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.
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. With chronic pain, there is a tendency not to move, which leads to deconditioning and other incapacities—deconditioning results in greater pain with any form of movement. Maintaining muscle mass prevents this downward spiral. It has also been shown that the more an individual participates in exercise, the less probability there is of them developing back pain. For those who have lower back pain, physical activity has been shown to improve their overall health significantly. Exercise, especially those performed in water, is beneficial for patients with arthritis pain, and aerobic exercise has effectively decreased pain connected with fibromyalgia (Moller, 2014).
Yoga and Pilates have also become popular alternative treatments, especially for back pain. However, some yoga poses can be a potential cause of injury, especially those that involve overstretching of the neck. Tai' Chi, another Chinese practice involving slow, gentle movements, and deep breathing, and relaxation, has positive effects on pain relief for several conditions, including fibromyalgia, arthritis, and low back pain (Moller, 2014).
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.
Vibration is a form of electric massage. When vibration is applied lightly, it may have a soothing effect similar to massage. Vibration applied with moderate pressure may relieve pain by causing numbness, paresthesia, and anesthesia of the area stimulated.
Heat and cold therapies can assist in the management of pain. 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 spasm, joint pathology, or nerve root irritation. Methods of cold application include ice massage, ice bags, and gel packs. Alternating heat and cold may be more effective than the use of 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) has proven to be an effective coping skill for those with chronic pain. CBT emphasizes the present moment, where individuals become aware of their thoughts, feelings, and behaviors and journal these perceptions. CBT helps decrease the emotional distress associated with chronic pain by focusing on how one perceives pain and adjusts to it. CBT has been shown to decrease pain in chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and back pain. It has also been used successfully as a means to prevent headaches (Moller, 2014).
Relaxation is a state of relative freedom from anxiety and skeletal muscle tension, a quieting or calming the mind and muscles. Although relaxation is a learned technique, it can be achieved quickly in a motivated patient.
Imagery/Visualization involves mentally creating a picture by using one's imagination. This mental picture may focus on a close 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. The stimuli focused upon can be auditory, visual, or tactile-kinesthetic (hearing, seeing, touching, and moving). By focusing 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 (DeSantana et al., 2008).
Biofeedback is a technique to harness the mind's power to allow the patient to be more aware of the body's sensations. The exact mechanism that it works 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 health care and educational settings.
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.
Like relaxation and guided imagery, music can strengthen the brain's right side, which controls the body's healing processes. 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.
Different surgical interventions or procedures can be used in the pain management plan. Procedures may include injections, spinal cord stimulation, deep brain stimulation, neural ablative techniques, and surgical interventions. These are potential options for those in whom other methods have not controlled the pain.