Contents part 1: Introduction




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Rating: 8b

Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G; On behalf of the COST B13 Working Group on Guidelines for Chronic Low Back Pain. Chapter 4 European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006 Mar;15(Supplement 2):s192-s300.

PMID: 16550448


Rating: 8a

Altindag O, Gur A, Altindag A. The relationship between clinical parameters and depression level in patients with myofascial pain syndrome. Pain Med. 2008;9:161-5.


RESULTS: Major depression was more frequently found in CPPs with MPS (P < 0.001). BDI scores were higher in the MPS group than in controls (P < 0.001). There was a significant correlation between the severity of pain and depression level in patients with MPS (r = 0.654, P < 0.001).
PMID: 18298698
Rating 3b

Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician. 2002 Feb 15;65(4):653-60.


Trigger-point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms.
PMID: 11871683
Rating: 5b
American Academy of Pain Medicine. Use of Opioids for the Treatment of Chronic Pain. (February 6, 2001).
These publications, which have been endorsed by AAPM and APS, state that opioids, sometimes called "narcotic analgesics", are an essential part of a pain management plan. There is currently no nationally accepted consensus for the treatment of chronic pain not due to cancer, yet the economic and social costs of chronic pain are substantial, with estimates ranging in the tens of billions of dollars annually.
Rating: 5b
Abrams DI, Couey P, Shade SB, Kelly ME, Benowitz NL. Cannabinoid-opioid interaction in chronic pain. Clin Pharmacol Ther. 2011 Dec;90(6):844-51. doi: 10.1038/clpt.2011.188. Epub 2011 Nov 2.
Cannabis augments the analgesic effects of opioids without significantly altering plasma opioid levels. The combination may allow for opioid treatment at lower doses with fewer side effects.
PMID: 22048225
Rating: 3c

Abs R, Verhelst J, Maeyaert J, Van Buyten JP, Opsomer F, Adriaensen H, Verlooy J, Van Havenbergh T, Smet M, Van Acker K. Endocrine consequences of long-term intrathecal administration of opioids. J Clin Endocrinol Metab. 2000;85:2215-22.


Decreased libido or impotency was present in 23 of 24 men receiving opioids. The serum testosterone level was below 9 nmol/L in 25 of 29 men and was significantly lower than that in the control group (P < 0.001). The serum LH level was less than 2 U/L in 20 of 29 men and was significantly lower than that in the control group (P < 0.001). Serum FSH was comparable in both groups. Decreased libido was present in 22 of 32 women receiving opioids. All 21 premenopausal females developed either amenorrhea or an irregular menstrual cycle, with ovulation in only 1. Supplementation with gonadal steroids improved sexual function in most patients. These findings suggest that further investigations are required to determine the need for systematic endocrine work-up in these patients and the necessity for substitutive therapy.
PMID: 10852454
Rating: 3c
Ackerman LL, Follett KA, Rosenquist RW. Long-term outcomes during treatment of chronic pain with intrathecal clonidine or clonidine/opioid combinations. J Pain Symptom Manage. 2003 Jul;26(1):668-77.
Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
15 patients. In this population, intrathecal clonidine was of limited utility for most patients.
PMID: 12850649
Rating: 5b

Ackermann, L., Follett, K., Rosenquist, R. “Long-Term Outcomes During Treatment of Chronic Pain with Intrathecal Clonidine or Clonidine/Opioid Combinations” Journal of Pain and Symptom Management. 2003; July, Volume 26: 668-76.
Rating: 2c
Quality: Low. Total Rating: 1.0. Comment: Does not meet inclusion criteria for evidence-based review. [CA DWC]

Adams RJ, Appleton SL, Gill TK, Taylor AW, Wilson DH, Hill CL. Cause for concern in the use of non-steroidal anti-inflammatory medications in the community--a population-based study. BMC Fam Pract. 2011 Jul 7;12:70.


There is a high prevalence of current NSAID use among groups at-risk for significant drug-related adverse events or who have major chronic conditions that are relative contraindications to NSAID use.
PMID: 21733195
Rating: 3a

Affaitati G, Fabrizio A, Savini A, Lerza R, Tafuri E, Costantini R, Lapenna D, Giamberardino MA. A randomized, controlled study comparing a lidocaine patch, a placebo patch, and anesthetic injection for treatment of trigger points in patients with myofascial pain syndrome: evaluation of pain and somatic pain thresholds. Clin Ther. 2009;31:705-20.


RESULTS: Sixty white patients were studied. Subjective symptoms did not change with placebo, but decreased significantly with the lidocaine patch and infiltration relative to baseline.
PMID: 19446144
Rating: 2b
The authors indicated that long-term effect remained to be determined

Afilalo M, Etropolski MS, Kuperwasser B, Kelly K, Okamoto A, Van Hove I, Steup A, Lange B, Rauschkolb C, Haeussler J. Efficacy and safety of Tapentadol extended release compared with oxycodone controlled release for the management of moderate to severe chronic pain related to osteoarthritis of the knee: a randomized, double-blind, placebo- and active-controlled phase III study. Clin Drug Investig. 2010;30(8):489-505.


METHODS: A total of 1030 patients. CONCLUSION: treatment with Tapentadol ER 100-250 mg twice daily or oxycodone HCl CR 20-50 mg twice daily was effective for the management of moderate to severe chronic osteoarthritis-related knee pain, with substantially lower incidences of gastrointestinal-related TEAEs associated with treatment with Tapentadol ER than with oxycodone CR.
PMID: 20586515
Rating: 2a

AGS (American Geriatrics Society) 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012 Apr;60(4):616-31. doi: 10.1111/j.1532-5415.2012.03923.x.


Potentially inappropriate medications (PIMs) continue to be prescribed and used as first-line treatment for the most vulnerable of older adults, despite evidence of poor outcomes from the use of PIMs in older adults.
PMID: 22376048
Rating: 1a

AHFS Drug Information. © Copyright, 1959-2008, Selected Revisions March 2008, American Society of Health-System Pharmacists, Inc. Bethesda, MD. 2008.


Rating: 9a

Akeson WH, Amiel D, Abel MF, Garfin SR, Woo SL. Effects of immobilization on joints. Clin Orthop Relat Res. 1987;:28-37.


PMID: 3581580
Rating: 5c

Albazaz R, Wong YT, Homer-Vanniasinkam S. Complex regional pain syndrome: a review. Ann Vasc Surg. 2008;22:297-306.


PMID: 18346583
Rating: 1b

Alexander B, Perry PJ. Detoxification from benzodiazepines: schedules and strategies. J Subst Abuse Treat. 1991;8:9-17.


Low-dose withdrawal includes patients who have received manufacturer-recommended doses of BZD on a daily basis for longer than 1 month. Gradual tapering of the BZD over 4 weeks on an outpatient basis is suggested. High-dose withdrawal includes patients who have been ingesting doses of BZD greater than the equivalent of diazepam 40 mg/d for longer than 8 months. It is recommended that the patients be tolerance tested with diazepam and, if tolerant, tapered off medication as inpatients at a rate of 10% per day.
PMID: 1675694
Rating: 5c

Alford DP, Labelle CT, Kretsch N, Bergeron A, Winter M, Botticelli M, Samet JH. Collaborative care of opioid-addicted patients in primary care using buprenorphine: five-year experience. Arch Intern Med. 2011 Mar 14;171(5):425-31.
RESULTS: From September 1, 2003, through September 30, 2008, 408 patients with opioid addiction were treated with buprenorphine. At 1 year, 51.3% underwent successful treatment. Of patients remaining in treatment at 12 months, 91.1% were no longer using illicit opioids or cocaine based on urine drug test results.
PMID: 21403039
Rating: 3a

