Non-Pharmacological Interventions for Chronic Pain Management: A Narrative Review
DOI:
https://doi.org/10.52609/jmlph.v5i4.207Keywords:
Chronic Pain, Cognitive Behavioural Therapy, Mindfulness-based Stress Reduction, Non-pharmacological Interventions, Occupational Therapy, Physical Therapy, Psychological TherapiesAbstract
Background: Chronic pain is a pervasive and debilitating condition affecting millions globally, leading to significant distress, disability, and economic burden. Characterized by persistent or recurring pain lasting beyond three months, it profoundly impacts quality of life, mental health, and socioeconomic well-being.
Objectives: This comprehensive review critically evaluates the efficacy and safety of various non-pharmacological interventions for chronic pain management.
Methods: A systematic search was conducted across PubMed, Scopus, CINAHL, and Web of Science databases for studies published in English between 2000 and 2024. Keywords related to chronic pain and non-pharmacological interventions were identified, including physical therapies, psychological therapies, and complementary and integrative medicine (CIM) modalities. Study selection focused on randomized controlled trials, controlled clinical trials, systematic reviews, cohort studies, and case-control studies involving adults with chronic pain.
Results: Physical therapies, such as manual therapy, exercise therapy, and therapeutic modalities, demonstrate benefits in improving physical function and reducing chronic pain. Psychological therapies, including cognitive behavioural therapy (CBT), mindfulness-based stress reduction (MBSR), and acceptance and commitment therapy (ACT), are crucial for addressing the psychological and emotional dimensions of chronic pain. CIM modalities such as yoga, Tai Chi, acupuncture, and massage therapy offer complementary approaches. The strength of evidence varies across interventions, with CBT and exercise therapy supported by robust evidence, while other modalities require further investigation.
Conclusions: This review underscores the importance of a multimodal approach to chronic pain management, integrating physical, psychological, and CIM therapies.
References
Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287-333.
Institute of Medicine. Relieving pain in America: A blueprint for transforming prevention, care, education, and research. National Academies Press; 2011.
Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health. 2011;11:770.
Dydyk AM, Conermann T. Chronic Pain. [Updated 2024 May 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553030/
Turk DC, Okifuji A. Treatment of chronic pain patients: Clinical outcomes, cost-effectiveness, and cost-benefits of multidisciplinary pain management. Crit Rev Phys Rehabil Med. 2001;13(2):79-119.
Woolf CJ. What is this thing called pain? J Clin Invest. 2010;120(11):3742-3744.
Nicholson B, Verma S. Comorbidities in chronic pain. Pain Med. 2004;5(1):69-77.
Bair MJ, Robinson RL, Katon W. Depression and anxiety in patients with chronic pain. J Pain Symptom Manage. 2003;25(5):399-408.
Ambrose KR, Golightly YM. Physical exercise as non-pharmacological treatment of chronic pain: Why and when. Best Pract Res Clin Rheumatol. 2015 Feb;29(1):120-30. doi: 10.1016/j.berh.2015.04.022. Epub 2015 May 23. PMID: 26267006; PMCID: PMC4534717.
National Guideline Centre (UK). Evidence review for manual therapy for chronic primary pain: Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain: Evidence review I. London: National Institute for Health and Care Excellence (NICE); 2021 Apr. (NICE Guideline, No. 193.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK569986/
Jurecka A, Papież M, Skucińska P, Gądek A. Evaluating the effectiveness of soft tissue therapy in the treatment of disorders and postoperative conditions of the knee joint - A systematic review. J Clin Med. 2021 Dec 18;10(24):5944. doi: 10.3390/jcm10245944. PMID: 34945240; PMCID: PMC8704673.
Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021 Sep 28;9(9):CD009790. doi: 10.1002/14651858.CD009790.pub2. PMID: 34580864; PMCID: PMC8477273.
Johns LD. Nonthermal effects of therapeutic ultrasound: the frequency resonance hypothesis. J Athl Train. 2002 Jul;37(3):293-9. PMID: 16558674; PMCID: PMC164359.
