Current Rheumatology Reports

, 15:306 | Cite as

Nonpharmacological Treatment of Pain in Rheumatic Diseases and Other Musculoskeletal Pain Conditions

  • Natoshia Raishevich Cunningham
  • Susmita Kashikar-Zuck
CHRONIC PAIN (LJ CROFFORD, SECTION EDITOR)
Part of the following topical collections:
  1. Topical Collection on Chronic Pain

Abstract

Pain is a complex phenomenon affected by biological, psychological, and social factors. Treatment of pain is most effective when using a multidisciplinary approach consisting of a careful selection of pharmacological and non-pharmacological interventions based upon disease factors, pain characteristics, psychological coping abilities, and lifestyle factors. In this review we focus on research-based evidence for non-pharmacological intervention including psychological intervention, physical exercise, patient education, and complementary approaches for pain management for patients with rheumatic diseases and common musculoskeletal pain conditions, such as low back pain. The vast majority of research studies on chronic pain conditions are focused on adults but pediatric studies are also reviewed wherever possible, to give the reader a more inclusive view of non-pharmacological approaches for pain management across the lifespan.

Keywords

Nonpharmacological treatment Rheumatic disease Rheumatoid arthritis Pain Osteoarthritis Fibromyalgia Lower back pain Cognitive–behavioral therapy Exercise Patient education Complementary and alternative medicine 