Altmaier EM, Lehmann TR, Russell DW, Weinstein JN, Kao CF. The effectiveness of psychological interventions for the rehabilitation of low back pain: a randomized controlled trial evaluation. Pain. 1992 Jun;49(3):329-35.
Division of Psychological and Quantitative Foundations, University of Iowa, Iowa City 52242.
Forty-five low back pain patients. 81% of the patients had returned to work or were engaged in active job retraining by the follow-up. Patient improvement, however, was not differentially affected by treatment group assignment, suggesting that the psychological treatment failed to add to the effectiveness obtained by the standard rehabilitation program.
PMID: 1408299
Rating: 2b

Altman RD, Aven A, Holmburg CE, Pfeifer LM, Sack M, Young GT. Capsaicin Cream 0.025% as Monotherapy for Osteoarthritis: A Double-Blind Study. Seminars in Arthritis and Rheumatism, June 1994;23: Suppl 3:25-33.
Patients (113). These results support the beneficial effects of 0.025% capsaicin cream as a first-line therapy for OA pain.
Rating 2c
Altman R, Barkin RL. Topical therapy for osteoarthritis: clinical and pharmacologic perspectives. Postgrad Med. 2009 Mar;121(2):139-47.
Neither salicylates nor capsaicin have shown significant efficacy in the treatment of OA. Topical diclofenac sodium 1% gel delivers effective diclofenac concentrations in the affected joint with limited systemic exposure.
PMID: 19332972
Rating: 5b

Altman RD, Barthel HR. Topical therapies for osteoarthritis. Drugs. 2011;71:1259-79.


The EULAR and NICE guidelines state that topical NSAIDs should be considered before oral therapies.
PMID: 21770475
Rating: 5c

American College of Medical Quality, acmq.org , Policy 30: Skilled vs. Custodial Care, 2005.


Rating: 8a

American Diabetes Association American Academy of Neurology. Consensus statement: Report and recommendations of the San Antonio conference on diabetic neuropathy. Diabetes Care. 1988 Jul-Aug;11(7):592-7.
What Is Diabetic Neuropathy? Diabetic neuropathy is a nerve disorder caused by diabetes. Symptoms of neuropathy include numbness and sometimes pain in the hands, feet, or legs.
PMID: 3060328
Rating: 5a
American Geriatrics Society (AGS). 2009 Annual Scientific Meeting. April 29 - May 03, 2009; Chicago, Illinois. AGS Panel on Pharmacological Management of Persistent Pain in Older Persons.
Revised practice guidelines on the management of persistent pain in the elderly issued by the American Geriatrics Society (AGS) advise physicians to have their patients avoid non-steroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors and consider the use of low-dose opioid therapy instead. The panel concluded that the risks of NSAIDs in older patients, which include increased cardiovascular risk and gastrointestinal toxicity, usually outweigh the benefits and the revised guidelines reflect this. The author pointed out that "a lot of physicians are frightened sometimes to start down that road of giving opioids for chronic pain, especially noncancer-related pain, so in some circles it is controversial."
Rating: 10a

Ang CD, Alviar MJ, Dans AL, Bautista-Velez GG, Villaruz-Sulit MV, Tan JJ, Co HU, Bautista MR, Roxas AA. Vitamin B for treating peripheral neuropathy. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD004573.
BACKGROUND: Vitamin B is frequently used for treating peripheral neuropathy but its efficacy is not clear. RESULTS: Thirteen studies involving 741 participants with alcoholic or diabetic neuropathy were included. CONCLUSIONS: There are only limited data in randomised trials testing the efficacy of vitamin B for treating peripheral neuropathy and the evidence is insufficient to determine whether vitamin B is beneficial or harmful.
PMID: 18646107
Rating: 1b

Angel IF, Gould HJ Jr, Carey ME. Intrathecal morphine pump as a treatment option in chronic pain of nonmalignant origin. Surg Neurol. 1998 Jan;49(1):92-8; discussion 98-9.


BACKGROUND: Implantable pumps for the delivery of intrathecal morphine have become a common option for administering opiate medication for the management of pain in patients with terminal cancer. Options for treating chronic pain of non-malignant origin are more controversial. METHODS: Eleven patients. CONCLUSIONS: The morphine pump was found to be a viable alternative in the management of failed back syndrome. Its use in long-term therapy, however, is not without limitations and should be a last choice option.
PMID: 9428901
Rating: 4c

Antman EM, Bennett JS, Daugherty A, Furberg C, Roberts H, Taubert KA. Use of Nonsteroidal Antiinflammatory Drugs. An Update for Clinicians. A Scientific Statement From the American Heart Association. Circulation. 2007 Feb 26.


PMID: 17325246
Rating: 6a
From Medscape:

The AHA recommends acetaminophen and aspirin as the best initial choices for analgesia of musculoskeletal pain. NSAIDs should be used at the smallest dose for the shortest course possible, and COX-2 inhibitors should be avoided if there is an alternative analgesic available.

starting with nonpharmacologic treatments, such as physical therapy and exercise, weight loss to reduce stress on joints, and heat or cold therapy. If this does not provide enough pain relief, acetaminophen, aspirin, and even short-term use of narcotic analgesics are recommended as first-line drugs. Then,

Some Question Narcotics as First-Line Treatment

While all appear to support the recommendation that COX-2 inhibitors should be last on the list, some experts have questioned the advice to give a narcotic before a non-COX-2 selective NSAID, particularly naproxen.

Appelboom T. Calcitonin in reflex sympathetic dystrophy syndrome and other painful conditions. Bone. 2002 May;30(5 Suppl):84S-86S.
Division of Rheumatology and Physical Medicine, Erasmus University Hospital, University of Brussels, Brussels, Belgium. tappelbo@ulb.ac.be
Salmon calcitonin (especially intranasal) provides an interesting analgesic effect in a series of painful conditions including reflex sympathetic dystrophy syndrome.
PMID: 12008165
Rating: 5b
American Physical Therapy Association (APTA). Orthopaedic Section BOD. Occupational Health Physical Therapy: Evaluating Functional Capacity Guidelines. 2011

Rating: 8a



Argoff CE. Topical agents for the treatment of chronic pain. Curr Pain Headache Rep. 2006 Feb;10(1):11-9.
Unlike systemic analgesics, topical analgesics exert their analgesic activity locally and without significant systemic absorption. This is in contrast to transdermal analgesics,
PMID: 16499825
Rating: 5b

Argoff CE, Katz N, Backonja M. Treatment of postherpetic neuralgia: a review of therapeutic options. J Pain Symptom Manage. 2004;28:396-411.

Postherpetic neuralgia (PHN) is a disabling consequence of the reactivation of the varicella zoster infection. Physicians can either add another agent to the current regimen or switch to a new type of monotherapy if there is inadequate response to initial therapy.


PMID: 15471658
Rating: 5b

Argoff CE, Galer BS, Jensen MP, Oleka N, Gammaitoni AR. Effectiveness of the lidocaine patch 5% on pain qualities in three chronic pain states: assessment with the Neuropathic Pain Scale. Curr Med Res Opin. 2004;20 Suppl 2:S21-8.


CONCLUSIONS: In patients with moderate-to-severe LBP, 2 weeks and 6 weeks of treatment with the lidocaine patch 5% significantly reduces the intensity of pain qualities as measured by all 4 NPS composite measures.
PMID: 15563741
Rating: 4c

Arnold LM, Goldenberg DL, Stanford SB, Lalonde JK, Sandhu HS, Keck PE Jr, Welge JA, Bishop F, Stanford KE, Hess EV, Hudson JI. Gabapentin in the treatment of fibromyalgia: a randomized, double-blind, placebo-controlled, multicenter trial. Arthritis Rheum. 2007 Apr;56(4):1336-44.
METHODS: A 12-week, randomized, double-blind study was designed to compare gabapentin (1,200-2,400 mg/day) (n=75 patients) with placebo (n=75 patients) RESULTS: Gabapentin-treated patients displayed a significantly greater improvement in the BPI average pain severity score.
PMID: 17393438
Rating: 2a

American Society of Addiction Medicine (ASAM). Public policy statement on rapid and ultra rapid opioid detoxification ( Formerly Public Policy Statement on Opioid Antagonist Agent Detoxification under Sedation or Anesthesia (OADUSA ). www.asam.org. April 2005.
1. Opioid detoxification alone is not a treatment of opioid addiction. ASAM does not support the initiation of acute opioid detoxification interventions unless they are part of an integrated continuum of services that promote ongoing recovery from addiction.

