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Relax? - don't do it


Relaxation techniques have been used to produce freedom from anxiety and skeletal muscle tension, and there have been suggestions that relaxation techniques can be useful for relief of acute and chronic pain. Two excellent systematic reviews [1,2] indicate that, at best, this is not proven.

Both reviews used extensive searching techniques to establish that all published material had been found. Inclusion criteria were full journal publication, relaxation being used alone and not as part of a multimodal therapy, randomised studies, pain outcomes and numbers of treated patients no fewer than 10 per group.

Acute pain

There were seven studies with 362 patients, predominantly after surgery. Controls were generally non-treatment, waiting list controls, or use of music tapes. Three studies (61 patients received relaxation) showed significantly less pain with relaxation, while four (128 patients received relaxation) did not.

Chronic pain

Nine studies with 414 patients studied relaxation in chronic pain, seven in non-malignant pain and two in cancer pain. Controls were again of various types, including waiting lists or studies compared different relaxation techniques.

Three studies showed some efficacy for relaxation at early assessments, but none was effective beyond four months of treatment. In several instances control interventions (splints, hydro-galvanic baths or bio-feedback) produced lower pain scores than relaxation.

Comment

Evidence for the pain-relieving effects of relaxation is underwhelming. In acute pain, for instance, it was interesting to note that the studies with larger numbers tended to be negative while those with smaller numbers tended to be positive. Vote-counting of positive and negative studies has to be tempered by the weight of evidence, and here the weight of 3:4 against relaxation being effective on vote counting becomes 1:2 by using patients on active treatments. When we add the knowledge that there are instances of smaller trials tending to over-estimate treatment efficacy [3], the weight may become as high as 1:3 against or even more.

This is also an area where goalposts are easily moved: new method, technical expertise and so on. The fact is that although 16 randomised trials were found and evaluated, most were small, and few found any beneficial effect beyond that which might be obtained from taking a couple of aspirin.

Relaxation may still make people feel better. It was Earl St Vincent who said of Napoleon's invasion force " I do not say they cannot come, I only say they cannot come by sea". Perhaps of relaxation we can say that we do not deny that it may have a benefit, we merely say it does not relieve pain.

References:

  1. K Seers, D Carroll. Relaxation techniques for acute pain management: a systematic review. Journal of Advanced Nursing 1998 27: 466-75.
  2. D Carroll, K Seers. Relaxation techniques for chronic pain: a systematic review. Journal of Advanced Nursing 1998 27: 476-87.
  3. RA Moore, D Carroll, PJ Wiffen, M Tramèr, HJ McQuay. Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs. British Medical Journal 1998 316: 333-8.



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