Title: Recommendations

Context:
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: 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