Examples of physical therapies used in the management of chronic pain include exercise and active physical therapy, yoga, manual therapies (such as spinal manipulation therapy and mobilization), acupuncture and massage. Physical and exercise therapies are varied and may include exercises to improve range of motion and muscle conditioning to increase the degree of stability and function and improve pain control. Exercises can be passive, during which external force is applied and there is no voluntary muscle contraction or can be active, assisted with partial contraction and external force applied. Acupuncture is an intervention that involves the insertion of needles at specific acupuncture points. In the management of chronic pain it has been hypothesized that acupuncture induces changes in the perception and memory of pain and may induce changes in the sympathetic nervous system. Massage therapy has been defined as “as soft tissue and joint manipulation using the hands or a handheld device” for therapeutic purposes and is another example of a physical therapy used to help control pain. Massage therapy is thought to have a broad range of benefits related to relaxation and circulation.

Familiarity with the evidence-based guidelines around the use of physical therapies to manage chronic pain is important given the diverse therapeutic modalities available in this category, the diverse nature of chronic pain syndromes and the potential for varied efficacy. This report will review existing evidence-based guidelines regarding the use of physical therapy treatments for chronic non-cancer pain.

Contents

• CONTEXT AND POLICY ISSUES
• RESEARCH QUESTION
• KEY FINDINGS
• METHODS
  • Literature Search Strategy
  • Selection Criteria and Methods
  • Exclusion Criteria
  • Critical Appraisal of Individual Studies
• SUMMARY OF EVIDENCE
  • Quantity of Research Available
  • Summary of Study Characteristics
  • Summary of Critical Appraisal
  • Summary of Findings
  • Limitations
• CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING
• REFERENCES
• APPENDIX 1. Selection of Included Studies
• Appendix 2. Grading of Recommendations and Levels of Evidence
• Appendix 3. Summary of Critical Appraisal Using AGREE II
• Appendix 4. Summary of Recommendations by Source

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources and a summary of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.