Clinical Cases Podcast Series-FREE NO CME-Non-Pharmacologic Treatments

Non-Pharmacologic Treatments

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This document from the Compass Opioid Prescribing Treatment Guidance Toolkit summarizes evidence-supported non-pharmacologic treatments for pain, emphasizing that non-pharmacological therapy is generally the preferred first-line approach, even when nonopioid medications are used as first-line pharmacologic options.<br /><br />Key lifestyle interventions include exercise and sleep restoration. Exercise is supported for improving both nociceptive pain (e.g., chronic low back pain) and centrally sensitized pain (e.g., fibromyalgia) and is often feasible as a self-directed strategy. Sleep restoration can be more complex; cognitive behavioral therapy (CBT) is highlighted as beneficial for improving sleep quality and, in turn, reducing chronic pain risk and pain severity.<br /><br />Physiotherapy options include active approaches such as physical and occupational therapy, therapeutic and aquatic exercise, neuromuscular re-education, functional training, and self-directed activity. The toolkit cites moderate to strong evidence that exercise therapy improves pain and function in musculoskeletal conditions. Massage therapy is described in detail, with evidence suggesting that massage combined with exercise can improve short-term pain and function for subacute low back pain, and that structured massage regimens may improve chronic low back and neck pain outcomes, with potential dose-related benefits.<br /><br />Psychotherapeutic interventions are recommended as part of chronic pain care (and sometimes acute pain), noting a neurophysiological basis for cognitive and behavioral approaches. CBT, acceptance and commitment therapy, pain education, and coping-skills-focused therapy can be delivered by appropriately trained and licensed behavioral health professionals, sometimes in consultation models.<br /><br />Complementary/alternative treatments reviewed include spinal/extremity manipulation (good evidence for pain and functional improvement) and acupuncture (evidence for chronic low back pain and knee osteoarthritis in older adults), with credentialing guidance for acupuncture providers. The document also lists multiple dietary supplements/phyto-chemicals with evidence for short-term use in certain pain conditions.<br /><br />Procedure-based interventions include trigger point injections (including some evidence for migraine and shoulder conditions), dry needling (short-term benefits for pain and range of motion), and TENS (evidence for musculoskeletal and postoperative pain). Finally, the toolkit organizes interventions into self-directed versus professionally directed categories to support practical care planning.

Keywords

non-pharmacologic pain treatment

exercise therapy

sleep restoration

cognitive behavioral therapy

physical therapy

massage therapy

acupuncture

spinal manipulation

trigger point injections

TENS