Pain Management

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 anxiety

  • Reduced depression

  • 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:

  • Exercise therapy

  • Weight loss

  • Acupuncture/Massage Therapy

  • Psychological therapies such as cognitive behavioral therapy (CBT)

  • Interventions to improve sleep

  • Certain procedures

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

Massage therapy

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


  • Effective

  • ***NIH recommends hatha yoga, iyengar and viniyoga for chronic back pain

Tai Chi


  • 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.