2. Ultra-Rapid Opioid Detoxification (UROD) is a procedure with uncertain risks and benefits, and its use in clinical settings is not supportable until a clearly positive risk-benefit relationship can be demonstrated. Further research on UROD should be conducted.

3. Although there is medical literature describing various techniques of Rapid Opioid Detoxification (ROD), further research into the physiology and consequences of ROD should be supported so that patients may be directed to the most effective treatment methods and practices.

4. Prior to participation in any particular modality of opioid detoxification, a patient should be provided with sufficient information by which to provide informed consent, including information about the risks of termination of a treatment plan of prescribed agonist medications such as methadone or Buprenorphine, as well as the need to comply with medical monitoring of their clinical status for a defined period of time following the procedure to ensure a safe outcome. Patients should also be informed of the risks, benefits and costs of alternative methods of treatment available.


Rating: 6b

Arnold LM, Rosen A, Pritchett YL, D'Souza DN, Goldstein DJ, Iyengar S, Wernicke JF. A randomized, double-blind, placebo-controlled trial of duloxetine in the treatment of women with fibromyalgia with or without major depressive disorder. Pain. 2005 Dec 15;119(1-3):5-15.
354 female patients. In conclusion, both duloxetine 60 mg QD and duloxetine 60 mg BID were effective and safe in the treatment of fibromyalgia in female patients with or without major depressive disorder.
PMID: 16298061
Rating: 2a

Arnold LM. Duloxetine and other antidepressants in the treatment of patients with fibromyalgia. Pain Med. 2007;8:S63-74.

DESIGN: Two randomized, placebo-controlled, double-blind, parallel-group, 12-week trials of duloxetine in the treatment of fibromyalgia were reviewed. RESULTS: Duloxetine has been shown to be an effective and safe treatment for many of the symptoms associated with fibromyalgia, particularly for women. CONCLUSIONS: Antidepressants play an important role in the treatment of patients with fibromyalgia. Agents with dual effects on serotonin and norepinephrine appear to have more consistent benefits than selective serotonin antidepressants for the treatment of persistent pain associated with fibromyalgia.


PMID: 17714117
Rating: 5a
Asfour SS, Khalil TM, Waly SM, Goldberg ML, Rosomoff RS, Rosomoff HL. Biofeedback in back muscle strengthening. Spine. 1990 Jun;15(6):510-3.
The results obtained indicate that the proposed methodology was an effective tool to achieve a significant improvement in the strength of lumbar paraspinal muscles of chronic low-back pain patients.
PMID: 2144915
Rating: 2c
The study included 30 patients, and found that the increase in strength was greater in the biofeedback group (81.3%) versus the control group (16.9%).

Ashton H. The diagnosis and management of benzodiazepine dependence. Curr Opin Psychiatry. 2005 May;18(3):249-55.
PMID: 16639148
Rting: 5b

Ashton H. The treatment of benzodiazepine dependence. Addiction. 1994;89:1535-41.


The benzodiazepine dosage should be tapered at an individually titrated rate which should usually be under the patient's control. Unwilling patients should not be forced to withdraw.
PMID: 7841868
Rating: 5c

Ashton CH. Review: brief interventions, gradual dose reduction and psychological interventions increase benzodiazepine cessation compared with routine care. Evid Based Ment Health. 2009;12:91. doi: 10.1136/ebmh.12.3.91.


PMID: 19633259
Rating: 2b

Asnis GM, Kohn SR, Henderson M, Brown NL. SSRIs versus non-SSRIs in post-traumatic stress disorder: an update with recommendations. Drugs. 2004;64(4):383-404.
Post-traumatic stress disorder (PTSD) is a highly prevalent (7.8% lifetime rate) anxiety disorder with impairment in daily functioning, frequent suicidal behaviour and high rates of co-morbidity. Besides being the most studied and effective drugs for PTSD, SSRIs have a favourable adverse effect profile, making them the first-line treatment for PTSD. Benzodiazepines were ineffective in a double-blind, placebo-controlled study despite encouraging case reports. They should be avoided or used only short term because of potential depressogenic effects, and the possibility that they may promote or worsen PTSD.
PMID: 14969574
Rating: 5b

Astin JA, Shapiro SL, Eisenberg DM, Forys KL, Mind-body medicine: state of the science, implications for practice, J Am Board Fam Pract. 2003 Mar-Apr;16(2):131-47.


BACKGROUND: Although emerging evidence during the past several decades suggests that psychosocial factors can directly influence both physiologic function and health outcomes. METHODS: RESULTS: Drawing principally from systematic reviews and meta-analyses, there is considerable evidence of efficacy for several mind-body therapies in the treatment of coronary artery disease (eg, cardiac rehabilitation), headaches, insomnia, incontinence, chronic low back pain.
PMID: 12665179
Rating: 1c

Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O'Connell D, Oxman AD, Phillips B, Schunemann HJ, Edejer TT, Varonen H, Vist GE, Williams JW Jr, Zaza S; GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ. 2004 Jun 19;328(7454):1490.
Judgments about the strength of a recommendation require consideration of the balance between benefits and harms, the quality of the evidence, translation of the evidence into specific circumstances, and the certainty of the baseline risk. It is also important to consider costs (resource utilisation) before making a recommendation.
PMID: 15205295
Rating: 5b

Attal N, Cruccu G, Haanpää M, Hansson P, Jensen TS, Nurmikko T, Sampaio C, Sindrup S, Wiffen P; EFNS Task Force. EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol 2006;13:1153-69.


Most of the randomized controlled trials included patients with postherpetic neuralgia (PHN) and painful polyneuropathies (PPN) mainly caused by diabetes. These trials provide level A evidence for the efficacy of tricyclic antidepressants, gabapentin, pregabalin and opioids, with a large number of class I trials, followed by topical lidocaine (in PHN) and the newer antidepressants venlafaxine and duloxetine (in PPN). The main peripheral pain conditions respond similarly well to tricyclic antidepressants, gabapentin, and pregabalin, but some conditions, such as HIV-associated polyneuropathy, are more refractory.
PMID: 17038030
Rating: 1A

Aydin G, Tomruk S, Keles I, Demir SO, Orkun S. Transcutaneous electrical nerve stimulation versus baclofen in spasticity: clinical and electrophysiologic comparison. Am J Phys Med Rehabil. 2005 Aug;84(8):584-92.


DESIGN: Patients with spinal cord injury and spasticity were included in the study. Ten patients were assigned to oral baclofen and 11 to TENS groups. For the comparison of H-reflex variables, 20 healthy individuals were allocated to a control group. The percentage change in clinical, electrophysiologic, and functional variables caused by baclofen was not different from that caused by repeated applications of TENS in the short- and long-term evaluations (P > 0.05). CONCLUSION: TENS may be recommended as a supplement to medical treatment in the management of spasticity.
PMID: 16034227
Rating: 2c

Backonja MM, Serra J. Pharmacologic management part 1: better-studied neuropathic pain diseases. Pain Med. 2004;5:S28-47.


This review summarizes the published results of randomized trials involving treatment for neuropathic pain conditions.
PMID: 14996228
Rating: 5a

Backonja MM. Use of anticonvulsants for treatment of neuropathic pain. Neurology. 2002. 10:59:s14-7.