Munari D, Serina A, Leonardelli A, et al. Effects of deep heating modalities on the morphological and elastic properties of the non-insertional region of achilles tendon: a pilot study. Int J Hyperthermia. 2022;39(1):222-228. doi:10.1080/02656736.2022.2026497
Canadian Agency for Drugs and Technologies in Health. Physical therapy treatments for chronic non-cancer pain: A review of guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2016 Nov 10. Appendix 4, Summary of recommendations by source. Available from: https://www.ncbi.nlm.nih.gov/books/NBK409571/ [Cited 2025 Aug 18].
Lagueux É, Dépelteau A, Masse J. Occupational therapy's unique contribution to chronic pain management: a scoping review. Pain Res Manag. 2018 Nov 12;2018:5378451. doi: 10.1155/2018/5378451. PMID: 30538795; PMCID: PMC6260403.
Physiopedia. Joint protection principles [Internet]. 2020 Oct 29 [cited 2025 Feb 8]. Available from: https://www.physio-pedia.com/index.php?title=Joint_Protection_Principles&oldid=257840
Williams ACC, Fisher E, Hearn L, Eccleston C. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2020 Aug 12;8(8):CD007407. doi: 10.1002/14651858.CD007407.pub4. PMID: 32794606; PMCID: PMC7437545.
Institute for Quality and Efficiency in Health Care (IQWiG). In brief: Cognitive behavioral therapy (CBT) [Updated 2022 Jun 2]. In: InformedHealth.org [Internet]. Cologne (Germany): Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279297/
Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognit Ther Res. 2012 Oct 1;36(5):427-440. doi: 10.1007/s10608-012-9476-1. Epub 2012 Jul 31. PMID: 23459093; PMCID: PMC3584580.
Hofmann SG, Gómez AF. Mindfulness-based interventions for anxiety and depression. Psychiatr Clin North Am. 2017 Dec;40(4):739-749. doi: 10.1016/j.psc.2017.08.008. Epub 2017 Sep 18. PMID: 29080597; PMCID: PMC5679245.
Hughes LS, Clark J, Colclough JA, Dale E, McMillan D. Acceptance and commitment therapy (ACT) for chronic pain: a systematic review and meta-analysis. Clin J Pain. 2017;33(6):552-568. doi:10.1097/AJP.0000000000000425
Tabish SA. Complementary and alternative healthcare: is it evidence-based? Int J Health Sci (Qassim). 2008 Jan;2(1):V-IX. PMID: 21475465; PMCID: PMC3068720.
Woodyard C. Exploring the therapeutic effects of yoga and its ability to increase quality of life. Int J Yoga. 2011 Jul;4(2):49-54. doi: 10.4103/0973-6131.85485. PMID: 22022122; PMCID: PMC3193654.
Chen Q. Neurobiological and anti-aging benefits of yoga: a comprehensive review of recent advances in non-pharmacological therapy. Exp Gerontol. 2024;196:112550. doi:10.1016/j.exger.2024.112550
Kuramoto AM. Therapeutic benefits of Tai Chi exercise: research review. WMJ. 2006;105(7):42-46.
Van Hal M, Dydyk AM, Green MS. Acupuncture. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532287/
Field T. Massage therapy research review. Complement Ther Clin Pract. 2016;24:19-31. doi:10.1016/j.ctcp.2016.04.005
Morcillo-Muñoz Y, Castellano MHJ, Exposito FJD, Sanchez-Guarnido AJ, Alcantara MG, Baena-Parejo MI. Multimodal interventions to improve the management of chronic non-malignant pain in primary care using participatory research. Clin Pract. 2021 Aug 26;11(3):561-581. doi: 10.3390/clinpract11030072. PMID: 34449567; PMCID: PMC8395459.
Nijs J, Malfliet A, Roose E, Lahousse A, van Bogaert W, Johansson E, et al. Personalized multimodal lifestyle intervention as the best-evidenced treatment for chronic pain: state-of-the-art clinical perspective. Journal of Clinical Medicine. 2024; 13(3):644. https://doi.org/10.3390/jcm13030644
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Copyright (c) 2025 Mohammed Albesher, Mohammed AlKhalifah, Abdulaziz Hazazi , Ghassan Hakeem , Bader Almogbel

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