Pain

Shown to lower knee and hip osteoarthritis pain by about 3 points on a 100-point scale, below the 9 points the reviewers set as clinically important.

Shown to give at least 50% pain relief to about 32% of people with postherpetic neuralgia, against 13% to 17% on placebo.

Shown to give at least 50% pain relief to 38% on gabapentin against 21% on placebo, and to 31% on pregabalin 300 mg against 24%.

Shown to lower acute low back pain by about 8 points on a 100-point scale within 2 weeks, with no gain in disability and more side effects.

Shown to ease knee osteoarthritis pain and stiffness over placebo, including topical diclofenac. Pain relief was similar to exercise therapy.

Shown to lower chronic non-cancer pain by about 0.7 points on a 10-point scale against placebo, with no advantage found over non-opioid drugs.

Shown to lower knee and hip osteoarthritis pain by small amounts against placebo, about 0.7 points of 10 for oxycodone-type opioids and 4% for tramadol.

Shown to ease pain in women with endometriosis against placebo, by 2.58 points on a visual analogue pain scale for oral progestins in pooled trials.

Compared with placebo or no treatment, pooled together [5]; placebo [6][7][8]

Shown to cut pain by half or more in painful diabetic neuropathy on duloxetine 60 mg, with about 5 treated for one extra person helped.

Shown to raise the share with 50% pain relief in fibromyalgia from about 21% to 31%, a gain Cochrane reviewers judged not clinically relevant.

Shown to give at least half pain relief to about half of adults after surgery with one dose, against about 20% on placebo.

Shown to give at least half pain relief to about 7 in 10 adults after surgery when taken with ibuprofen, against 7% on placebo.

Shown in very low quality evidence to make at least 50% pain relief about three times as likely as placebo, with about 4 treated for one extra responder.

Compared with placebo and other active treatments [6]

Shown to relieve bone pain in Paget's disease more often than placebo, 31% against 9%, with one zoledronic acid infusion normalizing alkaline phosphatase in 89% at 6 months.

Compared with placebo and other bisphosphonates [12]; risedronate [13]

Shown to give at least 50% pain relief to about 22% to 24% of people with fibromyalgia on pregabalin, against about 14% on placebo.

Shown to reduce period pain in women more than placebo, with improvement in 37% to 60% against 28%, along with more irregular bleeding, headache and nausea.

Compared with placebo or no treatment [5]

Shown to cut pain after surgery by about 19% and opioid use by about 8 mg morphine over 24 hours, when given around the operation.

Compared with placebo, or a basic pain reliever alone [10]

Shown to lower chronic pain scores by about 1.8 points on a 10-point scale for up to 2 weeks after an infusion, with 51% responding against 19%.

Compared with placebo infusions [11]

Shown to improve overall fibromyalgia symptoms with cyclobenzaprine, with about 5 treated for one extra person improved, and no change in fatigue or tender points.

Shown to lower acute low back pain slightly with diclofenac, with other NSAIDs unconfirmed or showing no benefit.

Shown to relieve pain after surgery in single doses, with about 3 adults given oxycodone 10 mg plus acetaminophen for one extra with half pain relief.

Shown to give at least half pain relief to 53% on tramadol against 30% on placebo in small nerve pain trials the reviewers rated low quality.

Shown to improve function slightly in sciatica from a herniated disk, with pain about half a point of 10 lower and no change in surgery rates.

Shown to raise the share with sore throat pain relieved at 24 hours by 12 percentage points after one low dose, mostly of dexamethasone.

Shown to ease endometriosis pain in women about as much as GnRH agonist injections such as leuprolide, with less bone loss and fewer hot flushes.

Compared with GnRH agonists [5]; leuprolide injections [9][10][11][1]; a GnRH antagonist [5]

Shown to lower back pain by about 5 points on a 100-point scale, which reviewers called not clinically important, and osteoarthritis pain by about 10 points.

Limited evidence: fatigue, brain fog, sleep and pain improved from baseline in uncontrolled studies of long COVID. No randomized trials were found.

One trial found 44% on methocarbamol stopped treatment early with complete pain relief, against 18% on placebo, in acute low back pain with spasm.

One small trial found norethindrone acetate 5 mg and dienogest 2 mg eased endometriosis pain in women to a similar degree over 12 months, with fewer dropouts on norethindrone acetate.

Compared with dienogest [13]; dienogest, in consecutive patients before and after a clinic switched drugs [14]

One trial found knee pain scores fell about 1.5 points more than placebo in people with knee osteoarthritis. The placebo group also improved.

One trial found duloxetine lowered pain from chemotherapy nerve damage by 0.73 points more than placebo on a 10-point scale over 5 weeks.