Lamotrigine has been reported to be effective in relieving pain from trigeminal neuralgia refractory to other treatments, HIV neuropathy, and central post-stroke pain.
PMID: 12221151
Rating: 1b
Backonja M, Beydoun A, Edwards KR, Schwartz SL, Fonseca V, Hes M, LaMoreaux L, Garofalo E. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA. 1998 Dec 2;280(21):1831-6.
CONCLUSION: Gabapentin monotherapy appears to be efficacious for the treatment of pain and sleep interference associated with diabetic peripheral neuropathy and exhibits positive effects on mood and quality of life.
PMID: 9846777
Rating: 2b

Bader S, Dürk T, Becker G. Methylnaltrexone for the treatment of opioid-induced constipation. Expert Rev Gastroenterol Hepatol. 2013 Jan;7(1):13-26. doi: 10.1586/egh.12.63.


PMID: 23265145
Rating: 5b

Baillargeon L, Landreville P, Verreault R, Beauchemin JP, Gregoire JP, Morin CM. Discontinuation of benzodiazepines among older insomniac adults treated with cognitive-behavioural therapy combined with gradual tapering: a randomized trial. CMAJ. 2003 Nov 11;169(10):1015-20.


INTERPRETATION: A combination of cognitive-behavioural therapy and benzodiazepine tapering was superior to tapering alone in the management of patients with insomnia and chronic benzodiazepine use.
PMID: 14609970
Rating: 2b

Bair MJ, Wu J, Damush TM, Sutherland JM, Kroenke K. Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients. Psychosom Med. 2008;70:890-7.


CONCLUSIONS: The added morbidity of depression and anxiety with chronic pain is strongly associated with more severe pain, greater disability, and poorer HRQL.
PMID: 18799425
Rating 3a

Baldwin DS, Anderson IM, Nutt DJ, Bandelow B, Bond A, Davidson JR, den Boer JA, Fineberg NA, Knapp M, Scott J, Wittchen HU; British Association for Psychopharmacology. Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2005; 19:567-96.


PMID: 16272179
Rating: 5a

Baliki MN, Geha PY, Apkarian AV, Chialvo DR. Beyond feeling: chronic pain hurts the brain, disrupting the default-mode network dynamics. J Neurosci. 2008 Feb 6;28(6):1398-403.


Recent studies have demonstrated that chronic pain harms cortical areas unrelated to pain.
PMID: 18256259
Rating: 4c
Bandelow B, Zohar J, Hollander E, Kasper S, Möller HJ; World Federation of Societies of Biological Psychiatry Task Force on Treatment Guidelines for Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders. World J Biol Psychiatry. 2002; 3:171-99
Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for panic disorder. Tri2-cyclic antidepressants (TCAs) are equally effective, but they are less well tolerated than the SSRIs..
PMID: 12516310
Rating: 5a
Bansal V, Kalita J, Misra UK. Diabetic neuropathy. Postgrad Med J. 2006 Feb;82(964):95-100.
For diagnosis of DN, symptoms, signs, quantitative sensory testing, nerve conduction study, and autonomic testing are used; and two of these five are recommended for clinical diagnosis.
PMID: 16461471
Rating: 5a

Baraf HS, Gloth FM, Barthel HR, Gold MS, Altman RD. Safety and efficacy of topical diclofenac sodium gel for knee osteoarthritis in elderly and younger patients: pooled data from three randomized, double-blind, parallel-group, placebo-controlled, multicentre trials. Drugs Aging. 2011 Jan 1;28(1):27-40.


RESULTS: The MES included both patients aged 25-64 (n = 602) and ≥65 (n = 374) years. Treatment-related application site dermatitis was more common with DSG. Gastrointestinal AEs were infrequent.
PMID: 21174485
Rating: 2b

Barbaud A. Contact dermatitis due to topical drugs. G Ital Dermatol Venereol. 2009;144:527-36.


In case of photosensitization 1) to ketoprofen or 2) piroxicam the topical and/or systemic administration of the following molecules are contraindicated with respectively 1) ketoprofen, tiaprofenic acid, fenofibrate, oxybenzone or 2) piroxicam, thimerosal.
PMID: 19834431
Rating: 5b

Barbui C, Guaiana G, Hotopf M. Amitriptyline for inpatients and SSRIs for outpatients with depression? Systematic review and meta-regression analysis. Pharmacopsychiatry. 2004 May;37(3):93-7.


CONCLUSIONS: These data suggest that a reasonable approach could be the first-line prescription of newer agents in the routine outpatient care of depressive subjects, and the use of amitriptyline in inpatients with severe depression.
PMID: 15179966
Rating: 1a

Barrows KA, Jacobs BP. Mind-body medicine. An introduction and review of the literature. Medical Clinics of North America. 01-Jan-2002; 86(1): 11-31.


MBM therapies are effective in improving quality of life, anxiety, and pain intensity for a variety of conditions.

PMID: 11795084



Bart G. Maintenance medication for opiate addiction: the foundation of recovery. J Addict Dis. 2012;31(3):207-25
PMID: 22873183
Rating: 5b

Bartels S, Sivilotti M, Crosby D, Richard J. Are recommended doses of acetaminophen hepatotoxic for recently abstinent alcoholics? A randomized trial. Clin Toxicol (Phila). 2008;46:243-9.


PMID: 18344107
Rating: 2b

Beals RK, Hickman NW. Industrial injuries of the back and extremities. Comprehensive evaluation--an aid in prognosis and management: a study of one hundred and eighty patients. J Bone Joint Surg Am. 1972;54:1593-611.


PMID: 4143913
Rating: 3b

Beerthuizen A, van 't Spijker A, Huygen FJ, Klein J, de Wit R. Is there an association between psychological factors and the Complex Regional Pain Syndrome type 1 (CRPS1) in adults? A systematic review. Pain. 2009;145:52-9.


PMID: 19573987
Rating: 1c

Beerthuizen A, Stronks DL, Huygen FJ, Passchier J, Klein J, Spijker AV. The association between psychological factors and the development of complex regional pain syndrome type 1 (CRPS1)--a prospective multicenter study. Eur J Pain. 2011;15:971-5.


PMID: 21459637
Rating: 3a

Benca RM. Diagnosis and treatment of chronic insomnia: a review. Psychiatr Serv. 2005;56:332-43.


CONCLUSIONS: Insomnia is particularly challenging for clinicians because of the lack of guidelines and the small number of studies conducted in patient populations with behavioral and pharmacologic therapies. Current treatment options do not address the needs of difficult-to-treat patients with chronic insomnia, such as the elderly, and those with comorbid medical and psychiatric conditions.
PMID: 15746509
Rating: 1c

Bendix AF, Bendix T, Labriola M, Boekgaard P. Functional restoration for chronic low back pain. Two-year follow-up of two randomized clinical trials. Spine. 1998 Mar 15;23(6):717-25.


STUDY DESIGN: Two randomized, prospective clinical trials involving 238 chronic low back disability patients were carried out. Results at 2-year follow-up are presented. METHODS: Two hundred thirty-eight patients with chronic low back disability of at least 6 months' duration were included. RESULTS: Of the remaining 225 patients, 20 (9%) did not complete treatment. The questionnaire response rate was 94%. In Project A, those patients receiving treatment (functional restoration) reported significantly less contact with the health care system, fewer sick leave days, and a less disabled life style during the follow-up period, compared with reports of patients in the control group. Other effect parameters did not demonstrate a significant difference between the two groups. CONCLUSIONS: indicate the necessity of testing a treatment program in different settings, in that the statistical variation may be a major factor in results of different studies.
PMID: 9549794
Rating: 2b

Bendix AF, Bendix T, Lund C, Kirkbak S, Ostenfeld S. Comparison of three intensive programs for chronic low back pain patients: a prospective, randomized, observer-blinded study with one-year follow-up. Scand J Rehabil Med. 1997;29:81-9.


Conclusively, it seems that there is human, as well as economical, benefit from a functional restoration program compared to less intensive programs for these patients.
PMID: 9198257
Rating: 2b

Bendix AF, Bendix T, Haestrup C. Can it be predicted which patients with chronic low back pain should be offered tertiary rehabilitation in a functional restoration program? A search for demographic, socioeconomic, and physical predictors. Spine. 1998;23:1775-83; discussion 1783-4.


