Attention A T users. To access the menus on this page please perform the following steps. 1. Please switch auto forms mode to off. 2. Hit enter to expand a main menu option (Health, Benefits, etc). 3. To enter and activate the submenu links, hit the down arrow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links.

Whole Health Library


Quick Links

Veterans Crisis Line Badge
My healthevet badge

Non-Drug Approaches to Chronic Pain

What Is the Difference Between Acute and Chronic Pain?

Acute pain is signaled through peripheral pain receptors at an anatomic site. As the site undergoes healing, the nociceptive receptors receive less stimulation, and activity decreases back to preinjury levels. Chronic pain often begins with the same nociceptive signals, but prolonged signaling results in changes to the nervous system. Neurons become hyperexcitable, and signals to the thalamus and cerebral cortex (where pain processing occurs) become amplified.[1] In addition, emotional and psychological changes that take place also color the pain experience.[1] The brain receives continued pain signals, even when there is no further tissue damage. This concept is at the core of what differentiates acute and chronic pain: when chronic, pain does not mean ongoing tissue damage.

How Is Pain Typically Treated?

Conventional treatments of pain include ice, medications, interventional treatments, and sometimes surgery. Analgesic medications include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol, and opioids. Adjunctive medications include tricyclic antidepressants and anticonvulsants. Collectively, these medications certainly have a role in treatment, but are limited in therapeutic success and have plentiful side effects.

What Are Some Non-Drug Treatments of Chronic Pain?

There are several classes of treatments other than pharmaceuticals that have the potential to help in pain. Exercise, nutrition, supplements, mind-body techniques, and modalities such as acupuncture and spinal manipulation all have evidence of benefit in pain disorders.

Does Exercise Help Chronic Pain?

Exercise can affect pain on multiple physiologic levels, making it an ideal treatment modality. Exercise can improve aerobic capacity, strength, and flexibility. This combination can lead to increased functional capacity over time. Exercise itself can alter pain perception, inducing hypoalgesia to new pain stimuli following both aerobic and strength training.[2] In individuals with chronic pain, this is best demonstrated at low- to moderate-intensity training.[2] Exercise is also known to have effects centrally, improving sleep and depressive symptoms.[3] These symptoms commonly coexist with chronic pain and impact pain perception, making them excellent targets for treatment. Overall, physical activity has been shown to have “few adverse events” and to “improve pain severity and physical function, and consequently quality of life”. [36]

Are Some Exercises Particularly Good for People with Chronic Pain?

Overall there is no best exercise program for patients with chronic pain. There is no evidence that one exercise program is superior to another. Because of this, it is most important to consider a patients current functional status and interests when making recommendations. Physical activity recommendations should be individualized.[37] In addition, physical activity that is practiced long-term and consistently has been shown to yield the greatest improvement in chronic pain.[38]

Yoga and tai chi are excellent exercises to consider for patients with chronic pain. Both can be done in a gentle manner and include important mind-body aspects, which can have added benefits. There are research studies showing positive outcomes with yoga as a treatment for chronic low back pain, rheumatoid arthritis, and chronic headaches.[4] TaiChi and Qigong have been found to improve function in people with pain secondary to kneeosteoarthritis,[39] improve the Fibromyalgia Impact Questionnaire in people with pain secondary to fibromyalgia,[40] improve pain associated with Parkinson’s Disease,[41] improve disability and quality of life in those diagnosed with rheumatoid arthritis,[42] decrease low back pain, and minimally improved pain associated with the neuropathic pain of multiple sclerosis.[43]

Of note, there is evidence to suggest that VA-hosted telemedicine facilitation of complementary and integrative health related movement therapies such as tai chi and yoga are effective for chronic pain as well.[44]

Can Nutrition Help with Pain?

