COVID-19 public health proscriptions have created severe if temporary, barriers to accessing face-to-face psychotherapy across the world. As disruptive as these are, they come on top of more long-standing barriers to getting psychotherapy faced by millions in need. eHealth interventions offer an avenue for redressing both types of barriers, but evidence about their efficacy remains a concern. This review of reviews and meta-analyses outlines the strength of evidence and effect sizes for guided and unguided approaches to eHealth interventions targeting common problems in psychotherapy (i.e., depression, anxiety, substance abuse, and general well-being). After a comprehensive search, a total of 65 reviews and meta-analyses were identified and evaluated for treatment effects, moderators, acceptability, and attrition. Findings show eHealth is acceptable and effective at improving depression, anxiety, alcohol-related problems, and general mental health compared to waitlist, and can even offer benefit as an adjunct to traditional psychotherapy. Mixed evidence was found when comparing guided versus unguided interventions as well as the strength of benefit relative to active controls and the degree to which these approaches are associated with attrition. eHealth interventions have the potential to be an effective tool for redressing both new and old psychotherapy access barriers. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
BACKGROUND & AIMS: Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care.
METHODS: A systematic search was conducted. Initial searches identified clinical guidelines, clinical pathways and systematic reviews. Additional searches found recently published trials and those addressing gaps in the evidence base. Data on study populations, interventions, and outcomes of intervention on pain and function were extracted. Quality of systematic reviews was assessed using AMSTAR, and strength of evidence rated using a modified GRADE approach.
RESULTS: Moderate to strong evidence suggests that exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain. NSAIDs and opioids reduce pain in the short-term, but the effect size is modest and the potential for adverse effects need careful consideration. Corticosteroid injections were found to be beneficial for short-term pain relief among patients with knee and shoulder pain. However, current evidence remains equivocal on optimal dose, intensity and frequency, or mode of application for most treatment options.
CONCLUSION: This review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most promising treatments is needed.
BACKGROUND: Complementary and alternative medicine (CAM) therapies may be used as a non-pharmacological approach to chronic pain management. While hundreds of trials about individual CAM modality have been conducted, a comprehensive overview of their results is currently lacking for pain clinicians and researchers. AIM: This umbrella review synthesized the quality of meta-analytic evidence supporting the efficacy, tolerability and safety of CAM therapies for the management of chronic pain. Materials & methods: MEDLINE, EMBASE, CINAHL, and CENTRAL were searched from October 1991 to November 2016. Reviews of clinical trials (randomized and non-randomized) with meta-analysis investigating the utility of any CAM modality for chronic pain were eligible. Pain relief post-intervention was the main outcome and secondary outcomes included patients' adherence and incidence of adverse effects during CAM protocol. RESULTS: Twenty-six reviews (207 clinical trials, > 12,000 participants) about 18 CAM modalities, falling under natural products, mind and body practices or other complementary health approaches were included. Inhaled cannabis, graded motor imagery, and Compound Kushen injection (a form of Chinese medicine) were found the most efficient (with moderate-to-high effect sizes and low heterogeneity) and tolerable (≥ 80% of adherence to study protocols) for chronic pain relief. When reported, adverse effects related to these CAM were minor. CONCLUSION: Although several CAM were found effective for chronic pain relief, it remains unclear when these modalities are a reasonable choice against or in conjunction with mainstream treatments. In that sense, future research with a clear emphasis on concurrent evaluation of CAM overall efficacy and patient adherence/tolerance is needed. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
There are several nonsurgical alternatives to treat radicular pain in degenerative lumbar spinal stenosis. Epidural steroid injections have been used for several decades, but the different studies have shown variable effects. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified nine systematic reviews including seven pertinent randomized controlled trials. We concluded epidural steroid injection probably leads to little or no effect on reducing radicular pain of spinal stenosis.
Most clinical guidelines do not recommend routine use of epidural steroid injections for the management of chronic low back pain. However, many clinicians do not adhere to these guidelines. This comprehensive evidence overview concluded that off-label epidural steroid injections provide small short-term but not long- term leg-pain relief and improvement in function; injection of steroids is no more effective than injection of local anesthetics alone; post-procedural complications are uncommon, but the risk of contamination and serious infections is very high. The evidence does not support routine use of off-label epidural steroid injections in adults with benign radicular lumbosacral pain.
COVID-19 public health proscriptions have created severe if temporary, barriers to accessing face-to-face psychotherapy across the world. As disruptive as these are, they come on top of more long-standing barriers to getting psychotherapy faced by millions in need. eHealth interventions offer an avenue for redressing both types of barriers, but evidence about their efficacy remains a concern. This review of reviews and meta-analyses outlines the strength of evidence and effect sizes for guided and unguided approaches to eHealth interventions targeting common problems in psychotherapy (i.e., depression, anxiety, substance abuse, and general well-being). After a comprehensive search, a total of 65 reviews and meta-analyses were identified and evaluated for treatment effects, moderators, acceptability, and attrition. Findings show eHealth is acceptable and effective at improving depression, anxiety, alcohol-related problems, and general mental health compared to waitlist, and can even offer benefit as an adjunct to traditional psychotherapy. Mixed evidence was found when comparing guided versus unguided interventions as well as the strength of benefit relative to active controls and the degree to which these approaches are associated with attrition. eHealth interventions have the potential to be an effective tool for redressing both new and old psychotherapy access barriers. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
