From the Guidelines
The most effective management strategy for chronic pain without the use of opioids involves a multimodal approach that combines non-pharmacologic therapies, such as cognitive behavioral therapy (CBT) and physical therapy, with non-opioid pharmacologic therapies. This approach is supported by the 2017 HIVMA of IDSA clinical practice guideline for the management of chronic pain in patients living with HIV, which recommends CBT for chronic pain management (strong, moderate) 1. Additionally, the guideline recommends yoga for the treatment of chronic neck/back pain, headache, rheumatoid arthritis, and general musculoskeletal pain (strong, moderate) 1.
Non-Pharmacologic Therapies
- CBT is recommended to promote patient acceptance of responsibility for change and the development of adaptive behaviors (eg, exercise) while addressing maladaptive behaviors (eg, avoiding exercise due to fears of pain) 1
- Yoga is recommended for the treatment of chronic neck/back pain, headache, rheumatoid arthritis, and general musculoskeletal pain (strong, moderate) 1
- Physical and occupational therapy are recommended for chronic pain (strong, low) 1
- Hypnosis is recommended for neuropathic pain (strong, low) 1
Non-Opioid Pharmacologic Therapies
- Acetaminophen and NSAIDs, such as ibuprofen or naproxen, can be used for pain management, as recommended by the CDC guideline for prescribing opioids for chronic pain (2016) 1
- Adjuvant medications, such as gabapentin or pregabalin, can be used for neuropathic pain, and duloxetine or amitriptyline can address both pain and associated depression
Comprehensive Approach
A comprehensive approach that combines non-pharmacologic and non-opioid pharmacologic therapies can improve function and quality of life while minimizing side effects compared to opioid therapy. Regular reassessment of pain management strategies is essential to optimize outcomes and adjust treatments as needed 1. This approach is supported by the CDC guideline, which recommends that clinicians consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient, and that opioids should be combined with non-pharmacologic therapy and non-opioid pharmacologic therapy, as appropriate 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Non-Pharmacological Interventions for Chronic Pain
- Non-pharmacological interventions, such as psychological interventions (e.g., cognitive behavioral therapy-based interventions and emotion-based therapies) and physical practices (e.g., exercise, massage, acupuncture, and yoga), have been found to be effective in managing chronic pain 2, 3, 4.
- These interventions target behaviors and brain processes underlying the experience of pain, and can be used as adjunctive or stand-alone interventions for chronic pain conditions 2.
- Multimodal non-invasive non-pharmacological therapies (NINPT) have been shown to be a valuable complementary option for chronic pain management, leveraging peripheral, spinal, and supraspinal mechanisms to restore normal pain processing and limit central sensitization 3.
Psychological Interventions
- Cognitive functional therapy (CFT) and cognitive behavioral therapy (CBT) have been found to be effective in managing chronic pain, allowing patients to better manage their symptoms and improve overall functioning 5.
- CFT is centered on a three-step process, including cognitive training, functional movement training, and physical activity and lifestyle changes 5.
- CBT focuses on identifying and changing maladaptive behaviors, thought patterns, and situations that contribute to psychiatric dysfunction and pain progression 5.
Physical Practices
- Exercise and physical activity have been shown to be effective in reducing pain and improving functioning in patients with chronic pain 4.
- Other physical practices, such as massage, acupuncture, and yoga, have also been found to be effective in managing chronic pain 2, 3.