Nutritional choices can influence pain directly or indirectly. Some foods have known anti-inflammatory properties, which may affect pain through altering cytokine and oxidant production.[5] Indirectly, food can affect pain through improving mood, energy level, and sleep, as well as by helping a person achieve a healthy weight. The Mediterranean diet offers many of the anti-inflammatory components offered above in addition to having research supporting cardiovascular health benefits. This diet emphasizes fruits, vegetables, whole grains, olive oil, and nuts while limiting the intake of meat and dairy products. A trial of a Mediterranean-style diet, provided a person can tolerate the grains included, is reasonable for most chronic pain patients as a means of attempting to improve multiple health measures, including pain. A 2022 systematic review of 24 studies revealed that a diet modified to a hypocaloric, Mediterranean or a healthier profile in general can significantly improve chronic non-cancer pain.[45] Processed foods should be minimized, and whole foods should be emphasized, regardless of the specific diet a person chooses to follow. A 2021 review showed an association between incorporating foods containing antiinflammatory nutrients such as fruits, vegetables, long chain and monounsaturated fats, antioxidants and fiber and a reduction in pain severity and interference.[46]

What Supplements Can Help with Chronic Pain?

Note: Please see the Passport to Whole Health, Chapter 15 on Dietary Supplements for more information about how to determine whether or not a specific supplement is appropriate for a given individual. Supplements are not regulated with the same degree of oversight as medications, and it is important that clinicians keep this in mind. Products vary greatly in terms of accuracy of labeling, presence of adulterants, and the legitimacy of claims made by the manufacturer.

Omega-3 supplementation

There is more research supporting the use of omega-3 fatty acids with overt inflammatory conditions. For instance, omega-3 supplementation has been found to improve joint tenderness and morning stiffness in rheumatoid arthritis.[6,47] Doses should be standardized based on the amount of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) present in the supplement; it should exceed 2 gms per day of EPA plus DHA to get the desired benefit. Omega-3 supplements are quite safe and may improve other aspects of health, such as lipid profiles.

Vitamin D

There is a high correlation between vitamin D deficiency and chronic pain, based on epidemiologic data.[7] It is not clear, however, if there is a causal relationship. A 2022 systematic review of 14 studies showed a correlation between vitamin D deficiency and chronic pain. In addition, 6 studies showed improved pain with Vitamin D supplementation in people with vitamin D deficiency. Eight studies showed that there may be pain reduction, regardless of vitamin D deficiency. Of note, a 2013 study specific to Veterans found that vitamin D improved pain, sleep, and quality-of-life measure in patients with chronic pain.[9] At this time, supplementation seems reasonable in those patients with low vitamin D levels, and empirical vitamin D supplementation for pain alone is supported by some evidence.[48]


Magnesium deficiency appears to be more common in patients with fibromyalgia, and deficiency is correlated with fibromyalgia symptoms. Supplementation with magnesium citrate has been shown to reduce the intensity of fibromyalgia symptoms.[10] Several clinical studies have found that Mg has beneficial effects in patients suffering from neuropathic pain, dysmenorrhea, tension headache, acute migraine attack, and others. These effects are considered to be due to blockade of the NMDA receptor, attenuation of central sensitization, and muscle relaxing effects.[49] Magnesium supplements can be calming for some patients, so it can be useful to take them before bed. A dose of 400-800 mgs of a magnesium supplement is often recommended. Magnesium oxide should be avoided as a supplement due to its laxative effects. Dietary sources of magnesium include whole grains, spinach, almonds, soybeans, and avocados.


Reseach has suggested that several other dietary supplements may also have benefits in the setting of chronic pain. While further study is necessary, the strongest evidence for these supplements are as follows:[49-52]

Supplements Role Indications Suggested Dose When Treating Pain
Vitamin B complex vitamin supplementation  Neuropathic pain, knee osteoarthritis, diabetic neuropathy use Reference Daily Intake (RDI)
 Aloha Lipoic Acid   antioxidant, anti-inflammatory Diabetic neuropathy, headache, carpal tunnel syndrome, burning mouth syndrome, rheumatoid arthritis, chronic pain 600-1000mg daily  
Acetyl Lipoic Acid antioxidant, modulates brain neurotransmitters including dopamine and serotonin diabetic neuropathy, carpal tunnel syndrome 500mg twice daily
Coenzyme Q10 (ubiquinone)   anti-inflammatory, antioxidant fibromyalgia, rheumatoid arthritis, migraines  30-100mg daily

A number of botanical supplements are also important for clinicians to be aware of:

Devils claw (Harpagophytum procumbens)

A 2007 meta-review included five systematic reviews on devils claw with strong evidence of effectiveness for low back pain and osteoarthritis (OA) pain of the knee and hip.[11] This effect was not inferior to NSAIDs. The review concluded by stating, Since there is strong evidence for devils clawthe possible place in the treatment schedule before NSAIDs should be considered.[11] Doses should be at least 50 mgs of the harpagoside, which equates to 2.6 gms/day of the root. Effects are dose dependent. It is generally well tolerated.