One small uncontrolled study found 14 of 16 patients reported knee pain relief after BPC-157 injections, some combined with thymosin beta-4.

Compared with the same patients' recall of their pain before the injection, with no other group [14]

Shown to lower knee osteoarthritis pain and stiffness and improve function against control in adults, in mostly small, low-quality trials.

Shown to lower pain after wisdom tooth surgery in adults, though reviews of the same small trials disagree on when the effect appears.

Shown to raise nerve conduction speed in people with diabetic neuropathy when given by IV for 2 to 4 weeks. Most trials were poor quality.

Shown to lower nerve symptom scores in people with diabetic neuropathy over 5 weeks. Over 4 years, the main combined measure did not change.

Shown to reduce osteoarthritis pain and disability modestly in adults over placebo.

Shown to lower period pain scores in women with primary dysmenorrhea when taken in the first 3 to 4 days of the cycle.

Shown to lower pain about 10% in trials under 6 months in people with osteoarthritis, mostly of the knee. Reviews disagree on whether this is meaningful.

Shown to improve knee osteoarthritis physical function scores over placebo in adults, with pain results mixed and gains called small.

Shown to lower period pain against placebo or NSAIDs in women with primary dysmenorrhea, in few trials with high heterogeneity.

Shown to ease cyclic breast pain against placebo, with a moderate effect, and to lower raised prolactin in women of reproductive age.

Compared with placebo [5]; dopamine agonists, NSAIDs, serotonin reuptake inhibitors and hormonal contraceptives [5]

Small trials found boron supplements eased knee discomfort over 2 weeks and lowered inflammation markers in arthritis. Several were short, and one was run by the maker.

One uncontrolled study by the manufacturer found most women reported lighter, less frequent bleeding and less period pain after 3 months, with no comparison group.

Compared with before treatment, in the same women [7]

Shown to ease chronic pain about 0.5 standard deviations more than no acupuncture and about 0.2 more than sham acupuncture, with effects lasting a year.

Compared with sham acupuncture [2][3]; no acupuncture [2][3]

Shown to ease osteoarthritis pain 14.5 points on a 100-point scale more than a waiting list in the short term. One later trial found no gain at 1 year.

Compared with waiting list [8]; no acupuncture [3][9]

Shown to ease chronic pain by a large amount against no treatment in the short term, and neck pain and fibromyalgia pain against no intervention or usual care.

Compared with no treatment [2]; no intervention [7]; usual care [6]

Shown to ease musculoskeletal pain more than no treatment, sham needling and other therapies pooled together, from 72 hours to 24 weeks, in low-quality evidence.

Compared with no treatment, sham dry needling and other therapies, pooled together [3][4]

Shown to ease chronic pain moderately (Hedges' g -0.42) against control treatments, with larger effects after 8 or more sessions.

Compared with control interventions the source abstract does not describe [13]; standard care, and other psychological interventions [14]

Shown to ease low back pain by about 13 points on a 100-point scale at 3 months, in pooled trials that mixed sham, usual care, physiotherapy and no-treatment comparisons.

Compared with sham treatment, usual medical care, physiotherapy and no treatment, pooled together [4]; control interventions the source abstract does not describe [5]; active treatment, placebo and no treatment [6]

Shown to ease chronic low back pain about 15 points on a 100-point scale against no treatment, usual care or placebo, with a smaller gain in function.

Compared with no treatment, usual care or placebo [2]; no-exercise true control [3]

Shown to ease chronic low back pain by about 20 points on a 100-point scale against no treatment. Against usual care the pain difference was smaller, about 10 points.

Compared with no treatment [4]; usual care [4]

Shown to ease neck pain slightly more than sham acupuncture in the short term, and more than a waiting list. The effect did not appear to last.

Compared with sham acupuncture [5]; inactive treatment [5]; waiting list [5]

Shown to reduce chronic back pain intensity with a moderate effect (Hedges' g 0.60) that held over about 8 months, alone or added to other treatment.

Compared with control conditions the source abstract does not describe, with before-and-after studies included [10]

Shown to ease acute low back pain by about 10 points on a 100-point scale and improve function modestly for up to 6 weeks, against sham or other treatments.

Compared with sham or alternative treatments [6]

Shown to ease acute and subacute neck pain more than inactive controls in the short term with thoracic manipulation. Neck manipulation and mobilization gave similar results.

Compared with inactive controls [7]; mobilization [7]; certain medications [7]

Shown to ease chronic pain, disability and distress slightly more than usual treatment. Against other active treatments the benefit was very small and did not last.

Compared with treatment as usual [15]; active control treatments [15]

Shown to ease neck pain in the short term against sham, placebo, waiting list or other needling pooled together. Neck function did not differ from physical or manual therapy.

