Rehabilitation of Patients with Chronic Pain Conditions

Tables of included studies

SBU’s Conclusions

Multimodal rehabilitation denotes a combination of psychological measures and physical activity/exercise, manual or physical methods. Health care personnel work in a team, of which the patient is also a member. The measures need to be coordinated and continued over a lengthy period of time. Multimodal rehabilitation is usually carried out at a hospital, in special clinics.

• Compared with less extensive treatment or no treatment at all, multimodal rehabilitation improves the potential for a patient to return to work. Other benefits include a reduction in sick leave and also the patients’ own perception of increased ability to work. With respect to these benefits, however, the scientific basis is inadequate to determine which type of multimodal rehabilitation gives the best results.
• Since the previous SBU report “Methods of treating chronic pain” in 2006, a number of high quality studies have been published on the effects of multimodal rehabilitation. With respect to the effect on pain relief, the overall scientific evidence has therefore changed, from supporting an effect, to showing no greater benefit than with less comprehensive treatment measures. This applies to chronic pain from the neck, shoulders and lower back.

Behavioural medicine is based on the concept that the patient’s thoughts, behaviour and environment are of importance for rehabilitation. Treatment strategies intended to change behaviour are combined with physical activity/ exercise. Together, the therapist, usually a physiotherapist and the patient share responsibility for carrying out the treatment. The treatment can be carried out in the primary care setting.

• This approach to treatment results in improved levels of activity compared with other treatment regimes that do not include a behavioural medicine approach. The effect persists for 2–5 years after completion of treatment. The long-term effects of physical activity/exercise, manual and physical methods and combinations of these cannot be differentiated. The scientific evidence is insufficient to determine the cost-effectiveness of these methods.

Acupuncture stimulates using needles which penetrate the skin or the mucous membrane. The method is applied both within orthodox health care and in alternative and complementary medicine.

• Compared with control methods involving some form of stimulation, acupuncture shows no difference with respect to either pain intensity or levels of activity three months after completion of treatment.