Notes

Disclosure

No potential conflicts of interest relevant to this article were reported.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    • Committee on Advancing Pain Research C, Education, Medicine Io. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research: The National Academies Press; 2011. This statement from the Institute of Medicine (IOM) is important because it assesses the state of pain science in the domains of research, care, and education and provides recommendations to advance the field.Google Scholar
  2. 2.
    Sharma L. Epidemiology of osteoarthritis. In: Moskowitz RW, Howell OS, Altman RD, Buckwalter JA, Goldberg VM, editors. Osteoarthritis: diagnosis and medical/surgical management. 3rd ed. Philadelphia: W. B. Sanders; 2001. p. 3–17.Google Scholar
  3. 3.
    Harris ED, Zorab R. Rheumatoid arthritis. Philadelphia: WB Sanders; 1997.Google Scholar
  4. 4.
    Wolfe F, Cathey MA, Hawley DJ. Prevalence of primary and secondary fibrositis. J Rheumatol. 1994;10:965–8.Google Scholar
  5. 5.
    Wolfe F, Ross CK, Anderson SK, Russell IJ. Aspects of fibromyalgia in the general population: sex, pain threshold, and fibromyalgia symptoms. Arthritis Rheum. 1995;38(1):19–28.PubMedCrossRefGoogle Scholar
  6. 6.
    Buskila D, Press J, Gedalia A, Klein M, Neumann L, Boehm R, et al. Assessment of nonarticular tenderness and prevalence of fibromyalgia in children. J Rheumatol. 1993;20:368–70.PubMedGoogle Scholar
  7. 7.
    Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis Rheum. 1990;33(2):160–72.PubMedCrossRefGoogle Scholar
  8. 8.
    Andersson GBJ. Epidemiological features of chronic low-back pain. Lancet. 1999;354:581–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344(5):363–70.PubMedCrossRefGoogle Scholar
  10. 10.
    Van Tulder MW. Treatment of low back pain: myths and facts. Der Schmertz. 2001;15:499–503.CrossRefGoogle Scholar
  11. 11.
    Deyo RA, Mirza SK, Martin BI. Back Pain Prevalence and Visit Rates: Estimates From U.S. National Surveys, 2002. Spine. 2006;31(23):2724–7  10.1097/01.brs.0000244618.06877.cd
  12. 12.
    Birket-Smith M. Somatization and chronic pain. Acta Anaesthesiol Scand. 2001;45(9):1114–20.PubMedCrossRefGoogle Scholar
  13. 13.
    Turk DC, Rudy TE. Cognitive factors and persistent pain: a glimpse into Pandora’s box. Cognit Ther Res. 1992;16(2):99–122.CrossRefGoogle Scholar
  14. 14.
    Palermo TM, Chambers CT. Parent and family factors in pediatric chronic pain and disability: an integrative approach. Pain. 2005;119:1–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Evers AWM, Kraaimaat FW, Geene R, Jacobs JWG, Bijlsma JWJ. Pain coping and social support as predictors of long-term functional disability and pain in early rheumatoid arthritis. Behav Res Ther. 2003;41(11):1295–310.PubMedCrossRefGoogle Scholar
  16. 16.
    Turner JA, Jensen MP, Romano JM. Do beliefs, coping, and catastrophizing independent predict functioning in patients with chronic pain? Pain. 2000;85(1–2):115–25.PubMedCrossRefGoogle Scholar
  17. 17.
    Keefe FJ, Abernethy AP, Campbell LC. Psychological approaches to understanding and treating disease-related pain. Annu Rev Psychol. 2005;56:601–30.PubMedCrossRefGoogle Scholar
  18. 18.
    Haythornthwaite JA, Menefee LA, Heinberg LJ, Clark MR. Pain coping strategies predict perceived control over pain. Pain. 1998;77(1):33–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Beck AT, Rush AJ, Shaw BF, Emery G, editors. Cognitive therapy of depression. New York: Guilford Press; 1979.Google Scholar
  20. 20.
    Eccleston C, Palermo TM, de C Williams AC, Lewandowski A, Morley S. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. 2009. doi: 10.1002/14651858.CD003968.pub2.
  21. 21.
