Applied Evidence

Nonpharmacologic treatment of chronic pain: What works?

Author and Disclosure Information


From The Journal of Family Practice | 2018;67(8):474-477,480-483.


In the management of headache pain, the literature has consistently found acupuncture to be beneficial in the prevention of migraine headaches. A 2016 Cochrane review found acupuncture beneficial compared to no treatment (4 trials; n=2199) or sham acupuncture (10 trials; n=1534), with benefit similar to prophylactic medications but with fewer adverse effects (3 trials; n=744).31

Evidence for benefit in OA pain has been mixed, but a 2016 meta-analysis evaluating 10 trials (n=2007) found acupuncture improved both short-term pain and functional outcome measures when compared with either no treatment or a sham control.32 There have also been reviews showing short-term benefit in fibromyalgia pain (TABLE 35,33-38).33

Complementary modalities for chronic pain: The evidence

Building an effective treatment plan

When creating a treatment plan for chronic pain, it’s helpful to keep the following points in mind:

  • Emphasize active treatments. Most traditional medical treatments and many complementary therapies are passive, meaning a patient receives a treatment with little agency in its implementation. Active therapies, such as exercise or relaxation practices, engage patients and improve pain-related coping skills. Active treatments promote self-efficacy, which is associated with improved outcomes in chronic pain.39
  • Use treatments from different categories. Just as it is uncommon to choose multiple medications from the same pharmaceutical class, avoid recommending more than one nonpharmacologic treatment from each category. For example, adding chiropractic therapy to a treatment plan of PT, osteopathic manipulation, and massage isn’t likely to add significant benefit because all of these are structural therapies. Addition of a mind-body therapy would likely be a better choice. Consider the template provided when putting together a pain management plan (FIGURE).
Pain management plan

Continue to: Good plan, but how did the office visit go?


Next Article: