Recommendations

Psychological therapies (e.g., cognitive behavioral interventions such as Cognitive Behavioral Therapy  [CBT], biofeedback) have been found to be effective for pain reduction in multiple pain conditions.[80-82] Exercise treatments, including yoga, also have evidence of benefit for reducing pain intensity and disability  when compared to usual care in the treatment of chronic pain conditions.[83-85] Exercise and  psychological therapies may each exert their influence through multiple mechanisms including but not  limited to the reduction in fear-avoidance, reduction in catastrophizing, and/or enhancing mood.[80]  Similarly, multidisciplinary biopsychosocial rehabilitation (described as a combination of a physical  intervention such as graded exercise and a psychological, social, or occupational intervention) has been  shown to be more effective than usual care in improving pain and disability.[81] These interventions are  safe and have not been shown to increase morbidity or mortality. In light of the low harms associated with exercise and psychological therapies when compared with LOT these treatments are preferred over LOT, and should be offered to all patients with chronic pain including  those currently receiving LOT. There is insufficient evidence to recommend psychological over physical  therapies or vice versa; the choice of which to try first should be individualized based on patient  assessment and a shared decision making process (see Patient Focus Group Methods and Findings).[80]

Question: What have been found to be effective for pain reduction in multiple pain conditions?
Answer: Psychological therapies (e.g., cognitive behavioral interventions such as Cognitive Behavioral Therapy  [CBT], biofeedback)

Question: What do psychological therapies help?
Answer: effective for pain reduction in multiple pain conditions

Question: What are some examples of psychological therapies?
Answer: cognitive behavioral interventions such as Cognitive Behavioral Therapy  [CBT], biofeedback

Question: What kind of treatments can be beneficial for reducing pain intensity and disability  when compared to usual care in the treatment of chronic pain condition?
Answer: Exercise treatments, including yoga

Question: How do exercise and  psychological therapies help reduce pain intensity and disability?
Answer: Exercise and  psychological therapies may each exert their influence through multiple mechanisms including but not  limited to the reduction in fear-avoidance, reduction in catastrophizing, and/or enhancing mood.

Question: What kind of intervention has been  shown to be more effective than usual care in improving pain and disability?
Answer: multidisciplinary biopsychosocial rehabilitation (described as a combination of a physical  intervention such as graded exercise and a psychological, social, or occupational intervention)

Question: What is multidisciplinary biopsychosocial rehabilitation?
Answer: described as a combination of a physical  intervention such as graded exercise and a psychological, social, or occupational intervention

Question: Which interventions are safe and have not been shown to increase morbidity or mortality?
Answer: multidisciplinary biopsychosocial rehabilitation (described as a combination of a physical  intervention such as graded exercise and a psychological, social, or occupational intervention)

Question: Which treatments should be offered to all patients with chronic pain including those currently receiving LOT?
Answer: exercise and psychological therapies

Question: Which treatments are preferred over LOT?
Answer: exercise and psychological therapies

Question: Why exercise and psychological therapies should be offered to all patients with chronic pain including  those currently receiving LOT?
Answer: In light of the low harms associated with exercise and psychological therapies when compared with LOT

Question: Why exercise and psychological therapies are preferred over LOT?
Answer: In light of the low harms associated with exercise and psychological therapies when compared with LOT

Question: What evidence is there to recommend psychological over physical therapies or vice versa?
Answer: insufficient

Question: How to choose between psychological and physical therapies as a first-try?
Answer: the choice of which to try first should be individualized based on patient  assessment and a shared decision making process