Willow bark (Salix alba)

Willow bark is an herb containing salicin, which is related to aspirin. It has been used for centuries to relieve pain.[12] The mechanism of action is thought to be COX-2 inhibition similar to aspirin, without the effects on prostaglandins or coagulation. There is evidence of efficacy in chronic low back similar to that seen in rofecoxib 12.5 mgs.[12] Evidence in osteoarthritis is mixed.[12] The effect is dose dependent, and the willow bark dosage used in studies was standardized to 240 mgs of salicin.

Topical capsaicin

Capsaicin is widely available a cream in various doses. It is useful as a short-term analgesic, and a review has shown this superior to placebo for acute episodes of chronic low back pain.[13] A 2016 Cochrane review confirmed Capsicum frutescens as superior to placebo in the treatment of pain.[53]

Turmeric (Curcumin) 

Curcuma longa L. is a plant of the Zingiberaceae family, native to south-eastern Asia, rich in bioactive molecules with numerous health and therapeutic benefits. Its anti-inflammatory effects seem to play a role in the mitigation of pain. Curcumin, which is the most represented component in turmeric extracts, also has antioxidant activity comparable to that of vitamin C and vitamin E. Studies have shown analgesic effects in the setting of osteoarthritis, chronic postsurgical pain, and active rheumatoid arthritis.[49,54] Turmeric is most often used at doses of 1500mg daily and has been studied at this dose for up to three months. Extracts typically include piperine, an active constituent of pepper, to improve turmeric bioavailability. This botanical medicine is generally well tolerated with most common side effects being Constipation, dyspepsia, diarrhea, distension, gastroesophageal reflux, nausea, and vomiting.[55]


Boswellia serrata or incense tree is an arboreal plant prevalent in the Maghreb region, in Southeast Asia, and in India.[49] The most convincing evidence for Boswellia’s use in chronic pain at this point in time is for osteoarthritis. A 2020 meta-analysis of small, low-quality randomized controlled trial concluded that Boswellia serrata extract 100-250mg daily for 1-3 months moderately reduces pain and improves function when compared with placebo.[56] Boswellia is generally well tolerated, with most common side effects including abdominal pain, diarrhea, heartburn, itching, nausea.[57]

Are Mind-Body Approaches Useful in Pain?

The link between mind-body interventions and chronic pain is important to consider, given the adaptive changes of the central nervous system that occur in chronic pain. Using mind-body interventions directly addresses this component of central-mediated pain.[14] Mind-body interventions not only improve pain, but also mood-related symptoms, stress management, and illness-related coping skills.

Mind-body interventions have been evaluated for their use in OA, rheumatoid arthritis, chronic low back pain, chronic headache, fibromyalgia, and post-surgical pain, among many others.[15] A Cochrane review on behavioral therapies in chronic low back pain concluded that strong evidence exists for a moderate effect on pain relief and mild improvement in functional status and behavioral outcomes with behavioral therapies.[16] Similar results were found for RA in a meta-analysis of studies that focused on psychological-behavioral interventions and their ability to improve pain, disability, psychological status, and coping.[15] The current evidence in fibromyalgia is currently less robust, with limited evidence of benefit when behavioral treatments are used in isolation.[17] However, there is moderate evidence of effectiveness when they are combined with aerobic exercise.[15] More general chronic pain (not linked to another diagnosis) also seems to be effectively treated with mind-body therapies.[58] A meta-analysis found cognitive behavioral therapy in chronic pain to be effective for improving pain intensity, coping skills, activity level, and social function.[18] In 2022, systematic reviews of clinical hypnosis,[59,60] neurobiofeedback,[61] and heart rate variability biofeedback[62] have demonstrated the positive effect of these practices in chronic musculoskeletal and neuropathic pain.