CONCLUSIONS: Different factors can be identified as predictive of outcome in a functional restoration program, but most of these factors were also shown to predict success for shorter control outpatient programs or of no treatment.
PMID: 9728378
Rating: 2b

Bendix T, Bendix A, Labriola M, Haestrup C, Ebbehøj N. Functional restoration versus outpatient physical training in chronic low back pain: a randomized comparative study. Spine. 2000;25:2494-500.


DISCUSSION: It may be that lower economic benefits during sick leave in the United States lead to favorable results from functional restoration programs, whereas greater benefits in Canada, Finland, and Denmark result in different conclusions.
PMID: 11013502
Rating: 2b

Bennett G, Burchiel K, Buchser E, Classen A, Deer T, Du Pen S, Ferrante FM, Hassenbusch SJ, Lou L, Maeyaert J, Penn R, Portenoy RK, Rauck R, Serafini M, Willis KD, Yaksh T. Clinical guidelines for intraspinal infusion: report of an expert panel. PolyAnalgesic Consensus Conference 2000. J Pain Symptom Manage. 2000 Aug;20(2):S37-43.


PMID: 10989256
Rating: 8b

Benzon HT, Raja SN, Molloy RE, Liu SS, Fishman SM. Essentials of Pain Medicine and Regional Anesthesia. 2nd ed. Elisevier 2005, p. 215.


Rating: 9a

Berlach DM, Shir Y, Ware MA. Experience with the synthetic cannabinoid nabilone in chronic noncancer pain. Pain Med. 2006 Jan-Feb;7(1):25-9.


In this article, we review our clinical experience of 20 adult patients with chronic noncancer pain. Nabilone may be a useful addition to pain management and should be further evaluated in randomized controlled trials.
PMID: 16533193
Rating: 4b

Bernacki EJ, Guidera JA, Schaefer JA, Tsai S, A facilitated early return to work program at a large urban medical center, J Occup Environ Med 2000 Dec;42(12):1172-7



Rating: 5a

Bhala N, Emberson J, Merhi A, Abramson S, Arber N, Baron JA, Bombardier C, Cannon C, Farkouh ME, FitzGerald GA, Goss P, Halls H, Hawk E, Hawkey C, Hennekens C, Hochberg M, Holland LE, Kearney PM, Laine L, Lanas A, Lance P, Laupacis A, Oates J, Patrono C, Schnitzer TJ, Solomon S, Tugwell P, Wilson K, Wittes J, Baigent C. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013 Aug 31;382(9894):769-79. doi: 10.1016/S0140-6736(13)60900-9.

PMID: 23726390


Rating: 1a

Bhattacharyya S, Crippa JA, Allen P, Martin-Santos R, Borgwardt S, Fusar-Poli P, Rubia K, Kambeitz J, O'Carroll C, Seal ML, Giampietro V, Brammer M, Zuardi AW, Atakan Z, McGuire PK. Induction of psychosis by {delta}9-tetrahydrocannabinol reflects modulation of prefrontal and striatal function during attentional salience processing. Arch Gen Psychiatry. 2012 Jan;69(1):27-36.


Δ9-Tetrahydrocannabinol and CBD differentially modulate prefrontal, striatal, and hippocampal function during attentional salience processing. These effects may contribute to the effects of cannabis on psychotic symptoms and on the risk of psychotic disorders.
PMID: 22213786
Rating: 3c

Bigos SJ, McKee JE, Holland JP, Holland CL, Hildebrandt J, Back pain, the uncomfortable truth - assurance and activity problem. Schmerz 2001 Dec;15(6):430-4


Rating: 5a

Birklein F. Complex regional pain syndrome. J Neurol. 2005 Feb;252(2):131-8.


PMID: 15729516
Rating: 5b

Biswal S, Medhi B, Pandhi P. Longterm efficacy of topical nonsteroidal antiinflammatory drugs in knee osteoarthritis: metaanalysis of randomized placebo controlled clinical trials. J Rheumatol. 2006;33:1841-4.


CONCLUSION: Topical NSAID are effective for pain relief in knee OA for a longer duration; however, this may not hold true for all the preparations.
PMID: 16960944
Rating: 1c

Bjordal JM, Klovning A, Ljunggren AE, Slørdal L. Short-term efficacy of pharmacotherapeutic interventions in osteoarthritic knee pain: A meta-analysis of randomised placebo-controlled trials. Eur J Pain. 2007;11:125-38.


Heterogeneity tests revealed that best efficacy values of topical NSAIDs may be slightly deflated, while data for oral NSAIDs may be slightly inflated due to probable patient selection bias.
PMID: 16682240
Rating 1c

Blommel ML, Blommel AL. Pregabalin: an antiepileptic agent useful for neuropathic pain. Am J Health Syst Pharm. 2007;15;64:1475-82.


Pregabalin may be beneficial for the treatment of neuropathic pain or partial-onset seizures in patients who do not respond to conventional treatments or cannot tolerate their adverse effects.
PMID: 17617497
Rating: 5b

BlueCross BlueShield, Surgery Section - Percutaneous Electrical Nerve Stimulation (PENS), Policy No: 44, 08/03/2004


Rating: 8b

BlueCross BlueShield, Durable Medical Equipment Section - Electrical Stimulation Devices for Home Use, DME Policy No: 11, Approved Date: 04/05/2005. Also Electrical Stimulators for pain, seizures, or cerebral palsy. Policy 003; Posted 4/23/07.


Rating: 8b

BlueCross BlueShield, Durable Medical Equipment Section - Sympathetic Therapy for the Treatment of Pain, DME Policy No: 65. Effective Date: 03/01/2005


Sympathetic therapy is considered investigational. The lack of published outcomes from well-designed clinical trials prohibits scientific conclusions concerning the health outcome effects of sympathetic therapy for the treatment of pain.
Rating: 8b

BlueCross BlueShield, Durable Medical Equipment Section - Interferential Stimulation, DME Policy No: 66. Effective Date: 03/01/2005. Updated 2006.


Interferential current stimulation is considered investigational. The results of placebo-controlled trials have reported negative findings of interferential therapy. Interferential therapy (such as RS-4i): Is denied experimental/investigational.
Rating: 8b

BlueCross BlueShield, Durable Medical Equipment Section - Biomagnetic Therapy, DME Policy No: 55, Effective Date: 03/01/2005


The data from the above randomized, placebo-controlled clinical trials fails to demonstrate that biomagnetic therapy results in improved health outcomes for any type of pain.
Rating: 8b
BlueCross BlueShield. Surgery Section - Fully Implantable Infusion Pump. Policy No: 18. Effective Date: 04/05/2005
Fully implantable infusion pumps are considered investigational for all other indications.
Rating: 8c
BlueCross BlueShield. Medicine Section - Low Level Laser Treatment of Neuromuscular Pain Disorders. Policy No: 105, Effective Date: 03/01/2005
Rating: 8b

BlueCross BlueShield. Utilization Management Section - Pain Rehabilitation Programs. Policy No: 5, Effective Date: 06/01/2004


Rating: 8b
BlueCross BlueShield. Surgery Section - Spinal Cord Stimulation for Treatment of Pain. Policy No: 45, Effective Date: 07/06/2004
Rating: 8b
BlueCross BlueShield. Allied Health - Biofeedback as a Treatment of Chronic Pain. Policy No: 28. Effective Date: 08/03/2004
The available evidence did not clearly show whether biofeedback’s effects exceeded nonspecific placebo effects. It was also unclear whether biofeedback added to the effectiveness of relaxation training alone.
Rating: 8b
References

