Nonpharmacologic therapies should be considered first-line options for chronic pain.
These may be used alone or combination with each other, medication treatments, surgeries or other procedures.
Their benefits in addition to pain control include:
Reduced nausea and vomiting
Improved sleep quality
Increased patient wellbeing
Increased functional gains and reduced debility
The CDC recommends the following nonpharmacologic therapies as doing less risk to patients than opioids while, in some instances, results in better outcomes, include:
Psychological therapies such as cognitive behavioral therapy (CBT)
Interventions to improve sleep
Among key findings from a CDC literature review were that exercise therapy
Can reduce pain and improve function immediately after exercise
Improves global wellbeing and physical function
Sustained treatment effects for at least 3-6 months
Achieved greater effectiveness when are involved a clinician that in the general population
Interventions for Chronic Pain:
Study Outcomes and Recommendations
Peripheral Neuropathy and Musculoskeletal pain
Benefit over control
Benefits persist over time
Treatment frequency individualized to the patient and the pain type and severity. In trials for OA and musculoskeletal pain, avg frequency was 8-15 treatments over 10-12 weeks, 15-60 minutes per session.
Manual or manipulative therapy
Lower extremity Osteoarthritis
Fair evidence for short term
All pain populations
Improved pain, function, mood, quality of life
Release of serotonin, which is the body's natural production of anti-pain chemicals.
Pain-coping skills training
Osteoarthritis, Rheumatoid Arthritis
Significant benefits for pain and psychological, physical and biological function.
Mind-body therapy that targets psychological factors common in chronic pain. It has been shown to benefit arthritis pain and can be delivered through Internet programs
Significant effects on pain, fatigue, depression, health related quality of life
***NIH recommends hatha yoga, iyengar and viniyoga for chronic back pain
Positive effects compared to controls on pain, physical function, joint stiffness (all results short term)
Weimer, M. B., MCR, FASAM. (2019). Nonpharmacologic, Nonopioid, and Opioid Treatment Options in Chronic Pain Therapy. 2019 New Jersey Medical Licensure Program,2-21.