Compared with sham, placebo, waiting list or another form of dry needling, pooled together [7]; manual therapy [7]; other physical therapy interventions [7]; sham dry needling, physical therapy or no treatment [8]

Shown to ease low back pain more than other treatments right after treatment in 11 trials. Effects on disability were smaller and effects at later follow-up unclear.

Compared with other treatments the review abstract does not list [9]; laser, physical therapy and other combined treatments [6]

Shown to ease nontraumatic shoulder pain by a small amount, about half a point, and disability by a larger amount, in the short term only.

Compared with comparison groups the review abstract does not describe [10]

Shown to ease tennis elbow pain and disability with large effects in the short term, and grip strength with a small effect.

Compared with comparison groups the review abstract does not describe [15]

Shown to ease endometriosis pain in women more than a sham diagnostic laparoscopy in two small blinded trials, with 80% against 32% improved after excision.

Compared with diagnostic laparoscopy alone, with the women unaware of their group (sham surgery) [1][2][3][4]

Shown to lower pain and cyst recurrence in women with endometriomas against drainage and ablation. Endometriomas recurred in 5% to 17% after excision against 37% after ablation.

Compared with drainage and ablation of the cyst [10]

Shown to lower endometriosis recurrence in women after conservative surgery when hormonal suppression followed, by about 59% against no treatment or placebo.

Compared with expectant management or placebo after surgery [13]

Shown to lower pain from lab pain tests in healthy volunteers (Hedges' g 0.54 to 0.76), mainly in people who respond strongly to suggestion.

Compared with no intervention [15]

Shown to ease pain more than no treatment, by a large margin, and more than sham or active treatments, by smaller margins, in a meta-analysis of 67 trials.

Compared with sham treatments [2]; no treatment [2]; active treatments [2]

Shown to ease subacute and chronic low back pain more than inactive controls in the short term, with no lasting difference. Against active treatments the pain difference was small.

Compared with inactive controls [4]; active treatments [4]; usual care [5]

Shown in pooled trials to give higher treatment success than steroid injections and more pain relief than medications at 6 months or more, with results similar to microdiscectomy.

Compared with steroid injections [5]; conventional medications [5]; microdiscectomy [5]

Shown to ease knee osteoarthritis pain about 12 points on a 100-point scale and improve function about 10 points against no exercise, right after treatment.

Compared with non-exercise or no-treatment control groups [4]

Shown to ease hip osteoarthritis pain and improve function about 8 and 7 points on a 100-point scale against no exercise, sustained 3 to 6 months later.

Compared with non-exercise control groups [5]

Shown in pooled trials to give better knee pain, function and WOMAC scores after injection than hyaluronic acid injections.

Compared with hyaluronic acid injections [5]

Shown to lower labor pain by about 1.9 points on a 0 to 10 scale and reduce anxiety, against placebo, usual care or no intervention.

Compared with placebo, usual care or no intervention [13]

Limited evidence: pooled small trials found less osteoarthritis pain and better function in the short term, with no difference at medium or long term.

Compared with non-drug treatments, sham techniques or no added treatment, pooled together [13]; control, sham or placebo treatment [14]

Linked to fewer repeat operations and more pain relief than excision alone in women, in observational studies. By 7 years, 77% to 92% avoided reoperation, against 45%.

Compared with laparoscopic excision with the uterus and ovaries kept [11][12]; hysterectomy with and without removal of the ovaries, against each other [11][12]

Limited evidence: four small trials found lower pain and fewer tender points than placebo, results the review authors call preliminary.

Compared with placebo [19]

One trial of 200 women found a 15-minute hypnosis session before breast surgery lowered pain at discharge from 48 to 22 on a 100-point scale against empathic listening.

Compared with nondirective empathic listening as an attention control [16]

One trial of 222 adults found weekly massage improved knee osteoarthritis scores more than light touch or usual care at 8 weeks, with no difference at 52 weeks.

Compared with light touch [7]; usual care [7]

Two small double-blind trials found ozone injections beside the spine eased back pain and disability more than injections of oxygen or very dilute ozone.

Compared with paraspinal injections of pure oxygen [2]; paravertebral injections of very dilute ozone, 0.1 µg/mL [3]

Limited evidence: one double-blind trial and three reviews found less knee osteoarthritis pain than placebo, and an umbrella review rated every review critically low in confidence.

Compared with placebo injections [6][7]

One trial of 156 adults found less knee pain and disability at 1 year with physical therapy than with a glucocorticoid injection.

Compared with intra-articular glucocorticoid injection [8]

Shown to ease period pain in women against no treatment, by about 1.9 cm on a 10 cm scale over 3 months of use, in pooled trials of low certainty.

Compared with no treatment [3][4]

Shown to ease period pain in women as much as, or slightly more than, NSAIDs or acetaminophen, in two reviews of trials.

