profession you trust about what other options might be appropriate for your case, like regenerative medicine. My take home from this article: persistence and creativity, with a foundation in research, can lead to excellent results for those suffering from musculoskeletal pain.

By Dr Ben Matheson. Published on 07/04/2017. Like this blog post? Sign up to our newsletter, or read our other blog posts here!

Babatunde, O. O., Jordan, J. L., Van der Windt, D. A., Hill, J. C., Foster, N. E., & Protheroe, J. (2017). Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLOS ONE12(6), e0178621.

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