Medical pain management is in a time of crisis. The opioid epidemic has spooked providers about prescribing opioids. Issues like dependence, diversion, and overdose plague physician efforts to curb the pervasiveness of pain and onerous burden of inadequate pain treatment. Furthermore, the costs of treating this pain are ballooning, and various state and federal agencies—including the CDC, FDA, NIH, DOD, and VHA—have stepped in to manage the repercussions of pain management care.
Pressure exists among physicians to use non-pharmacologic pain management. With that in mind, here are six options to consider.
Acupuncture is the insertion and manipulation of solid needles at specified points on the body. With acupuncture, stimulation can be applied via electricity, pressure, and heat. It is sometimes combined with other traditional remedies, including cupping, moxibustion, and herbal medicines. Acupuncture is based on ancient Asian calculus focusing on the inter-relationship of organs, body points, channels, associated symptoms, disability, and disease.
Various meta-analyses have demonstrated that acupuncture is effective in treating post-surgical pain. According to the research, acupuncture reduces opioid need at 8 hours post-op by 21% and at 72 hours by 29%.
Acupuncture is also effective at treating chronic pain. For instance, based on the results of meta-analysis, the American College of Physicians recommends it for the first-line treatment of lower back pain. Furthermore, research has shown that acupuncture is comparable to drugs when treating acute back pain in the emergency department. Other lines of research support the use of acupuncture to treat migraine, burns, and acute injuries.
Acupuncture has a low rate of negative side effects. In fact, some people who receive the intervention claim to feel elation and relaxation post-treatment. Incidences of infection and pneumothorax trace back to the inexperience of the practitioner. Of note, some people feel itching at the point where the needle is inserted.
With massage therapy, soft tissue structures are manipulated to prevent or alleviate pain, spasm, tension, and stress to enhance wellness. Researchers of a systematic review spanning 16 studies found that massage therapy was effective compared with active comparators in reducing pain intensity/severity and anxiety in patients undergoing surgery. Massage therapy is safe, with low rates of muscle soreness and other minor complaints.
The effects of music on pain has proven to be a buzzworthy topic in media coverage. A meta-analysis of 97 studies on many different types of pain—acute, procedural, cancer, and chronic—showed significant reductions in pain intensity, emotional distress, analgesic use, and opioid/non-opioid pain medicine intake. Other research has shown that music therapy can decrease post-Caesarean pain.
This intervention serves as a distraction to pain by immersing the patient in a three-dimensional, digital environment. According to the research, when paired with standard anesthesia, virtual reality has been shown to help with the reduction of burn-induced pain and burn-wound care in children and adults alike. Virtual reality has also shown promise in inpatient cancer care. Researchers of one study found that virtual reality-assisted burn and non-burn wound care compared with no virtual reality yielded a reduction in opioid need by 39%. Levels of anxiety and pain, however, were comparable.
To avoid collision and injury while using virtual reality, designated safe areas and spotters can be used. Moreover, children and those sensitive to the effects of the immersive experience should be educated following treatment.
Spinal manipulative therapy
This intervention falls within the domain of chiropractors and osteopathic physicians. It involves the treatment of joints in the body with high velocity, low amplitude thrust techniques, in addition to low velocity, low amplitude joint mobilization techniques.
Researchers of systematic reviews have found that spinal manipulative therapy is effective for the treatment of lower back pain, neck pain, sprains, plantar fasciitis, headache, knee and hip osteoarthritis, and more. Adverse effects of this intervention are usually minor and related to soreness or transient heightening in pain. Rarely, spinal manipulation can lead to cervical artery dissection, neck injury, and stroke.
Biofeedback for chronic pain entails training the patient to manipulate body physiology (ie, heart rate and muscle tension) by means of a signal generated by a machine. Results from a meta-analysis indicate that biofeedback reduces pain, depression, disability, and muscle tension in patients with lower back pain. Consequently, the American College of Physicians issued guidelines recommending electromyography biofeedback for the treatment of chronic lower back pain. Other research has indicated that biofeedback could help reduce the pain of tension headaches and fibromyalgia.
Nonpharmacologic treatments have been shown to be cost-effective in addition to being clinically effective. Experts suggest that they should be considered for the treatment of common conditions such as lower back pain, knee osteoarthritis, and headache.