Broadly speaking, mind-body therapies have shown promise in decreasing pain and improving function with many diagnoses.[15] What is not known, however, is which specific interventions provide the most benefit. Most mind-body interventions seem effective. The best choice for individual patients will depend on what is available in through their VA facility or in their local area, as well as which therapies resonate most with a given patient. For more information about mind-body approaches and specific tools that might be of use, refer to “Power of the Mind” overview and related tools.

What Are Some Hands-on Modalities that May Be Useful in Treating Chronic Pain?

Manual therapies such as osteopathic manipulation, chiropractic manipulation, massage therapy, and acupuncture are examples of adjunctive modalities that are useful in different types of chronic pain.

Is manipulation helpful?

Osteopathic and chiropractic manipulation treatments are readily available and commonly used modalities in treating musculoskeletal pain. Spinal manipulative therapy has been evaluated by multiple clinical trials and several systematic reviews. Manipulation treatments appear to be most helpful in the treatment of low back pain. A 2005 systematic review and a 2011 Cochrane review both found evidence of improved pain control in patients with chronic low back pain who received spinal manipulation.[19,20] The National Institute for Health and Care Excellence (NICE) guidelines on treatment of persistent low back pain also include manipulation as one of the initial modalities of choice.[21] A 2022 meta-analysis on spinal manipulation in adults between 65 and 91 suggested that manipulation should be considered an effective treatment for chronic low back pain in this population.[63]

Spinal manipulation is commonly used for pain conditions other than chronic low back pain, although the evidence supporting its use is less conclusive. Preliminary results from a 2019 systematic review of spinal manipulation for migraine pain and disability suggest that manipulation may be an effective therapeutic intervention[64] There is inconclusive evidence for manipulation in the treatment of temporomandibular joint dysfunction.[22] Currently, systematic reviews do not support the use of spinal manipulation for the treatment of chronic neck pain or fibromyalgia.[23][24] For additional information, refer to the section on Osteopathy in Chapter 16 of the Passport to Whole Health.

Is massage helpful?

Massage therapy is commonly used for both relaxation purposes and as a therapeutic modality for pain. A 2008 review concluded that strong evidence exists that massage is effective for nonspecific chronic low back pain.[25] Interestingly, effects of massage can be long-lasting, with improvements shown at 1-year follow-up.[25] There is also evidence of benefit of massage therapy in patients with fibromyalgia.[26] A 2019 review confirmed that massage is effective in chronic pain conditions to improve pain and function, specifically for chronic low back pain and fibromyalgia.[65] A 2021 review assessed that manual therapy may also benefit people suffering from chronic tension-type headaches.[66] A 2022 review demonstrated that manual soft tissue therapy is effective at alleviating chronic neck pain. Massage therapy is safe, although care needs to be taken in patients with a trauma history or hypersensitivity to not cause a flare of pain with more aggressive soft tissue treatments. For more information, refer to the section on Massage in Chapter 16 of the Passport to Whole Health.

What is acupuncture? Is it effective for pain?

Acupuncture is one of several elements of traditional Chinese medicine (TCM), and it has a history of more than 2,000 years of use. TCM is a holistic system encompassing acupuncture, herbal medicine, nutrition, meditative practices (qi gong), and movement (tai chi). TCM is based on the belief that health is maintained by balancing two opposing forces, yin and yang. Yin is the cold, slow, or passive force, and yang represents the hot, excited, or active force.[27] Yin and yang balance is managed by qi, the bodys vital energy source, believed to flow in channels throughout the body. Disease results from an imbalance of yin and yang with resultant blockages in the free flow of qi. The goal of TCM modalities is to restore and maintain the balance of yin and yang. Acupuncture stimulates points on the body, usually with needles, altering the flow of qi attempting to achieve this balance. Even though acupuncture represents one piece of TCM, it is often practiced as an independent therapy. For additional information, refer to the section on Chinese Medicine and Acupuncture in Chapter 18 of the Passport to Whole Health.

