Multimodal Non-Pharmacological Chronic Pain Management Strategies: a Systematic Review

Document Type : Systematic Review

Author
Physical Medicine and Rehabilitation Department, School of Medicine, Tehran University of Medical Science, Tehran, Iran.
Abstract
Aims: This study was conducted to provide a comprehensive analysis of multimodal pain prevention strategies, focusing on their effectiveness in managing and preventing various types of chronic pain.

Method and Materials: In this systematic review comprehensive search of electronic databases, PubMed, was conducted to identify relevant studies published up to January 2024. The search strategy included terms related to multimodal pain prevention, such as "pain management," "non-pharmacological interventions," and "integrated pain care." Studies were included if they evaluated multimodal pain prevention strategies in various clinical populations and reported outcomes related to pain intensity, functional status, adverse effects, and patient satisfaction. The methodological quality of the included studies was assessed, and data were synthesized to provide an overview of the findings.

Findings: The search yielded a total of 6 studies that met the inclusion criteria. The included studies encompassed a diverse range of patient populations, focusing on those experiencing chronic pain and receiving palliative care. Multimodal pain prevention strategies were found to be associated with improved pain control and reduced drug consumption in patients experiencing chronic pain. Furthermore, non-pharmacological interventions, such as physical therapy and cognitive-behavioral therapy, were shown to enhance pain management outcomes in various clinical contexts. The integration of these modalities in a coordinated and individualized manner appeared to be particularly beneficial in addressing the complex nature of pain.

Conclusion: The findings support the use of multimodal approaches in clinical practice and emphasize the importance of individualized, patient-centered care in pain management. Future research should focus on identifying the most effective combinations of interventions and elucidating the mechanisms underlying the synergistic effects of multimodal approaches.

Keywords

Subjects


References:
1. El-Metwally A, Shaikh Q, Aldiab A, Al-Zahrani J, Al-Ghamdi S, Alrasheed AA, et al. The prevalence of chronic pain and its associated factors among Saudi Al-Kharj population; a cross sectional study. BMC Musculoskelet Disord. 2019;20(1):177.
2. Al-Maharbi S, Abolkhair AB, Al Ghamdi H, Haddara M, Tolba Y, El Kabbani A, et al. Prevalence of depression and its association with sociodemographic factors in patients with chronic pain: A cross-sectional study in a tertiary care hospital in Saudi Arabia. Saudi J Anaesth. 2018;12(3):419-25
3. Zahlan G, De Clifford-Faugère G, Nguena Nguefack HL, Guénette L, Pagé MG, Blais L, et al. Polypharmacy and Excessive Polypharmacy Among Persons Living with Chronic Pain: A Cross-Sectional Study on the Prevalence and Associated Factors. J Pain Res. 2023;16:3085-100.
4. Mochari-Greenberger H, Peters A, Vue L, Pande RL. A Nationally Scaled Telebehavioral Health Program for Chronic Pain: Characteristics, Goals, and Psychological Outcomes. Telemed J E Health. 2017;23(8):640-8.
5. Elbers S, Pool J, Wittink H, Köke A, Smeets R. Exploring the Feasibility of Relapse Prevention Strategies in Interdisciplinary Multimodal Pain Therapy Programs: Qualitative Study. JMIR Hum Factors. 2020;7(4):e21545
6. Hans GH, Wildemeersch D, Meeus I, Louies B, Maertens R. Pain@home: An integrated, holistic, multimodal, digital approach to the prevention of chronic pain. International Journal of Integrated Care. 2023.
7. Ojo SA, Adeola OL, Orhin AE, Mmaduabuchi JI, Nwachukwu O, Okobi OE, et al. Exercise and Weight Loss as a Strategy for Chronic Pain Control: A Comprehensive Review. Journal of Advances in Medicine and Medical Research. 2023.
8. Pasini I, Perlini C, Donisi V, Mason A, Schweiger V, Secchettin E, et al. "INTEGRO INTEGRated Psychotherapeutic InterventiOn" on the Management of Chronic Pain in Patients with Fibromyalgia: The Role of the Therapeutic Relationship. Int J Environ Res Public Health. 2023;20(5).
9. Albornoz-Cabello M, Barrios-Quinta CJ, Espejo-Antúnez L, Escobio-Prieto I, Casuso-Holgado MJ, Heredia-Rizo AM. Immediate clinical benefits of combining therapeutic exercise and interferential therapy in adults with chronic neck pain: a randomized controlled trial. Eur J Phys Rehabil Med 2021;57:767-74. DOI: 10.23736/S1973-9087.21.06688-0
10. Monticone M, Ambrosini E, Vernon H, Rocca B, Finco G, Foti C, et al. Efficacy of two brief cognitive-behavioral rehabilitation programs for chronic neck pain: results of a randomized controlled pilot study. Eur J Phys Rehabil Med. 2018;54(6):890-9.
11. Morcillo-Muñoz Y, Sánchez-Guarnido AJ, Calzón-Fernández S, Baena-Parejo I. Multimodal Chronic Pain Therapy for Adults via Smartphone: Randomized Controlled Clinical Trial. J Med Internet Res. 2022;24(5):e36114.
12. Dekker C, Goossens ME, Bastiaenen CH, Verbunt JA. Study protocol for a multicentre randomized controlled trial on effectiveness of an outpatient multimodal rehabilitation program for adolescents with chronic musculoskeletal pain (2B Active). BMC Musculoskelet Disord. 2016;17:317.
13. Lanhers C, Pereira B, Gay C, Hérisson C, Levyckyj C, Dupeyron A, et al. Evaluation of the efficacy of a short-course, personalized self-management and intensive spa therapy intervention as active prevention of musculoskeletal disorders of the upper extremities (Muska): a research protocol for a randomized controlled trial. BMC Musculoskelet Disord. 2016;17(1):497.
14. Heapy AA, Higgins DM, Goulet JL, LaChappelle KM, Driscoll MA, Czlapinski RA, et al. Interactive Voice Response-Based Self-management for Chronic Back Pain: The COPES Noninferiority Randomized Trial. JAMA Intern Med. 2017;177(6):765-73.