    Keefe FJ, Affleck G, Lefebvre JC, Starr K, et al. Pain coping strategies and coping efficacy in rheumatoid arthritis: a daily process analysis. Pain. 1997;69(1–2):35–42.PubMedCrossRefGoogle Scholar
  22. 22.
    Burckhardt CS, Goldenberg DL, Crofford L, Gerwin R, S. G, Jackson DA, et al. Guidelines for the management of fibromyalgia syndrome pain in adults and children. APS Clinical Practice Guidelines Series. Glenview, IL: American Pain Society; 2005Google Scholar
  23. 23.
    Thieme K, Turk DC, Flor H. Comorbid depression and anxiety in fibromyalgia syndrome: relationship to somatic and psychosocial variables. Psychosom Med. 2004;66(6):837–44.PubMedCrossRefGoogle Scholar
  24. 24.
    Evers AW, Kraaimaat FW, Geenen R, Jacobs JW, Bijlsma J. Longterm predictors of anxiety and depressed mood in early rheumatoid arthritis: a 3 and 5 year followup. J Rheumatol. 2002;29(11):2327–36.PubMedGoogle Scholar
  25. 25.
    Gatchel RJ, Robinson RC, Pulliam C, Maddrey AM. Biofeedback with pain patients: evidence for its effectiveness. Semin Pain Med. 2003;1(2):55–66.CrossRefGoogle Scholar
  26. 26.
    Astin JA, Beckner W, Soeken K, Hochberg MC, Berman B. Psychological interventions for rheumatoid arthritis: a meta-analysis of randomized controlled trials. Arthritis Care Res. 2002;47(3):291–302.CrossRefGoogle Scholar
  27. 27.
    Williams DA. Psychological and behavioural therapies in fibromyalgia and related syndromes. Best Pract Res Clin Rheumatol. 2003;17(4):649–65.PubMedCrossRefGoogle Scholar
  28. 28.
    Buckelew SP, Conway R, Parker JC, Deuser WE, Read J, Witty TE, et al. Biofeedback/relaxation training and exercise interventions for fibromyalgia: a prospective trial. Arthritis Care Res. 1998;11(3):196–209.PubMedCrossRefGoogle Scholar
  29. 29.
    Nielson WR, Walker C, McCain GA. Cognitive behavioral treatment of fibromyalgia syndrome: preliminary findings. J Rheumatol. 1992;19:98–103.PubMedGoogle Scholar
  30. 30.
    Singh BB, Berman BM, Hadhazy V, Creamer P. A pilot study of cognitive behavioral therapy in fibromyalgia. Altern Ther Health Med. 1998;4(2):67–70.PubMedGoogle Scholar
  31. 31.
    Soares JJF, Grossi G. A randomized, controlled comparison of educational and behavioral interventions for woman with fibromyalgia. Scand J Occup Ther. 2002;9:35–45.CrossRefGoogle Scholar
  32. 32.
    Vlaeyen JW, Teeken-Gruben NJ, Goossens ME, Rutten-van Molken MP, Pelt RA, Van Eek H, et al. Cognitive-educational treatment of fibromyalgia: a randomized clinical trial. I. Clinical effects. J Rheumatol. 1996;23(7):1237–45.PubMedGoogle Scholar
  33. 33.
    Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Health Psychol. 2007;26(1):1–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Walco GA, Varni JW, Illowite NT. Cognitive-behavioral pain management in children with juvenile rheumatoid arthritis. Pediatrics. 1992;89:1075–9.PubMedGoogle Scholar
  35. 35.
    Anthony KK, Schanberg L. Juvenile primary fibromyalgia syndrome. Curr Rheumatol Rep. 2001;3(2):165–71.PubMedCrossRefGoogle Scholar
  36. 36.
    Kashikar-Zuck S, Swain NF, Jones BA, Graham TB. Efficacy of cognitive-behavioral intervention for juvenile primary fibromyalgia syndrome. J Rheumatol. 2005;32(8):1594–602.PubMedGoogle Scholar
  37. 37.
    • Kashikar-Zuck S, Ting TV, Arnold LM, Bean J, Powers SW, Graham TB, et al. Cognitive behavioral therapy for the treatment of juvenile fibromyalgia: A multisite, single-blind, randomized, controlled clinical trial. Arthritis & Rheumatism. 2012;64(1):297–305. This paper was the first RCT for a sample of youth with juvenile FMS to demonstrate that CBT is a safe and effective treatment for reducing functional disability and depressive symptoms compared with an education control. Google Scholar
  38. 38.
    McCracken LM, Eccleston C. A prospective study of acceptance of pain and patient functioning with chronic pain. Pain. 2005;118:164–9.PubMedCrossRefGoogle Scholar