While the World Health Organization lists over 40 disorders effectively treated with acupuncture, pain is the common reason acupuncture is used.[28] There is a growing literature base and multiple reviews in support of using acupuncture for these multiple indications. From 1991 to 2009 nearly 4,000 acupuncture research studies were published, and pain was the focus of 41% of them.[28] Cochrane reviews showing the effectiveness of acupuncture have been published for neck pain, low back pain, headaches, and osteoarthritis.[29] Several other literature reviews support the use of acupuncture in the treatment of chronic low back pain.[67] The NICE low back pain treatment guidelines list acupuncture as a primary therapeutic option.[30-32] The Cochrane summary on the use of acupuncture in migraines concludes that “acupuncture is at least as effective, and possibly more effective, than prophylactic drug treatment and has fewer adverse effects.”[33] And there is a growing literature base that supports the use of acupuncture in fibromyalgia treatment.[68]

Overall, acupuncture is an appealing therapeutic modality for the treatment of chronic pain. It has evidence of benefit in several common pain syndromes and can also help address some of the common coexisting symptoms, such as sleep problems.[34] Acupuncture is quite safe and normally well tolerated. With the growing use of the protocolized auricular Battlefield Acupuncture (BFA) to treat pain in the VA, it is important to mention that at this point reviews of some low-quality studies have shown an association between BFA treatment and improved pain. More study is warranted.[69,70]


Resource Links


“Non-Drug Approaches to Chronic Pain” was written by Russell Lemmon, DO and updated by Vincent Minichiello, MD (2014, updated in 2016, updated in 2022).


