From the Guidelines
When a patient opts for non-pharmacological treatment, they choose approaches that don't involve medications to manage their condition, such as exercise, mind-body practices, psychological interventions, and physical modalities, which can improve pain and function without risk for serious harms, as supported by high-quality evidence from the 2022 CDC clinical practice guideline for prescribing opioids for pain 1. These treatments may include lifestyle modifications such as diet changes, regular exercise, stress management techniques, physical therapy, psychotherapy, acupuncture, massage, or other complementary therapies. The specific non-pharmacological treatments depend on the patient's condition - for example, cognitive behavioral therapy for anxiety disorders, physical therapy for musculoskeletal problems, or dietary modifications for certain gastrointestinal issues. Some key non-pharmacological approaches that have been shown to be effective include:
- Exercise therapy for back pain, fibromyalgia, and hip or knee osteoarthritis, which can reduce pain and improve function immediately after treatment and sustain improvements for at least 2–6 months 1
- Cognitive behavioral therapy for knee osteoarthritis, which can improve pain and function without apparent risk for serious harm 1
- Mind-body practices, such as yoga, tai chi, and qigong, which can encourage active patient participation in the care plan and help address the effects of pain in the patient’s life 1 These approaches often address the underlying causes of symptoms rather than just masking them, and they typically have fewer side effects than medications. Non-pharmacological treatments may be used alone for mild conditions or in combination with medications for more severe cases. They often require more active participation from the patient and may take longer to show results compared to medications, but can provide sustainable long-term benefits. Many healthcare providers now recommend starting with non-pharmacological approaches when appropriate before moving to medication options, as they can provide additional health benefits, such as preventing or reducing symptoms of depression, and can be used even when access to specialty care is limited 1.
From the Research
Non-Pharmacological Treatment Options
When a patient opts for non-pharmacological treatment, they are choosing therapies that do not involve medication. These treatments can be used as stand-alone therapies or to augment and complement pharmacologic treatments 2.
Types of Non-Pharmacological Therapies
Some examples of non-pharmacological therapies include:
- Behavioral therapy for short-term pain relief 2
- Cognitive behavioral therapy for reducing long-term pain and disability [(2,3)]
- Hypnosis as adjunctive therapy 2
- Guided imagery, diaphragmatic breathing, and muscle relaxation 2
- Mindfulness-based stress reduction for patients with chronic low back pain [(2,4,5)]
- Acupuncture for multiple pain conditions [(2,4,5)]
- Combination manipulation, manual therapy, endurance exercise, stretching, and strengthening for chronic neck pain 2
- Animal-assisted therapy 2
- S-adenosyl-L-methionine for joint pain 2
Benefits and Effectiveness
Non-pharmacological interventions have shown promise in offering relief for people with chronic pain 4. These interventions can be critical adjunctive or stand-alone interventions for chronic pain conditions 4. However, the evidence for an empirically detected effectiveness of all these forms of therapy is not very high and often inconsistent 6.
Treatment Approach
A comprehensive and multimodal treatment approach is recommended, which consists of a combination of pain neuroscience education and cognitive-behavioral therapy, such as Acceptance and Commitment Therapy 3. This approach aims to provide flexibility and resilience in patients with chronic pain 3. Clinicians should become familiar with these interventions to offer patients flexibility in the pain management approach 2.