From the Guidelines
Based on the most recent and highest quality evidence, cognitive behavioral therapy (CBT) is recommended as an additional therapy for chronic pain management 1. When considering additional therapy, healthcare providers typically:
- Evaluate the effectiveness of current treatments
- Assess for any side effects or complications
- Consider the patient's overall health status and comorbidities
- Review recent lab results and diagnostic tests
- Discuss the patient's goals and preferences Potential additional therapies could include:
- Adjusting medication dosages
- Adding a new medication to the existing regimen
- Incorporating non-pharmacological interventions (e.g., physical therapy, dietary changes)
- Exploring alternative treatment modalities Other options such as yoga, physical and occupational therapy, hypnosis, and acupuncture may also be considered based on individual patient needs and circumstances 1. It is essential to note that the choice of additional therapy should be tailored to the individual's specific needs and circumstances to ensure optimal outcomes and minimize potential risks. In some cases, biobehavioural therapy and acupuncture may be considered as adjuncts to acute and preventive medication or as stand-alone preventive treatment when medication is contraindicated 1.
From the FDA Drug Label
To minimize the potential risk for an adverse GI event in patients treated with a NSAID, the lowest effective dose should be used for the shortest possible duration Patients and physicians should remain alert for signs and symptoms of GI ulcerations and bleeding during NSAID therapy and promptly initiate additional evaluation and treatment if a serious GI event is suspected. For high-risk patients, alternate therapies that do not involve NSAIDs should be considered
The recommended additional therapy is to use the lowest effective dose of NSAIDs for the shortest possible duration. Patients and physicians should be alert for signs and symptoms of GI ulcerations and bleeding, and alternate therapies should be considered for high-risk patients 2.
From the Research
Additional Therapy Recommendations
The following therapies have been recommended in addition to the primary treatment:
- Occupational therapy: This has been shown to be effective in improving symptoms, with 70% of patients reporting improvement 3
- Bracing: This has also been found to be effective, with 70% of patients reporting improvement 3
- Complimentary/alternative treatments: These were the most common treatments used, with 88 patients using them 3
- Physical therapy: This has been mentioned as a treatment option, but its effectiveness has not been specifically reported 3
Considerations for Therapy Selection
When selecting additional therapies, the following factors should be considered:
- Patient-specific needs: The Patient-Specific Needs Evaluation (PSN) can be used to assess patient-specific information needs, treatment goals, and personal meaningful gain (PMG) 4
- Clinical prediction rules: These can be used to quantify the contributions of relevant patient characteristics and provide numeric indices to assist clinicians in making predictions 5
- Shared decision-making: Patients should be involved in the decision-making process, and their preferences and values should be taken into account 6
Limitations and Future Directions
There is a need for further research to develop a comprehensive treatment database for Ehlers-Danlos syndrome, as the current literature is limited 3. Additionally, the role of occupational therapy in the intensive care unit needs to be further clarified 7.