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Soft Tissue Pain

  • When specific causes of symptoms aren’t known, doctors sometimes refer to conditions simply by naming the symptoms. Such is the case for so-called “soft tissue pain.” The term soft tissue pain simply refers to discomfort somewhere in the interconnected system of muscles, tendons, and ligaments, as opposed to the bones, and says nothing about the particular cause.
    The most commonly used conventional treatments for soft tissue pain consist primarily of drugs that relieve pain and/or inflammation in general, such as ibuprofen and acetaminophen, as well as muscle relaxants. Physical therapy methods are commonly recommended for selected forms of soft tissue pain, but there is little to no reliable scientific evidence that they help. 1–511-14 Other methods, such as therapeutic exercises, may help, but most reported studies are significantly flawed by the lack of a credible placebo treatment. (For why this is important, see Why Does This Database Rely on Double-blind Studies? )
    A similar lack of reliable evidence exists regarding other non-surgical, non-drug methods used to control soft tissue pain, such as injection therapy, radiofrequency denervation, and transcutaneous electrical nerve stimulation (TENS). 6–10
    Surgery may be useful for certain selected forms of soft tissue pain, although again the supporting research evidence is generally very incomplete.
  • Proposed Natural Treatments

    Natural treatments for the following forms of soft tissue pain are discussed in their own articles:
    Alternative therapies that may be useful for soft tissue pain in general include acupuncture , biofeedback , chiropractic , hypnosis , magnet therapy , massage , prolotherapy , and relaxation therapy .
    Herbs and supplements that may have a general pain-relieving effect include boswellia , butterbur , devil’s claw , D-phenylalanine , proteolytic enzymes , and white willow .
  • References

    1 Robertson VJ, Baker KG. A review of therapeutic ultrasound: effectiveness studies. Phys Ther . 2001;81:1339–1350.

    2 van der Heijden GJ, Beurskens AJ, Koes BW, et al. The efficacy of traction for back and neck pain: a systematic, blinded review of randomized clinical trial methods. Phys Ther . 1995;75:93–104.

    3 Philadelphia Panel. Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for neck pain. Phys Ther . 2001;81:1701–1717.

    4 Philadelphia Panel. Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for low back pain. Phys Ther . 2001;81:1641–1674.

    5 Philadelphia Panel. Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for shoulder pain. Phys Ther . 2001;81:1719–1730.

    6 Milne S, Welch V, Brosseau L, et al. Transcutaneous electrical nerve stimulation (TENS) for chronic low back pain. Cochrane Database Syst Rev . 2001;(2):CD003008.

    7 Assendelft WJ, Hay EM, Adshead R, et al. Corticosteroid injections for lateral epicondylitis: a systematic overview. Br J Gen Pract . 1996;46:209–216.

    8 Shrier I, Matheson GO, Kohl HW 3rd. Achilles tendonitis: are corticosteroid injections useful or harmful? Clin J Sport Med . 1996;6:245–250.

    9 Niemisto L, Kalso E, Malmivaara A, et al. Radiofrequency denervation for neck and back pain. A systematic review of randomized controlled trials. Cochrane Database Syst Rev . 2003;(1):CD004058.

    10 Nelemans PJ, de Bie RA, de Vet HC, et al. Injection therapy for subacute and chronic benign low back pain. Cochrane Database Syst Rev . 2000;(2):CD001824.

    11 Frost H, Lamb SE, Doll HA et al. Randomised controlled trial of physiotherapy compared with advice for low back pain. BMJ . 2004;329:708. Epub 2004 Sep 17.

    12 Koes BW, Malmivaara A, van Tulder MW et al. Trend in methodological quality of randomised clinical trials in low back pain. Best Pract Res Clin Rheumatol . 2005;19:529-39.

    13 Bisset L, Paungmali A, Vicenzino B et al. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med . 2005;39:411-22; discussion 411-22.

    14 Hayden JA, van Tulder MW, Malmivaara AV et al. Meta-analysis: exercise therapy for nonspecific low back pain. Ann Intern Med . 2005;142:765-75.

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