1. BlueCross BlueShield Association Medical Policy Reference Manual; Policy No. 2.01.30

2. NIH Technology Assessment Panel. Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. JAMA 1996;276(4):313-8

3. 1996 TEC Assessment: Biofeedback

4. Bush C, Ditto B, Feuerstein M. A controlled evaluation of paraspinal EMG biofeedback in the treatment of chronic low back pain. Health Psychol 1985;4(4):307-21

5. Stuckey SJ, Jacobs A, Goldfarb J. EMG biofeedback training, relaxation training, and placebo for the relief of chronic back pain. Percept Mot Skills 1986;63(3):1023-36

6. Flor H, Haag G, Turk DC et al. Efficacy of EMG biofeedback, pseudotherapy, and conventional medical treatment for chronic rheumatic back pain. Pain 1983;17(1):21-31

7. Buckelew SP, Conway R, Parker J et al. Biofeedback/relaxation training and exercise interventions for fibromyalgia: a prospective trial. Arthritis Care Res 1998;11(3):196-209

8. Dursun N, Dursun E, Kilic Z. Electromyographic biofeedback-controlled exercise versus conservative care for patellofemoral pain syndrome. Arch Phys Med Rehabil 2001; 82(12):1692-5

9. Humphreys PA, Gevirtz RN. Treatment of recurrent abdominal pain: components analysis of four treatment protocols. J Pediatr Gastroenterol Nutr 2000;31(1):47-51

10. Bergeron S, Binik YM, Khalife S et al. A randomized comparison of group cognitive-behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain 2001;91(3):297-306

11. van Santen M, Bolwijn P, Verstappen F et al. A randomized clinical trial comparing fitness and biofeedback training versus basic treatment in patients with fibromyalgia. J Rheumatol 2002;29(3):575-81

12. Astin JA, Beckner W, Soeken K et al. Psychological interventions for rheumatoid arthritis: a meta-analysis of randomized controlled trials. Arthritis Rheum 2002;47(3):291-302

13. Weydert JA, Ball TM, Davis MF. Systematic review of treatments for recurrent abdominal pain. Pediatrics 2003; 111(1):e1-11


BlueCross BlueShield. Medicine Section - Trigger Point Therapy. Policy No: 39. Effective Date: 11/01/2004
Rating: 8c
BlueCross BlueShield. Medicine Section - Prolotherapy. Policy No: 40. Effective Date: 07/11/06
Rating: 8b
BlueCross BlueShield. Radiology Section - Thermography. Policy No: 17. Effective Date: 04/05/2005
Rating: 8b
BlueCross. Pulsed Radiofrequency (PRF) Treatment for Chronic Pain Syndromes. Policy #: MED.00071. Current Effective Date: 09/22/2005

Rating: 8c


BlueCross of California. Implantable Infusion Pumps. Policy #: SURG.00068. Current Effective Date: 07/14/2005
Rating: 8a

Blum K, Chen TJ, Martinez-Pons M, Dinubile NA, Waite RL, Schoolfield J, Blum SH, Mengucci J, Downs BW, Meshkin B. The H-Wave small muscle fiber stimulator, a nonpharmacologic alternative for the treatment of chronic soft-tissue injury and neuropathic pain: an extended population observational study. Adv Ther. 2006 Sep-Oct;23(5):739-49.


PMID: 17142209
Rating: 4c
Patient Selection Criteria from the study: All enrolled patients had a previous physician-documented diagnosis of chronic soft-tissue injury or neuropathic pain in an upper or lower extremity or the spine that was unresponsive to conventional therapy, such as physical therapy, medications, and transcutaneous electrical nerve stimulation (TENS), and other analgesic electrical stimulator modalities.

Blum K, DiNubile NA, Tekten T, Chen TJ, Waite RL, Schoolfield J, Martinez-Pons M, Callahan MF, Smith TL, Mengucci J, Blum SH, Meshkin B. H-Wave, a nonpharmacologic alternative for the treatment of patients with chronic soft tissue inflammation and neuropathic pain: a preliminary statistical outcome study. Adv Ther. 2006 May-Jun;23(3):446-55.


PMID: 16912027
Rating: 4c
Blum K, Chen AL, Chen TJ, Prihoda TJ, Schoolfield J, Dinubile N, Waite RL, Arcuri V, Kerner M, Braverman ER, Rhoades P, Tung H. The H-Wave(R) device is an effective and safe non-pharmacological analgesic for chronic pain: a meta-analysis. Adv Ther. 2008 Jul;25(7):644-57.
PMID: 18636234
Rating: 1c
Note: The low quality rating for this “meta-analysis” is primarily because the numbers were dominated by results from studies that were not prospective randomized controlled trials. For reported results concerning "Reduction in pain medication" and "Increased functionality," the meta-analysis relied 100% on the Blum 2006 studies. For reported results concerning "Reduction in pain," there were 4 studies, with 3 small prospective studies that looked only at diabetic neuropathy, plus the Blum 2006 study, but the Blum study accounted for 92% of the effect size sample for this measurement. The study also says, “RCTs were found to have a signifcantly lower effect size.” The Blum 2006 studies that dominate this meta-analysis were retrospective observational studies using a patient survey, the H-Wave Customer Service Questionnaire, without a prospective control group. According to this meta-analysis, "double-blinded studies of the H-Wave device are currently underway and results will be awaited with interest." The study author is an outside independent consultant of Electronic Waveform Lab, Inc.

Blum K, Chen AL, Chen TJ, Waite RL, Downs BW, Braverman ER, Kerner MM, Savarimuthu SM, DiNubile N. Repetitive H-wave device stimulation and program induces significant increases in the range of motion of post operative rotator cuff reconstruction in a double-blinded randomized placebo controlled human study. BMC Musculoskelet Disord. 2009 Oct 29;10:132. doi: 10.1186/1471-2474-10-132.


PMID: 19874593
Rating: 2c

Bocanegra TS, Weaver AL, Tindall EA, Sikes DH, Ball JA, Wallemark CB, Geis GS, Fort JG. Diclofenac/misoprostol compared with diclofenac in the treatment of osteoarthritis of the knee or hip: a randomized, placebo controlled trial. Arthrotec Osteoarthritis Study Group. J Rheumatol. 1998;25:1602-11.
CONCLUSION: Diclofenac 50 mg/misoprostol 200 microg t.i.d. and diclofenac 75 mg/misoprostol 200 microg b.i.d. are as efficacious as diclofenac 75 mg b.i.d. in the treatment of OA, but are associated with a significantly lower incidence of gastric and/or duodenal ulcers.
PMID: 9712107
Rating: 2a

Bolona ER, Uraga MV, Haddad RM, Tracz MJ, Sideras K, Kennedy CC, Caples SM, Erwin PJ, Montori VM. Testosterone use in men with sexual dysfunction: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin Proc. 2007;82:20-8.


Testosterone use in men is associated with small improvements in satisfaction with erectile function and moderate improvements in libido. Unexplained inconsistent results across trials, wide CIs, and possible reporting bias weaken these inferences.
PMID: 17285782
Rating: 1a
Boothby LA, Doering PL, Halton RC. Carisoprodol: A marginally effective skeletal muscle relaxant with serious abuse potential. Hospital Pharmacy. 2003;38:337-45.
Rating: 9b

Borchers AT, Gershwin ME. Complex regional pain syndrome: A comprehensive and critical review. Autoimmun Rev. 2013 Oct 23. pii: S1568-9972(13)00181-X. doi: 10.1016/j.autrev.2013.10.006.


PMID: 24161450
Rating: 5a

Borg-Stein J, Simons DG. Focused review: myofascial pain. Arch Phys Med Rehabil. 2002 Mar;83(3 Suppl 1):S40-7, S48-9.