  1. Salzberg L. The physiology of low back pain. Prim Care. 2012;39(3):487-498.
  2. Naugle KM, Fillingim RB, Riley JL, III. A meta-analytic review of the hypoalgesic effects of exercise. J Pain. 2012;13(12):1139-1150.
  3. Sculco AD, Paup DC, Fernhall B, Sculco MJ. Effects of aerobic exercise on low back pain patients in treatment. Spine J. 2001;1(2):95-101.
  4. Bussing A, Ostermann T, Ludtke R, Michalsen A. Effects of yoga interventions on pain and pain-associated disability: a meta-analysis. J Pain. 2012;13(1):1-9.
  5. Tall JM, Raja SN. Dietary constituents as novel therapies for pain. Clin J Pain. 2004;20(1):19-26.
  6. Goldberg RJ, Katz J. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain. 2007;129(1-2):210-223.
  7. Macfarlane GJ, Palmer B, Roy D, Afzal C, Silman AJ, O’Neill T. An excess of widespread pain among South Asians: are low levels of vitamin D implicated? Ann Rheum Dis. 2005;64(8):1217-1219.
  8. Straube S, Derry S, Straube C, Moore RA. Vitamin D for the treatment of chronic painful conditions in adults. Cochrane Database Syst Rev. 2015(5):Cd007771.
  9. Huang W, Shah S, Long Q, Crankshaw AK, Tangpricha V. Improvement of pain, sleep, and quality of life in chronic pain patients with vitamin D supplementation. Clin J Pain. 2013;29(4):341-347.
  10. Bagis S, Karabiber M, As I, Tamer L, Erdogan C, Atalay A. Is magnesium citrate treatment effective on pain, clinical parameters and functional status in patients with fibromyalgia? Rheumatol Int. 2013;33(1):167-172.
  11. Chrubasik JE, Roufogalis BD, Chrubasik S. Evidence of effectiveness of herbal antiinflammatory drugs in the treatment of painful osteoarthritis and chronic low back pain. Phytother Res. 2007;21(7):675-683.
  12. Vlachojannis JE, Cameron M, Chrubasik S. A systematic review on the effectiveness of willow bark for musculoskeletal pain. Phytother Res. 2009;23(7):897-900.
  13. Gagnier JJ. Evidence-informed management of chronic low back pain with herbal, vitamin, mineral, and homeopathic supplements. Spine J. 2008;8(1):70-79.
  14. Flor H. Cortical reorganisation and chronic pain: implications for rehabilitation. J Rehabil Med. 2003(41 Suppl):66-72.
  15. Astin JA. Mind-body therapies for the management of pain. Clin J Pain. 2004;20(1):27-32.
  16. van Tulder MW, Ostelo R, Vlaeyen JW, Linton SJ, Morley SJ, Assendelft WJ. Behavioral treatment for chronic low back pain: a systematic review within the framework of the Cochrane Back Review Group. Spine. 2000;25(20):2688-2699.
  17. Lauche R, Cramer H, Dobos G, Langhorst J, Schmidt S. A systematic review and meta-analysis of mindfulness-based stress reduction for the fibromyalgia syndrome. J Psychosom Res. 2013;75(6):500-510.
  18. Morley S, Eccleston C, Williams A. Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain. 1999;80(1-2):1-13.
  19. Licciardone JC, Brimhall AK, King LN. Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2005;6:43.
  20. Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev. 2011(2):CD008112.
  21. National Institute for Health and Care Excellence. Early management of persistent non-specific low back pain. 2009; National Institute for Health and Care Excellence, website. Available at: Accessed September 20, 2013.
  22. Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010;18:3.
  23. Posadzki P. Is spinal manipulation effective for pain? An overview of systematic reviews. Pain Med. 2012;13(6):754-761.
  24. Ernst E. Chiropractic treatment for fibromyalgia: a systematic review. Clin Rheumatol. 2009;28(10):1175-1178.
  25. Imamura M, Furlan AD, Dryden T, Irvin E. Evidence-informed management of chronic low back pain with massage. Spine J. 2008;8(1):121-133.
  26. Kalichman L. Massage therapy for fibromyalgia symptoms. Rheumatol Int. 2010;30(9):1151-1157.
  27. Ammendolia C, Furlan AD, Imamura M, Irvin E, van Tulder M. Evidence-informed management of chronic low back pain with needle acupuncture. Spine J. 2008;8(1):160-172.
  28. Han JS. Acupuncture analgesia: areas of consensus and controversy. Pain. 2011;152(3 Suppl):S41-48.
  29. Lee MS, Ernst E. Acupuncture for pain: an overview of Cochrane reviews. Chin J Integr Med. 2011;17(3):187-189.