Compared with NSAIDs [3]; pain medicines [4]; ibuprofen 400 mg three times a day [5]; acetaminophen 1,000 mg [6]

Shown to ease chronic pain slightly in pooled trials rated low in quality. In back pain, an 8-week course matched CBT and beat usual care.

Compared with treatment as usual, passive controls, and education or support groups [8]; active control programs [3]; usual care and cognitive behavioral therapy [9]

Shown to reduce knee osteoarthritis pain compared with placebo, by about 14 mm on a 100 mm scale in one meta-analysis. A later review rated certainty very low.

Shown to ease period pain in women more than an unheated placebo patch, in two trials. Mean pain relief over 2 days was 3.27 with heat against 1.95 without.

Compared with an unheated patch with a placebo pill (sham) [4][5]

Shown to ease acute and subacute low back pain slightly against an oral placebo after 5 days, by about 1 point on a 0 to 5 scale, in two trials.

Compared with oral placebo [7]; a comparison the abstract does not describe, for a heated blanket [7]

Shown to ease muscle soreness after exercise when applied within an hour, in pooled trials, with hot packs ranking highest in a network analysis.

Compared with control groups the abstract does not describe [10]; passive recovery and other cold and heat methods [11]

Shown to reduce pain in people with fibromyalgia in one meta-analysis of 9 small studies. Adverse events occurred in 23.8% of treated patients.

Shown to reduce chronic neck pain by about 20 mm on a 100 mm scale compared with placebo, lasting up to 22 weeks after treatment, in one meta-analysis.

Shown to reduce pain in lower-limb tendinopathy and plantar fasciitis by about 13 mm on a 100 mm scale in one meta-analysis, with wide intervals.

Shown to improve fibromyalgia symptom, pain and fatigue scores compared with placebo laser in one meta-analysis. It added nothing to an exercise program.

Shown to ease knee osteoarthritis pain and stiffness and improve function in one meta-analysis of 16 trials. A small trial found more relief than wellness education and stretching.

Compared with control groups the source abstract does not describe [8]; wellness education and stretching, as an attention control [9]

Shown to ease period pain in women by 1.39 points with high-frequency and 2.04 with low-frequency TENS, against sham or no treatment pooled together, at low certainty.

Compared with placebo TENS or no treatment, pooled together [5]

Shown to lower pain during or right after use against placebo TENS in adults with many kinds of pain, across 91 trials, at moderate certainty.

Compared with placebo TENS [8]; sham TENS [9]

Shown to lower pain during or right after use more than medicines or other usual treatments, across 61 trials in adults, at low certainty.

Compared with drug and non-drug treatments used as standard care [8]

Shown to lower pain with movement in women with fibromyalgia, by 1.0 point against placebo TENS and 1.8 points against no TENS, out of 10.

Compared with placebo TENS [12]; no TENS [12]; physical therapy alone [13]

Shown to improve back function and pain slightly against no exercise in a Cochrane review, by amounts below the thresholds the reviewers set as clinically important.

Compared with waiting list, usual care or education [1]; a self-care book [2]; an educational book and newsletters [3]

Limited evidence: two small studies reported less pain while grounded, one in 16 massage therapists compared with ungrounded weeks and one uncontrolled study of 12 adults.

Compared with weeks without grounding, in the same people [3]; before grounding, in the same people [2]

One trial found a heat wrap eased acute low back pain more than ibuprofen 1,200 mg or acetaminophen 4,000 mg a day, on day 1 and days 3 to 4.

Compared with ibuprofen and acetaminophen [8]

One trial found a heat wrap plus exercise restored function in 72% of people with acute low back pain, against about 20% with heat, exercise or a booklet alone.

Compared with an education booklet [9]; exercise alone [9]; a heat wrap alone [9]

One study found 77% of chronic pain patients given daily far-infrared sessions alongside usual treatment had returned to work at 2 years, against 50% without the sessions.

Limited evidence: pain fell by about half in 13 women with fibromyalgia given Waon therapy, in a study with no control group.

Limited evidence: pain scores fell from a median of 5 to 3 in 37 people after 10 sauna sessions, in a study with no control group.

One trial of 226 adults with fibromyalgia found tai chi improved symptom scores more than aerobic exercise at 24 weeks, by 16.2 points when matched for time.

Compared with supervised aerobic exercise twice a week for 24 weeks [11]

Small trials found less pain and better quality of life scores in people with fibromyalgia after a course of sessions, compared with rest or usual care.

Limited evidence: pain and disability scores fell after a course of sessions in two studies with no control group.

One trial in office workers found less neck and shoulder pain after 3 months of a program to cut sitting, and no change in back pain.

Compared with control offices whose workers behaved as usual [12]