The Italian Society of Physical and Rehabilitation Medicine (SIMFER) recently published the 2026 Clinical Practice Guideline on chronic pain physical modalities for primary pain management. Chronic primary pain remains a leading cause of disability worldwide. Therefore, doctors require a multimodal management approach to achieve better clinical results. In addition, the society developed the guideline following the GRADE methodology to help clinicians navigate complex cases. Consequently, this framework assists in treating complex regional pain syndrome, fibromyalgia, and primary bone marrow edema syndromes effectively.

Optimizing Outcomes with Chronic Pain Physical Modalities

The panel issued a conditional recommendation in favor of adding instrumental physical therapies to conventional treatment plans. Specifically, evidence suggests modest to large improvements in pain and disability for modalities like TENS and low-level laser therapy. Moreover, electromagnetic field therapy shows promising results for chronic primary pain patients. Because adverse events are generally mild and transient, clinicians find these adjunctive interventions highly acceptable for daily practice. Furthermore, patient satisfaction typically increases when using these non-invasive technologies.

However, the overall certainty of evidence currently ranges from moderate to very low. This is because methodological limitations and heterogeneity in existing studies impact the strength of the data. Consequently, while the current findings are encouraging, clinicians must await high-quality trials with standardized protocols. Furthermore, long-term follow-up remains essential to strengthen future clinical recommendations. In summary, by integrating these chronic pain physical modalities into a comprehensive rehabilitation plan, healthcare providers can offer holistic care for their patients.

Which specific physical modalities did SIMFER evaluate?

The guidelines evaluated several instrumental therapies, showing significant interest in TENS, low-level laser therapy, and electromagnetic field therapy for their clinical benefits in pain reduction.

For which conditions are these physical therapies recommended?

The SIMFER panel recommends these as adjunctive treatments for chronic primary pain syndromes, including fibromyalgia, complex regional pain syndrome (CRPS), and primary bone marrow edema syndromes.

What is the safety profile of these instrumental therapies?

According to the guidelines, the adverse events associated with these physical modalities are generally mild and transient, leading to high patient acceptability and low risk of complications.

Disclaimer: This content is for informational and educational purposes only. It does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

1. Iolascon G et al. SIMFER guidelines on physical modalities for chronic primary pain management. Eur J Phys Rehabil Med. 2026 Jun 09. doi: 10.23736/S1973-9087.26.09631-0. PMID: 42262745.

2. WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. World Health Organization; 2023.

3. American College of Occupational and Environmental Medicine. ACOEM Chronic Pain Guideline. Reed Group; 2025.