  39. 39.
    McCracken LM, Vowles KE, Eccleston C. Acceptance of chronic pain: component analysis and a revised assessment method. Pain. 2004;107(1–2):159–66.PubMedCrossRefGoogle Scholar
  40. 40.
    McCracken LM, Vowles KE, Eccleston C. Acceptance-based treatment for persons with complex, long standing chronic pain: a preliminary analysis of treatment outcome in comparison to a waiting phase. Behav Res Ther. 2005;43(10):1335–46.PubMedCrossRefGoogle Scholar
  41. 41.
    Vowles KE, McCracken LM. Acceptance and values-based action in chronic pain: a study of treatment effectiveness and process. J Consult Clin Psychol. 2008;76(3):397–407.PubMedCrossRefGoogle Scholar
  42. 42.
    Wicksell RK, Olsson GL, Hayes SC. Mediators of change in Acceptance and Commitment Therapy for pediatric chronic pain. Pain. 2011;152(12):2792–801.PubMedCrossRefGoogle Scholar
  43. 43.
    Simon LS, Lipman AG, Caudill-Slosberg M, Gill LH, Kerr KL, al. e, editors. Guidelines for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis. Glenville, IL: American Pain Society; 2002Google Scholar
  44. 44.
    Osteoarthritis ACoRSo. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Arthritis & Rheumatism. 2000;43(9):1905–15Google Scholar
  45. 45.
    American College of Rheumatology Subcommittee on Rheumatoid Arthritis G. Guidelines for the management of rheumatoid arthritis: 2002 Update. Arthritis Rheum. 2002;46(2):328–46.CrossRefGoogle Scholar
  46. 46.
    Liddle SD, Baxter GD, Gracey JH. Exercise and chronic low back pain: what works? Pain. 2004;107(1–2):176–90.PubMedCrossRefGoogle Scholar
  47. 47.
    Jones KD, Burckhardt CS, Clark JE, Bennett RM, Potempa KM. A randomized controlled trial of muscle strengthening versus flexibility training in fibromyalgia. J Rheumatol. 2002;29(5):1041–8.PubMedGoogle Scholar
  48. 48.
    Hauser W, Klose P, Langhorst J, Moradi B, Steinbach M, Schiltenwolf M, et al. Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomised controlled trials. Arthritis research & therapy. 2010;12(3):R79Google Scholar
  49. 49.
    Sim J, Adams N. Systematic review of randomized controlled trials of nonpharmacological interventions for fibromyalgia. Clin J Pain. 2002;18(5):324–36.PubMedCrossRefGoogle Scholar
  50. 50.
    Sculco AD, Paup DC, Fernhall B, Sculco MJ. Effects of aerobic exercise on low back pain patients in treatment. Spine J. 2001;1(2):95–101.PubMedCrossRefGoogle Scholar
  51. 51.
    Hurkmans E, van der Giesen FJ, Vliet Vlieland TP, Schoones J, Van den Ende C. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. Cochrane Database of Systematic Reviews. 2009;(4)Google Scholar
  52. 52.
    Brosseau L, MacLeay L, Welch V, Tugwell P, Wells GA. Intensity of exercise for the treatment of osteoarthritis. Cochrane Database of Systematic Reviews. 2003;(2)Google Scholar
  53. 53.
    Bartels EM, Lund H, Hagen KB, Dagfinrud H, Christensen R, Danneskiold-Samoe B. Aquatic exercise for the treatment of knee and hip osteoarthritis (Review). Cochrane Database of Systematic Reviews. 2009;(4)Google Scholar
  54. 54.
    • Escalante Y, Saavedra JM, García-Hermoso A, Silva AJ, Barbosa TM. Physical exercise and reduction of pain in adults with lower limb osteoarthritis: A systematic review. Journal of Back and Musculoskeletal Rehabilitation. 2010;23(4):175–86. This review summarized the results of 33 research studies that evaluated the effect of exercise programs on pain for patients with hip and knee osteoarthritis. On the basis of these studies, this article reports evidence of the effectiveness of exercise programs on pain for individuals with OA.Google Scholar
  55. 55.