  30. Hutchinson AJ, Ball S, Andrews JC, Jones GG. The effectiveness of acupuncture in treating chronic non-specific low back pain: a systematic review of the literature. J Orthop Surg Res. 2012;7:36.
  31. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012;172(19):1444-1453.
  32. Yuan J, Purepong N, Kerr DP, Park J, Bradbury I, McDonough S. Effectiveness of acupuncture for low back pain: a systematic review. Spine. 2008;33(23):E887-900.
  33. Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev. 2009(1):CD001218.
  34. Cao H, Pan X, Li H, Liu J. Acupuncture for treatment of insomnia: a systematic review of randomized controlled trials. J Altern Complement Med. 2009;15(11):1171-1186.
  35. Rabago D, Patterson JJ, Mundt M, et al. Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Fam Med. 2013;11(3):229-237.
  36. Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017 Apr 24;4(4):CD011279.
  37. Fleckenstein J, Flössel P, Engel T, Krempel L, Stoll J, Behrens M, Niederer D. Individualized exercise in chronic non-specific low back pain: a systematic review with meta-analysis on the effects of exercise alone or in combination with psychological interventions on pain and disability. J Pain. 2022 Jul 29:S1526-5900(22)00364-9.
  38. Borisovskaya A, Chmelik E, Karnik A. Exercise and Chronic Pain. Adv Exp Med Biol. 2020;1228:233-253.
  39. Wen YR, Shi J, Wang YF, Lin YY, Hu ZY, Lin YT, Wang XQ, Wang YL. Are Mind-Body Exercise Beneficial for Treating Pain, Function, and Quality of Life in Middle-Aged and Old People With Chronic Pain? A Systematic Review and Meta-Analysis. Front Aging Neurosci. 2022 Jun 21;14:921069.
  40. Vasileios P, Styliani P, Nifon G, Pavlos S, Aris F, Ioannis P. Managing fibromyalgia with complementary and alternative medical exercise: a systematic review and meta-analysis of clinical trials. Rheumatol Int. 2022 Jul 7.
  41. Zhang YH, Hu HY, Xiong YC, Peng C, Hu L, Kong YZ, Wang YL, Guo JB, Bi S, Li TS, Ao LJ, Wang CH, Bai YL, Fang L, Ma C, Liao LR, Liu H, Zhu Y, Zhang ZJ, Liu CL, Fang GE, Wang XQ. Exercise for Neuropathic Pain: A Systematic Review and Expert Consensus. Front Med (Lausanne). 2021 Nov 24;8:756940.
  42. Imoto AM, Amorim FF, Palma H, Lombardi Júnior I, Salomon AL, Peccin MS, Silva HECD, Franco ESB, Göttems L, Santana LA. Evidence for the efficacy of Tai Chi for treating rheumatoid arthritis: an overview of systematic reviews. Sao Paulo Med J. 2021 Mar-Apr;139(2):91-97.
  43. Urits I, Schwartz RH, Orhurhu V, Maganty NV, Reilly BT, Patel PM, Wie C, Kaye AD, Mancuso KF, Kaye AJ, Viswanath O. A Comprehensive Review of Alternative Therapies for the Management of Chronic Pain Patients: Acupuncture, Tai Chi, Osteopathic Manipulative Medicine, and Chiropractic Care. Adv Ther. 2021 Jan;38(1):76-89.
  44. Mullur RS, Kaur Cheema SP, Alano RE, Chang LE. Tele-Integrative Medicine to Support Rehabilitative Care. Phys Med Rehabil Clin N Am. 2021 May;32(2):393-403.
  45. Xu Lou I, Gil-García E, Cáceres-Matos R, Ali K, Molina E. Nutritional aspects in chronic non-cancer pain: A systematic review. Front Nutr. 2022 Aug 8;9:931090.
  46. Brain K, Burrows TL, Bruggink L, Malfliet A, Hayes C, Hodson FJ, Collins CE. Diet and Chronic Non-Cancer Pain: The State of the Art and Future Directions. J Clin Med. 2021 Nov 8;10(21):5203.
  47. Raad T, Griffin A, George ES, Larkin L, Fraser A, Kennedy N, Tierney AC. Dietary Interventions with or without Omega-3 Supplementation for the Management of Rheumatoid Arthritis: A Systematic Review. Nutrients. 2021 Oct 4;13(10):3506.
  48. Lombardo M, Feraco A, Ottaviani M, Rizzo G, Camajani E, Caprio M, Armani A. The Efficacy of Vitamin D Supplementation in the Treatment of Fibromyalgia Syndrome and Chronic Musculoskeletal Pain. Nutrients. 2022 Jul 22;14(15):3010.
  49. Marchesi N, Govoni S, Allegri M. Non-drug pain relievers active on non-opioid pain mechanisms. Pain Pract. 2022 Feb;22(2):255-275.
  50. Karaganis S, Song XJ. B vitamins as a treatment for diabetic pain and neuropathy. J Clin Pharm Ther. 2021 Oct;46(5):1199-1212.
  51. Cassanego G, Rodrigues P, De Freitas Bauermann L, Trevisan G. Evaluation of the analgesic effect of .-lipoic acid in treating pain disorders: A systematic review and meta-analysis of randomized controlled trials. Pharmacol Res. 2022 Mar;177:106075.
