Numerous non-pharmacologic therapies manage pain. These may include a combination of physical and psychological techniques. Some methods used other than medications include physical therapy, exercise, massage, ultrasound therapy, heat/cold application, chiropractic manipulation, psychotherapy, biofeedback, relaxation therapy, acupuncture, transcutaneous electrical nerve stimulation (TENS), music therapy, injections, neuromodulation, spinal cord stimulation, deep brain stimulation, and radiofrequency ablation of nerve tissue (National Institute of Health [NIH], 2018).
For those with pain, a trial of physical therapy or occupational therapy can be helpful. With the help of a physical therapist, exercises targeting a specific type of pathology can help manage pain. Occupational therapists can help recommend devices that can assist in enhancing activities of daily living.
There is a tendency not to move with chronic pain, which leads to deconditioning and further incapacity—deconditioning results in more significant pain with any form of movement. Maintaining muscle mass prevents this downward spiral. The more an individual participates in exercise, the less probability of developing back pain. For those who have lower back pain, physical activity improves overall health significantly. Exercise, especially in water, is beneficial for patients with arthritis pain, and aerobic exercise has effectively decreased pain connected with fibromyalgia (NIH, 2018).
Yoga and Pilates have also become popular alternative treatments, especially for back pain (NIH, 2018). Tai' Chi, a Chinese practice involving slow, gentle movements, deep breathing, and relaxation, has positive effects on pain relief for several conditions, including fibromyalgia, arthritis, and low back pain. However, some yoga poses can be a potential cause of injury, especially those that involve overstretching of the neck.
Massage is soothing and relaxing, both physically and mentally. Massage may decrease pain by relaxing muscle tension and increasing capillary circulation, thereby improving general circulation.
A vibration is a form of electric massage. When vibration is applied lightly, it may have a soothing effect similar to massage. Vibration used with moderate pressure may relieve pain by causing numbness, paresthesia, and anesthesia of the area stimulated.
Heat and cold therapies can assist in managing pain (NIH, 2018). Heat reduces inflammation and promotes relaxation. It can be in the form of hot tub baths, heating pads, or heat packs. Cold is often more effective in relieving pain than heat. The application of cold reduces muscle spasms secondary to underlying skeletal muscle pain, joint pathology, or nerve root irritation. Cold application methods include ice massage, ice bags, and gel packs. Alternating heat and cold may be more effective than using either one alone.
Multiple psychological techniques can aid in reducing pain. The basis for using these methods is that thought influences feelings, and if thought (and behaviors) can be changed, so can feelings and even sensations, such as pain. Cognitive-behavioral methods require the patient's active participation.
Cognitive-behavioral therapy (CBT) is an effective coping skill for those with chronic pain (NIH, 2018). CBT emphasizes the present moment, where the individual becomes aware of their thoughts, feelings, and behaviors, and may include journaling these perceptions. CBT helps decrease the emotional distress associated with chronic pain by focusing on perceiving pain and adjusting to it. CBT decreases pain in chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and back pain. It also helps prevent headaches.
Relaxation is a state of relative freedom from anxiety and skeletal muscle tension, quieting or calming the mind and muscles. Relaxation is a learned technique but can be learned quickly in a motivated patient.
Imagery/visualization involves mentally creating a picture by using one's imagination. This mental picture may focus on a person, a place of enjoyment, a past event, or anything that brings pleasure. An occupied mind does not focus on the pain.
Distraction from pain is the focusing of attention on stimuli other than the pain sensation (NIH, 2018). The stimuli focused upon can be auditory, visual, or tactile-kinesthetic (hearing, seeing, touching, and moving). By concentrating on stimuli other than pain, the pain moves to the periphery of awareness. Distraction does not make the pain go away, nor does the effectiveness of distraction indicate the absence of pain. Music and humor are good means of distraction.
Transcutaneous Electrical Nerve Stimulation (TENS) provides low-voltage electricity to the body via electrodes placed on the skin. TENS may help with acute or chronic pain. Electrical stimulation of sensory nerves helps block pain signals going to the brain. TENS is contraindicated in patients with pacemakers, electrical implants, cardiac arrhythmias, circulation problems, and pregnancy.
Biofeedback is a technique to harness the mind's power to make the patient more aware of the body's sensations. Its exact mechanism is unclear, but it promotes relaxation and helps reduce pain (NIH, 2018).
Acupuncture is a neurostimulation technique that treats pain by inserting small, solid needles into the skin at varying depths. Various theories exist to explain how acupuncture works. The Chinese theory of acupuncture is that it allows the release of blocked energy in the body. In Chinese medicine, this energy source is known as Qi, and its ability to flow freely through the body is related to overall well-being (NIH, 2018).
Music therapy treats pain. Music therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a credentialed professional's therapeutic relationship. This individual has to complete an approved music therapy program. Research in music therapy supports its effectiveness in a wide variety of healthcare and educational settings (NIH, 2018).
Music therapists use music to facilitate changes that are non-musical. Individuals doing music therapy listen to music created under the guidance of a specially educated and certified professional in music therapy.
The theory of music therapy's effect on chronic pain deals with how pain signals travel through the body. When the brain senses injury to the body, pain signals begin in the somatosensory cortex and the hypothalamus and work their way through the "pain pathway," ultimately sending signals that provide pain relief. Some signals stimulate the release of neurotransmitters such as endorphins, dynorphins, and enkephalins. Music helps in pain reduction by activating these sensory pathways. Like relaxation and guided imagery, music can strengthen the brain's right side, which controls the body's healing processes.
Different surgical interventions or procedures assist in the pain management plan. Procedures include injections, spinal cord stimulation, deep brain stimulation, neural ablative techniques, and surgical interventions. These are potential options for those for whom other methods have not controlled the pain (NIH, 2018).