    Hooten WM, Qu W, Townsend CO, Judd JW. Effects of strength vs aerobic exercise on pain severity in adults with fibromyalgia: a randomized equivalence trial. Pain. 2012;153(4):915.PubMedCrossRefGoogle Scholar
  56. 56.
    Busch AJ, Barber KAR, Overend TJ, Peloso PMJ, Schachter CL, editors. Exercise for treating fibromyalgia syndrome: John Wiley & Sons, Ltd; 2007Google Scholar
  57. 57.
    van Saten M, Bowlwijn P, Verstappen F, et al. A randomized clinical trial comparing fitness and biofeedback training versus basic treatment in patients with fibromyalgia. J Rheumatol. 2002;29:575–81.Google Scholar
  58. 58.
    Mannerkorpi K. Exercise in fibromyalgia. Curr Opin Rheumatol. 2005;17:190–4.PubMedCrossRefGoogle Scholar
  59. 59.
    Sherry DD. Pain syndromes in children. Curr Rheumatol Rep. 2000;2:337–42.PubMedCrossRefGoogle Scholar
  60. 60.
    Stephens S, Feldman BM, Bradley N, Schneiderman J, Wright V, Singh-Grewal D, et al. Feasibility and effectiveness of an aerobic exercise program in children with fibromyalgia: results of a randomized controlled pilot trial. Arthritis Rheum. 2008;59(10):1399–406.PubMedCrossRefGoogle Scholar
  61. 61.
    Kimura Y, Walco GA. Treatment of chronic pain in pediatric rheumatic disease. Nat Clin Pract Rheumatol. 2007;3(4):210–8.PubMedCrossRefGoogle Scholar
  62. 62.
    Gowans SE, deHueck A. Effectiveness of exercise in management of fibromyalgia. Curr Opin Rheumatol. 2004;16(2):138–42.PubMedCrossRefGoogle Scholar
  63. 63.
    Lorig K, Holman H. Arthritis self-management studies: a twelve-year review. Health Educ Q. 1993;20(1):17–28.PubMedCrossRefGoogle Scholar
  64. 64.
    Warsi A WPSLMPAJSDH. Self-management education programs in chronic disease: A systematic review and methodological critique of the literature. Archives of Internal Medicine. 2004;164(15):1641–9Google Scholar
  65. 65.
    Superio-Cabuslay E, Ward MM, Lorig KR. Patient education interventions in osteoarthritis and rheumatoid arthritis: a meta-analytic comparison with nonsteroidal antiinflammatory drug treatment. Arthritis Care Res. 1996;9(4):292–301.PubMedCrossRefGoogle Scholar
  66. 66.
    • Riemsma RP, Kirwan JR, Taal E, Rasker JJH. Patient education for adults with rheumatoid arthritis. Cochrane Database of Systematic Reviews. 2010;(11). This Cochrane review examined the results of 31 research studies on patient education for individuals with RA. It concluded significant effects of patient education at first follow-up for scores on disability, joint counts, patient global assessment, psychological status, and depression, with no effects on anxiety and disease activity.Google Scholar
  67. 67.
    Nicassio PM, Radojevic V, Weisman MH, Schuman C, Kim J, Schoenfeld-Smith K, et al. A comparison of behavioral and educational interventions for fibromyalgia. J Rheumatol. 1997;24(10):2000–7.PubMedGoogle Scholar
  68. 68.
    Cherkin DC, Deyo RA, Battié M, Street J, Barlow W. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. N Engl J Med. 1998;339(15):1021–9.PubMedCrossRefGoogle Scholar
  69. 69.
    Eccleston C, Palermo TM, Williams AC, Lewandowski A, Morley S. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane database of systematic reviews (Online). 2009;(2):CD003968Google Scholar
  70. 70.
    Ramos-Remus C. Complementary and alternative practices in rheumatology. Best Pract Res Clin Rheumatol. 2008;22:741–57.PubMedCrossRefGoogle Scholar
  71. 71.
    Chung W, Xu S, Eken A, He J. Current status of complementary and alternative medicine in the treatment of rheumatic disease pain. Curr Rheumatol Rev. 2009;5(4):194–8.CrossRefGoogle Scholar
  72. 72.
    Fiechtner J, Dinning D. Non-pharmacologic treatment options in rheumatologic disease. Curr Rheumatol Rev. 2009;5:199–203.CrossRefGoogle Scholar
  73. 73.