  52. Sarzi-Puttini P, Giorgi V, Di Lascio S, Fornasari D. Acetyl-L-carnitine in chronic pain: A narrative review. Pharmacol Res. 2021 Nov;173:105874.
  53. Gagnier JJ, Oltean H, van Tulder MW, Berman BM, Bombardier C, Robbins CB. Herbal Medicine for Low Back Pain: A Cochrane Review. Spine (Phila Pa 1976). 2016 Jan;41(2):116-33.
  54. Bagherniya M, Darand M, Askari G, Guest PC, Sathyapalan T, Sahebkar A. The Clinical Use of Curcumin for the Treatment of Rheumatoid Arthritis: A Systematic Review of Clinical Trials. Adv Exp Med Biol. 2021;1291:251-263.
  55. Natural Standard Database, Turmeric, Date Accessed 8/31/22
  56. Yu G, Xiang W, Zhang T, Zeng L, Yang K, Li J. Effectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis. BMC Complement Med Ther. 2020;20(1):225.
  57. Natural Standard Database, Boswellia serrata, date accessed 8/31/22
  58. Oliveira I, Garrido MV, Bernardes SF. On the body-mind nexus in chronic musculoskeletal pain: A scoping review. Eur J Pain. 2022 Jul;26(6):1186-1202.
  59. Langlois P, Perrochon A, David R, Rainville P, Wood C, Vanhaudenhuyse A, Pageaux B, Ounajim A, Lavallière M, Debarnot U, Luque-Moreno C, Roulaud M, Simoneau M, Goudman L, Moens M, Rigoard P, Billot M. Hypnosis to manage musculoskeletal and neuropathic chronic pain: A systematic review and meta-analysis. Neurosci Biobehav Rev. 2022 Apr;135:104591.
  60. McKittrick ML, Connors EL, McKernan LC. Hypnosis for Chronic Neuropathic Pain: A Scoping Review. Pain Med. 2022 May 4;23(5):1015-1026.
  61. Hesam-Shariati N, Chang WJ, Wewege MA, McAuley JH, Booth A, Trost Z, Lin CT, Newton-John T, Gustin SM. The analgesic effect of electroencephalographic neurofeedback for people with chronic pain: A systematic review and meta-analysis. Eur J Neurol. 2022 Mar;29(3):921-936.
  62. Fournié C, Chouchou F, Dalleau G, Caderby T, Cabrera Q, Verkindt C. Heart rate variability biofeedback in chronic disease management: A systematic review. Complement Ther Med. 2021 Aug;60:102750.
  63. Jenks A, de Zoete A, van Tulder M, Rubinstein SM; International IPD-SMT group. Spinal manipulative therapy in older adults with chronic low back pain: an individual participant data meta-analysis. Eur Spine J. 2022 Jul;31(7):1821-1845.
  64. Rist PM, Hernandez A, Bernstein C, Kowalski M, Osypiuk K, Vining R, Long CR, Goertz C, Song R, Wayne PM. The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-Analysis. Headache. 2019 Apr;59(4):532-542.
  65. Skelly AC, Chou R, Dettori JR, Turner JA, Friedly JL, Rundell SD, Fu R, Brodt ED, Wasson N, Winter C, Ferguson AJR. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Jun. Report No.: 18-EHC013-EF.
  66. Turkistani A, Shah A, Jose AM, Melo JP, Luenam K, Ananias P, Yaqub S, Mohammed L. Effectiveness of Manual Therapy and Acupuncture in Tension-Type Headache: A Systematic Review. Cureus. 2021 Aug 31;13(8):e17601.
  67. Asano H, Plonka D, Weeger J. Effectiveness of Acupuncture for Nonspecific Chronic Low Back Pain: A Systematic Review and Meta-Analysis. Med Acupunct. 2022 Apr 1;34(2):96-106.
  68. Berger AA, Liu Y, Nguyen J, Spraggins R, Reed DS, Lee C, Hasoon J, Kaye AD. Efficacy of acupuncture in the treatment of fibromyalgia. Orthop Rev (Pavia). 2021 Jun 22;13(2):25085.
  69. Yang J, Ganesh R, Wu Q, Li L, Ogletree SP, Del Fabro AS, Wahner-Roedler DL, Xiong D, Bauer BA, Chon TY. Battlefield Acupuncture for Adult Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Chin Med. 2021;49(1):25-40.
  70. Salamone FJ, Federman DG. Battlefield Acupuncture as a Treatment for Pain. South Med J. 2021 Apr;114(4):239-245.
  71. Chutumstid T, Susantitaphong P, Koonalinthip N. Effectiveness of dextrose prolotherapy for the treatment of chronic plantar fasciitis: A systematic review and meta-analysis of randomized controlled trials. PM R. 2022 Mar 25.
  72. Giordano L, Murrell WD, Maffulli N. Prolotherapy for chronic low back pain: a review of literature. Br Med Bull. 2021 Jun 10;138(1):96-111.
  73. Bae G, Kim S, Lee S, Lee WY, Lim Y. Prolotherapy for the patients with chronic musculoskeletal pain: systematic review and meta-analysis. Anesth Pain Med (Seoul). 2021 Jan;16(1):81-95.