PMID: 11973695
Rating: 5a
Borsook D, Becerra LR. Breaking down the barriers: fMRI applications in pain, analgesia and analgesics. Mol Pain. 2006 Sep 18;2:30.
PMID: 16982005
Rating: 5b
Borsook, D., et al. Neuroimaging revolutionizes therapeutic approaches to chronic pain. Molecular Pain. 2000; Volume 3, Number 25.
Rating: 5c
Quality: N/A. Total Rating: N/A. Comment: Does not meet inclusion criteria for evidence-based review. [CA DWC]

Boseman J, Disability management. Application of a nurse based model in a large corporation, AAOHN J 2001 Apr;49(4):176-86


PMID: 11760522

Rating: 5b


Boswell MV, Shah RV, Everett CR, Sehgal N, Mckenzie-Brown AM, Abdi S, Bowman RC, Deer TR, Datta S, Colson JD, Spillane WF, Smith HS, Lucas LF, Burton AW, Chopra P, Staats PS, Wasserman RA, Manchikanti L. Interventional Techniques in The Management of Chronic Spinal Pain: Evidence-Based Practice Guidelines. Pain Physician. 2005;8:1-47
[Note: Much of the evidence used in this practice guideline for pain physicians is based on studies published in Pain Physician, a journal not included in Medline’s list of indexed journals evaluated for quality that offer the credibility of an independent peer-review process. These studies were not part of the evidence base for ODG Treatment or the ACOEM Guidelines.]
Rating: 6c

Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L. Interventional Techniques: Evidence-based Practice Guidelines in the Management of Chronic Spinal Pain. Pain Physician. 2007;10:7-111.


These guidelines also do not represent a “standard of care.”
Rating: 6b
Braham R, Dawson B, Goodman C, The effect of glucosamine supplementation on people experiencing regular knee pain, Br J Sports Med. 2003 Feb;37(1):45-9; discussion 49
PMID: 12547742

Rating: 2b


Bramness JG, Skurtveit S, Mørland J, Engeland A. The risk of traffic accidents after prescriptions of carisoprodol. Accid Anal Prev. 2007;39:1050-5.
PMID: 17854578
Rating: 3a

Bramness JG, Skurtveit S, Mørland J. Impairment due to intake of carisoprodol. Drug Alcohol Depend. 2004;74:311-8.


PMID: 15194209
Rating: 4b

Breit R, Van der Wall H. Transcutaneous electrical nerve stimulation for postoperative pain relief after total knee arthroplasty. J Arthroplasty. 2004 Jan;19(1):45-8.


We conclude that there is no utility for TENS in the postoperative management of pain after knee arthroplasty.
PMID: 14716650
Rating 2c

Broomhead A, Kerr R, Tester W, O'Meara P, Maccarrone C, Bowles R, Hodsman P. Comparison of a once-a-day sustained-release morphine formulation with standard oral morphine treatment for cancer pain. J Pain Symptom Manage. 1997;14:63-73.

PMID: 9262035


Rating: 1c

Brosseau L, Welch V, Wells G, DeBie R, Gam A, Harman K, Morin M, Shea B, Tugwell P, Low level laser therapy (Classes I, II and III) for treating osteoarthritis, Cochrane Database Syst Rev. 2004;(3):CD002046


CONCLUSIONS: For OA, the results are conflicting in different studies and may depend on the method of application and other features of the LLLT application.
PMID: 15266461
Rating: 1b
Brown JE, Chatterjee N, Younger J, Mackey S. Towards a Physiology-Based Measure of Pain: Patterns of Human Brain Activity Distinguish Painful from Non-Painful Thermal Stimulation. PLoS ONE 6(9): e24124. Sept. 13, 2011.
In fMRI experiments, 24 individuals were presented painful and nonpainful thermal stimuli. Our findings demonstrate that fMRI with SVM learning can assess pain without requiring any communication from the person being tested.
Rating: 3c

Browning R, Jackson JL, O'Malley PG, Cyclobenzaprine and back pain: a meta-analysis, Arch Intern Med. 2001 Jul 9;161(13):1613-20.


CONCLUSIONS: Cyclobenzaprine is more effective than placebo in the management of back pain; the effect is modest and comes at the price of greater adverse effects. The effect is greatest in the first 4 days of treatment, suggesting that shorter courses may be better.
PMID: 11434793

Rating: 1a

Bruce B, Fries J, Lubeck D. Aerobic exercise and its impact on musculoskeletal pain in older adults: a 14 year prospective, longitudinal study. Arthritis Res Ther 2005 Sept 19; R1263-R1270

Exercise was associated with significantly lower pain scores over time in the Runners' Association group after adjusting for gender, baseline BMI, and study attrition (p < 0.01). Similar differences were observed for Ever-Runners versus Never-Runners. Consistent exercise patterns over the long-term in physically active seniors are associated with about 25% less musculoskeletal pain than reported by more sedentary controls, either by calendar year or by cumulative area-under-the-curve pain over average ages of 62 to 76 years.

Rating: 3a


Bruehl S, Harden RN, Galer BS, Saltz S, Bertram M, Backonja M, Gayles R, Rudin N, Bhugra MK, Stanton-Hicks M. External validation of IASP diagnostic criteria for Complex Regional Pain Syndrome and proposed research diagnostic criteria. International Association for the Study of Pain. Pain. 1999 May;81(1-2):147-54.
These results indicate that the current IASP criteria for CRPS have inadequate specificity and are likely to lead to overdiagnosis.
PMID: 10353502
Rating: 4b

Bruehl S. An update on the pathophysiology of complex regional pain syndrome. Anesthesiology. 2010;113:713-25.


PMID: 20693883
Rating: 5b
Bruns D. Colorado Division of Workers’ Compensation, Comprehensive Psychological Testing: Psychological Tests Commonly Used in the Assessment of Chronic Pain Patients. 2001
The following 26 tests are described and evaluated:


  1. BHI™ 2 (Battery for Health Improvement – 2nd edition)

  2. MBHI™ (Millon Behavioral Health Inventory) [Has been superceded by the MBMD. The updated version of the test, the MBMD, should be administered instead.]

  3. MBMD™ (Millon Behavioral Medical Diagnostic)

  4. PAB (Pain Assessment Battery)

  5. MCMI-111™ (Millon Clinical Multiaxial Inventory, 3rd edition)

  6. MMPI-2™ (Minnesota Inventory- 2nd edition ™)

  7. PAI™ (Personality Assessment Inventory)

  8. BBHI™ 2 (Brief Battery for Health Improvement – 2nd edition)

  9. MPI (Multidimensional Pain Inventory)

  10. P-3™ (Pain Patient Profile)

  11. Pain Presentation Inventory

  12. PRIME-MD (Primary Care Evaluation for Mental Disorders)

  13. PHQ (Patient Health Questionnaire)

  14. SF 36 ™

  15. (SIP) Sickness Impact Profile

  16. BSI® (Brief Symptom Inventory)

  17. BSI® 18 (Brief Symptom Inventory-18)

  18. SCL-90-R® (Symptom Checklist –90 Revised)

  19. BDI ®–II (Beck Depression Inventory-2nd edition)

  20. CES-D (Center for Epidemiological Studies Depression Scale)

  21. PDS™ (Post Traumatic Stress Diagnostic Scale)

  22. Zung Depression Inventory

  23. MPQ (McGill Pain Questionnaire)

  24. MPQ-SF (McGill Pain Questionnaire – Short Form)

  25. Oswestry Disability Questionnaire

  26. Visual Analogue Pain Scale (VAS)

Rating: 7a

Burch F, Codding C, Patel N, Sheldon E. Lidocaine patch 5% improves pain, stiffness, and physical function in osteoarthritis pain patients. A prospective, multicenter, open-label effectiveness trial. Osteoarthritis Cartilage. 2004;12:253-5.
PMID: 14972343
Rating: 4b

Burch FX, Tarro JN, Greenberg JJ, Carroll WJ. Evaluating the benefits of patterned stimulation in the treatment of osteoarthritis of the knee: a multi-center, randomized, single-blind, controlled study with an independent masked evaluator. Osteoarthritis Cartilage. 2008 Aug;16(8):865-72. Epub 2008 Feb 8.