    Bronfort G, Haas M, Evans R, Kawchuk G, Dagenais S, et al. Evidence-informed management of chronic low back pain with spinal manipulation and mobilization. Spine J. 2008;8:213–25.PubMedCrossRefGoogle Scholar
  74. 74.
    Manheimer E, White A, Berman BM, Forys KL, Ernst E. Meta-analysis: acupuncture for low back pain. Annals of internal medicine. 2005;142(651–63)Google Scholar
  75. 75.
    Kwon YD, Pittler MH, Ernst E. Acupuncture of peripheral joint osteoarthritis: a systematic review and meta-analysis. Rheumatology (Oxford, England). 2006;45:1331–7Google Scholar
  76. 76.
    Fouladbakhsh J. Complementary and alternative modalities to relieve osteoarthritis symptoms: a review of the evidence on several therapies often used for osteoarthritis management. Orthop Nurs. 2012;31(2):115–21.PubMedCrossRefGoogle Scholar
  77. 77.
    Soeken KL, Selected CAM. Therapies for arthritis-related pain: the evidence from systematic reviews. Clin J Pain. 2004;20(1):13–8.PubMedCrossRefGoogle Scholar
  78. 78.
    Ernst E. Systematic review of systematic reviews of acupuncture. Clinical medicine (London, England). 2006;6(5):508–9Google Scholar
  79. 79.
    Ernst E. Complementary or alternative therapies for osteoarthritis. Nat Clin Pract Rheumatol. 2006;2(2):74–80.PubMedCrossRefGoogle Scholar
  80. 80.
    Sarzi-Puttini P, Atzeni F, Lubrano E. [Complementary medicine in rheumatoid arthritis] La medicina complementare nell'artrite reumatoide. Reumatismo. 2005;57(4):226–31Google Scholar
  81. 81.
    Ernst E, Posadzki P. Complementary and alternative medicine for rheumatoid arthritis and osteoarthritis: an overview of systematic reviews. Curr Pain Headache Rep. 2011;15(6):431–7.PubMedCrossRefGoogle Scholar
  82. 82.
    Lee H-J, Park H-J, Chae Y, Kim S-Y, Kim S-N, Kim S-T, et al. Tai Chi Qigong for the quality of life of patients with knee osteoarthritis: a pilot, randomized, waiting list controlled trial. Clin Rehabil. 2009;23(6):504–11.PubMedCrossRefGoogle Scholar
  83. 83.
    Brismee J-M, Paige RL, Chyu M-C, Boatright JD, Hagar JM, McCaleb JA, et al. Group and home-based tai chi in elderly subjects with knee osteoarthritis: a randomized controlled trial. Clin Rehabil. 2007;21(2):99–111.PubMedCrossRefGoogle Scholar
  84. 84.
    Terry R, Perry R, Ernst E. An overview of systematic reviews of complementary and alternative medicine for fibromyalgia. Clin Rheumatol. 2012;31(1):55–66.PubMedCrossRefGoogle Scholar
  85. 85.
    Langhorst J, Klose P, Musial F, Irnich D, Hauser W. Efficacy of acupuncture in fibromyalgia syndrome—a systematic review with a meta-analysis of controlled clinical trials. Rheumatology (Oxford, England). 2010;49(4):778–88Google Scholar
  86. 86.
    Verkamp EK, Flowers SR, Lynch-Jordan AM, Taylor J, Ting TV, Kashikar-Zuck S. A survey of conventional and complementary therapies used by youth with juvenile-onset fibromyalgia. Pain management nursing : official journal of the American Society of Pain Management Nurses. 2012Google Scholar
  87. 87.
    Barbour C. Use of complementary and alternative treatments by individuals with fibromyalgia syndrome. J Am Acad Nurse Pract. 2000;12(8):311–6.PubMedCrossRefGoogle Scholar
  88. 88.
    Carson JW, Carson KM, Jones KD, Bennett RM, Wright CL, Mist SD. A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia. Pain. 2010;151(2):530–9.PubMedCrossRefGoogle Scholar
  89. 89.
    van Koulil S, Effting M, Kraaimaat FW, van Lankveld W, van Helmond T, Cats H, et al. Cognitive-behavioural therapies and exercise programmes for patients with fibromyalgia: state of the art and future directions. Ann Rheum Dis. 2007;66(5):571–81.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Natoshia Raishevich Cunningham
    • 1
  • Susmita Kashikar-Zuck
    • 1
  1. 1.Division of Behavioral Medicine and Clinical PsychologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA

Personalised recommendations