SIMFER guidelines on physical modalities for chronic primary pain management

Area of Science:

• Physical Medicine and Rehabilitation
• Pain Management
• Evidence-Based Medicine

Background:

• Chronic primary pain is a significant global cause of disability.
• Instrumental physical therapies are common in rehabilitation but have variable effectiveness.
• A multimodal approach is essential for managing chronic pain.

Purpose of the Study:

• To synthesize evidence and provide recommendations on instrumental physical therapies for chronic primary pain.
• To develop a clinical practice guideline based on the GRADE methodology.
• To address conditions including fibromyalgia, complex regional pain syndrome, and primary bone marrow edema syndromes.

Main Methods:

• Systematic literature searches of major databases (Medline, Embase, Cochrane Library).
• Appraisal of evidence quality using GRADE methodology (risk of bias, inconsistency, etc.).
• Formulation of recommendations using the Evidence-to-Decision framework.

Main Results:

• A conditional recommendation supports adding instrumental physical therapies to conventional treatment for specific chronic pain conditions.
• Modest to large improvements in pain and disability observed with TENS, low-level laser therapy, and electromagnetic field therapy.
• Overall certainty of evidence is moderate to very low due to methodological limitations and heterogeneity.

Conclusions:

• Instrumental physical therapies can be considered as adjunctive treatments within a multimodal strategy for chronic primary pain.
• Mild and transient adverse events were reported, with high patient acceptability.
• High-quality trials with standardized protocols are needed to enhance the certainty of evidence and future recommendations.