OBJECTIVE: This study investigated the benefits of the combination of interferential (IF) and patterned muscle stimulation in the treatment of osteoarthritis (OA) of the knee. CONCLUSIONS: In patients with OA of the knee, home-based patterned stimulation appears to be a promising therapy for relieving pain, decreasing stiffness, and increasing function.
PMID: 18262443
Rating: 2b
The device used to deliver the electrical stimulation was the RS-4i Stimulator (RS Medical, 14001 SE First Street, Vancouver, WA). Stimulators were pre-programmed to deliver either IF plus patterned muscle stimulation or low-current TENS treatment. The study assessed the benefits of a home-based electrostimulation treatment combining IF and patterned muscle stimulation in treatment of OA of the knee. Low-current TENS was applied as a control. Our results suggest that patterned stimulation has the potential to be a more effective treatment modality than conventional single-step TENS for OA of the knee.

Conflict of interest: This study was supported by industrial funding. The sponsoring organization, RS Medical, has financial interest in patterned stimulation supplied by the RS-4i electrostimulation device. The corresponding author, WJ Carroll, is employed by the sponsor as Vice President of Research and Product Development. J.J. Greenberg was employed by the sponsor as Research Scientist during the conduct of the study. F.X. Burch, M.D., of Radiant Research, San Antonio and J.N. Tarro, M.D., of Radiant Research, Portland were paid contributors (as principal investigators).

Role of the Funding Source: The sponsor of this study, RS Medical, designed the study and provided the infrastructure for collecting study data. RS Medical and its paid consultants analyzed and interpreted the data and prepared this manuscript. RS Medical is responsible for the decision to submit the manuscript for publication.


Burton AW, Interventional Therapies. In: Complex Regional Pain Syndrome: Treatment Guidelines. Ed. Harden N. Reflex Sympathetic Dystrophy Syndrome Association. 2006. Retrieved July 2008. Available at: http://www.rsds.org/3/clinical_guidelines/index.html.
No abstract available. A discussion of the role of interventional therapy for CRPS.
Rating: 5a

Buchner M, Zahlten-Hinguranage A, Schiltenwolf M, Neubauer E. Therapy outcome after multidisciplinary treatment for chronic neck and chronic low back pain: a prospective clinical study in 365 patients. Scand J Rheumatol. 2006 Sep-Oct;35(5):363-7.


CONCLUSION: Evaluation of the main results of this study suggests that patients with chronic NP also derive significant benefit from a multidisciplinary treatment strategy, demonstrated in the literature so far mainly for patients with chronic LBP.
PMID: 17062436
Rating: 3a

Burleson AM. American Academy of Pain Medicine 24th Annual Meeting (Orlando, FL): Abstract 105. February 15, 2008.


Physical conditioning in chronic pain patients can have immediate and long-term benefits, according to a new study presented at the American Academy of Pain Medicine 24th Annual Meeting. The final sample of 28 patients.
Rating: 10b

Buscemi N, Vandermeer B, Friesen C et al. Manifestations and Management of Chronic Insomnia in Adults. Summary,Evidence Report/Technology Assessment No. 125. (Prepared by the University of Alberta Evidence-based Practice Center, under Contract No. C400000021.) AHRQ Publication No.05-E021-1. Rockville, MD: Agency for Healthcare Research and Quality. June 2005.


Rating 1 a

Buscemi N, Vandermeer B, Friesen C, Bialy L, Tubman M, Ospina M, Klassen TP, Witmans M. The efficacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCTs. J Gen Intern Med. 2007;22:1335-50.


BACKGROUND: Hypnotics have a role in the management of acute insomnia; however, the efficacy and safety of pharmacological interventions in the management of chronic insomnia is unclear. CONCLUSIONS: Benzodiazepines and non-benzodiazepines are effective treatments in the management of chronic insomnia, although they pose a risk of harm. There is also some evidence that antidepressants are effective and that they pose a risk of harm.
Rating: 1a

Busch AJ, Barber KA, Overend TJ, Peloso PM, Schachter CL. Exercise for treating fibromyalgia syndrome. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003786.


CONCLUSIONS: There is 'gold' level evidence (www.cochranemsk.org) that supervised aerobic exercise training has beneficial effects on physical capacity and FMS symptoms. Strength training may also have benefits on some FMS symptoms.
PMID: 17943797
Rating: 1b

Bush C, Ditto B, Feuerstein M. A controlled evaluation of paraspinal EMG biofeedback in the treatment of chronic low back pain. Health Psychol. 1985;4(4):307-21.


PMID: 2932330
Rating: 2b

Büssing A, Ostermann T, Lüdtke R, Michalsen A. Effects of yoga interventions on pain and pain-associated disability: a meta-analysis. J Pain. 2012 Jan;13(1):1-9.


This meta-analysis suggests that yoga is a useful supplementary approach with moderate effect sizes on pain and associated disability.
PMID: 22178433
Rating: 1b

Buvanendran A, Kroin JS. Useful adjuvants for postoperative pain management. Best Pract Res Clin Anaesthesiol. 2007 Mar;21(1):31-49.


Gabapentin-like compounds have low potency against acute pain, but in combination with opioids allow a reduction in opioid dose with improved analgesia.
PMID: 17489218
Rating: 5b

Buynak R, Shapiro DY, Okamoto A, Van Hove I, Rauschkolb C, Steup A, Lange B, Lange C, Etropolski M. Efficacy and safety of tapentadol extended release for the management of chronic low back pain: results of a prospective, randomized, double-blind, placebo- and active-controlled Phase III study. Expert Opin Pharmacother. 2010 Aug;11(11):1787-804.


DESIGN: Patients (N = 981) were randomized. CONCLUSIONS: Tapentadol ER effectively relieved moderate to severe chronic low back pain over 15 weeks and had better gastrointestinal tolerability than oxycodone.
PMID: 20578811
Rating: 2a
Calandre EP, Morillas-Arques P, Molina-Barea R, Rodriguez-Lopez CM, Rico-Villademoros F. Trazodone plus pregabalin combination in the treatment of fibromyalgia: a two-phase, 24-week, open-label uncontrolled study. BMC Musculoskelet Disord. 2011 May 16;12:95.
CONCLUSIONS: Trazodone significantly improved fibromyalgia severity and associated symptomatology. with pregabalin potentiated this improvement and the tolerability of the drugs in association was good.
PMID: 21575194
Rating: 3b

Caldwell JR. Avinza - 24-h sustained-release oral morphine therapy. Expert Opin Pharmacother. 2004;5:469-72


PMID: 14996642
Rating: 5c

California Technology Assessment Forum. Interferential stimulation for the treatment of musculoskeletal pain. 2005.


Interferential stimulation: Does Not Meet CTAF Criteria

Note: Click on link above to go to a description of each individual study.


Hou CR, Tsai LC, Cheng KF, Chung KC, Hong CZ. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil. Oct 2002;83(10):1406-1414.

Hurley DA, McDonough SM, Dempster M, Moore AP, Baxter GD. A randomized clinical trial of manipulative therapy and interferential therapy for acute low back pain. Spine. Oct 15 2004;29(20):2207-2216.

Hurley DA, Minder PM, McDonough SM, Walsh DM, Moore AP, Baxter DG. Interferential therapy electrode placement technique in acute low back pain: a preliminary investigation. Arch Phys Med Rehabil. Apr 2001;82(4):485-493.

Jarit GJ, Mohr KJ, Waller R, Glousman RE. The effects of home interferential therapy on post-operative pain, edema, and range of motion of the knee. Clin J Sport Med. Jan 2003;13(1):16-20.

Werners R, Pynsent PB, Bulstrode CJ. Randomized trial comparing interferential therapy with motorized lumbar traction and massage in the management of low back pain in a primary care setting. Spine. Aug 1 1999;24(15):1579-1584.

Rating: 8b

California. Division of Workers’ Compensation. Functional Improvement Report. October 2007.

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