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Nonpharmacologic and noninterventional therapies are valuable in treating pain. In fact, cognitive behavioral therapy and physical or functional therapy have been shown to be the most effective for management of chronic pain. In multiple randomized, controlled studies, cognitive behavioral therapy has been proven effective as a primary evidence-based treatment for chronic pain. Because mood and psychological issues play an important role in the patient’s perception of and response to pain, psychotherapy, support groups, prayer, and pastoral counseling can also help in pain management. Depression and anxiety, which may be instigated by chronic pain or may alter the response to pain, should be treated aggressively with antidepressants and anxiolytics.

Urits  I  et al. An update on cognitive therapy for the management of chronic pain: a comprehensive review. Curr Pain Headache Rep. 2019;23:57.
[PubMed: 31292747]  


Physical therapy is a mainstay of chronic pain management and encompasses several modalities, including strength training, manual therapy, and massage.

Physical therapy can be beneficial for a variety of types of chronic pain. For musculoskeletal pain, hot or cold packs, massage, and stretching (including traction) can be helpful.

But physical therapy can help not just musculoskeletal pain but also neuropathic pain. For example, if there is a cervical radiculopathy, the position and posture of individual neck muscles may exacerbate the narrowing of the neuroforamina; or nerves may become entrapped within hypertrophied muscles, leading to neuropathic pain. Therefore, functional rehabilitation through physical therapy may address multiple types of pain.

Physical therapy for management of low-back pain may involve “core stabilization.” Bounded by the diaphragm and the pelvic floor, the body’s “core” is composed of the abdominal muscles and back and gluteal muscles. Exercises can help stabilize the entirety of the core, so that the low back does not need to exert as much effort for movement, lifting, bending, etc. “Core stabilization” can thereby decrease low-back pain.

Because physical therapy has minimal potential harms associated with it, as opposed to pharmacologic or interventional approaches for pain management, it should be a key component in management of both acute and chronic pain. While physical therapy can be used on its own, it is often preferable to engage in it as part of a multidisciplinary approach to pain management (which may include psychological therapies).

Araujo  FM  et al. Physical therapy modalities for treating fibromyalgia. F1000Res. 2019;8:F1000.
[PubMed: 32047594]  
Martin-Gomez  et al.. Motor control using cranio-cervical flexion exercises versus other treatments for non-specific chronic neck pain: a systematic review and meta-analysis. Musculoskelet Sci Pract. 2019;42:52.
[PubMed: 31030111]  
Owen  PJ  et al. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. Br J Sports Med. 2020;54:1279.
[PubMed: 31666220]  


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