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Acute Pain | Chronic Pain | General

Relaxation for chronic pain

Clinical bottom line:

Relaxation does not appear to be effective in relieving chronic non-malignant pain. Although some trials report benefit with relaxation, it is unclear whether this is clinically meaningful. There are no long-term benefits of relaxation. In cancer pain, there is insufficient evidence to assess the role of relaxation.

Relaxation interventions are a common component of multi-modal chronic pain management programmes. Relaxation interventions are especially popular either alone or together with biofeedback in the treatment of headache and migraine.

Systematic review

Carroll, D.; Seers, K. Relaxation for the relief of chronic pain: a systematic review. Journal of Advanced Nursing. 1998; 27: 476-487.

Inclusion criteria were randomised, controlled trials of relaxation.

Reviewers assessed efficacy of relaxation based on findings of original trials.


Chronic non-malignant pain

Seven trials compared relaxation with a control intervention. Two of seven trials reported significant improvement with relaxation (one rheumatoid arthritis trial of 60 patients, with 10-120 minutes of progressive muscle relaxation at least twice daily for four weeks vs. routine treatment control, and one trial in ulcerative colitis in 40 patients, with six sessions of 75 minutes vs. waiting list with weekly telephone calls). In both cases the improvement was seen at the early post-treatment session. None of three trials with longer term assessments (at least four months) reported benefit any benefit with relaxation.

Four trials compared relaxation with an active control. No trial found significant benefit of relaxation. Three of four trials found significant benefit with other interventions: with temporo-mandibular joint dysfunction, oral splint device was more effective than relaxation; with fibromyalgia the morning pain scores were significantly lower with hydro-galvanic bath compared with relaxation; with low back pain biofeedback was more effective than relaxation). The remaining trial found no significant difference between biofeedback and relaxation for temporo-mandibular joint dysfunction.

Cancer pain

Two trials examined relaxation in cancer pain. One of two trials found a significant benefit of two relaxation interventions compared with no treatment. Interventions were progressive muscle relaxation plus imagery tape at least twice daily for three weeks, and live relaxation. The second trial found no significant differences between progressive muscle relaxation and guided imagery, although this may have been confounded by baseline differences.

Adverse effects

Reviewers state that none of the original trials reported complications due to relaxation.

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