Non-invasive, non-pharmacological therapies for chronic pain

Pain in one or more places in the body that lasts or recurs for more than three months is referred to as chronic pain. Chronic pain is linked to psychological distress and functional impairment that makes it difficult to carry out everyday tasks.1 Due to lost productivity and direct medical expenses, chronic pain is also associated with a significant social burden.2,3 Especially when used over an extended time, traditional medications for chronic pain including opioids and nonsteroidal anti-inflammatory drugs have serious risks and limitations, such as addiction, tolerance, dependency, gastrointestinal bleeding, renal impairment, and cardiovascular events.4,5

Options for safely and efficiently controlling chronic pain without producing major side effects or tissue damage are provided by non-invasive, non-pharmacological therapies (NINPT).6 These methods can be classified into physical modalities, psychological interventions, complementary and alternative therapies, and other cutting-edge methods for treating chronic pain disorders.6,7 Physical modalities such as massage, heat therapy, cryotherapy, and transcutaneous electrical nerve stimulation intend to adjust chronic pain signals through physiological mechanisms.8-10 On the other hand, psychological therapies such as mindfulness-based therapy and cognitive-behavioral therapy promote constructive behavioral and psychological changes.11-13 Acupuncture, yoga, and music therapy are complementary and alternative therapies that offer additional options to reduce chronic pain through mechanisms incorporating physical and psychological components.14-16 Various other interventions, such as biofeedback, virtual reality therapy, and chiropractic care, use methods to modify chronic pain.17-19 Depending on the specific circumstances, the patient's choices, and the resources available, NINPT can be used alone or in conjunction with traditional treatments for chronic pain management.

The Agency for Healthcare Research and Quality conducted a Comparative Effectiveness Review, which revealed evidence of long-lasting benefits for certain nonpharmacological, noninvasive treatments for particular chronic pain syndromes. Although the data were sparse for many interventions, the report's trials, exercise, multidisciplinary rehabilitation, acupuncture, cognitive behavioral therapy, mindfulness, and mind-body practices were most consistently linked to long-lasting small to moderate improvements in pain and function for particular chronic pain conditions. According to Skelly et al. (2018), the review findings offered some support for clinical strategies that center on nonpharmacological therapy for particular chronic pain problems.  NINPT is a domain of great promise that includes a variety of therapies aimed at modulating pain via pathways that include peripheral, spinal, and supraspinal. 20

References

1. Nicholas M, Vlaeyen JWS, Rief W, et al. The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain 2019;160:28–37. 

2. Witt EA, Kenworthy J, Isherwood G, et al. Examining the association between pain severity and quality-of-life, work-productivity loss, and healthcare resource use among European adults diagnosed with pain. J Med Econ 2016;19:858–65.

3. Dueñas M, Ojeda B, Salazar A, et al. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res 2016;9:457–67.

4. Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P, Donovan MI, Fishbain DA, Foley KM, Fudin J. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113-30.e22.

5. Fowler TO, Durham CO, Planton J, Edlund BJ. Use of nonsteroidal anti-inflammatory drugs in the older adult. J Am Assoc Nurse Pract. 2014;26(8):414–23.

6. Qaseem A, Wilt TJ, McLean RM, Forciea MA, Denberg TD, Barry MJ, Boyd C, Chow RD, Fitterman N, Harris RP, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514–30.

7. Skelly AC, Chou R, Dettori JR, Turner JA, Friedly JL, Rundell SD, Fu R, Brodt ED, Wasson N, Kantner S, et al. Noninvasive nonpharmacological treatment for chronic pain: a systematic review update. Agency for Healthcare Research and Quality (US): Rockville; 2020.

8. Johnson MI, Paley CA, Jones G, Mulvey MR, Wittkopf PG. Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: a systematic review and meta-analysis of 381 studies (the meta-TENS study). BMJ Open. 2022;12(2):e051073.

9. Wang Y, Lu H, Li S, Zhang Y, Yan F, Huang Y, Chen X, Yang A, Han L, Ma Y. Efect of cold and heat therapies on pain relief in patients with delayed onset muscle soreness: a network meta-analysis. J Rehabil Med. 2022;54:jrm00258.

10. Field T. Massage therapy research review. Complement Ther Clin Pract. 2016;24:19–31.

11. Ehde DM, Dillworth TM, Turner JA. Cognitive-behavioral therapy for individuals with chronic pain: efcacy, innovations, and directions for research. Am Psychol. 2014;69(2):153.

12. Cherkin DC, Sherman KJ, Balderson BH, Cook AJ, Anderson ML, Hawkes RJ, Hansen KE, Turner JA. Efect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and funcional limitations in adults with chronic low back pain: a randomized clinical trial. JAMA. 2016;315(12):1240–9.

13. Shi Y, Cui S, Zeng Y, Huang S, Cai G, Yang J, Wu W. Brain network to placebo and nocebo responses in acute experimental lower back pain: a multivariate granger causality analysis of fMRI data. Front Behav Neurosci. 2021;15:696577.

14. Shi Y, Liu Z, Zhang S, Li Q, Guo S, Yang J, Wu W. Brain network response to acupuncture stimuli in experimental acute low back pain: an fMRI study. Evid-Based Compl Alt: eCAM. 2015;2015:210120.

15. Saper RB, Lemaster C, Delitto A, Sherman KJ, Herman PM, Sadikova E, Stevans J, Keosaian JE, Cerrada CJ, Femia AL, et al. Yoga, physical therapy, or education for chronic low back pain: a randomized noninferiority trial. Ann Intern Med. 2017;167(2):85–94.

16. Gutgsell KJ, Schluchter M, Margevicius S, DeGolia PA, McLaughlin B, Harris M, Mecklenburg J, Wiencek C. Music therapy reduces pain in palliative care patients: a randomized controlled trial. J Pain Symptom Manage. 2013;45(5):822–31.

17. Urits I, Schwartz RH, Orhurhu V, Maganty NV, Reilly BT, Patel PM, Wie C, Kaye AD, Mancuso KF, Kaye AJ. A comprehensive review of alternative therapies for the management of chronic pain patients: acupuncture, tai chi, osteopathic manipulative medicine, and chiropractic care. Adv Ther. 2021;38:76–89.

18. Bergmann A, Edelhof D, Schubert O, Erdelt KJ, Pho Duc JM. Efect of treatment with a full-occlusion biofeedback splint on sleep bruxism and TMD pain: a randomized controlled clinical trial. Clin Oral Investig. 2020;24(11):4005–18.

19. Ahmadpour N, Randall H, Choksi H, Gao A, Vaughan C, Poronnik P. Virtual Reality interventions for acute and chronic pain management. Int J Biochem Cell Biol. 2019;114:105568.

20. Skelly, A.C., Chou, R., Dettori, J.R., Turner, J.A., Friedly, J.L., Rundell, S.D., Fu, R., Brodt, E.D., Wasson, N., Winter, C. and Ferguson, A.J., 2018. Noninvasive nonpharmacological treatment for chronic pain: a systematic review.