This section of Pain Treatment Topics focuses on the variety of non-opioid therapies -- both pharmacologic and non-pharmacologic -- from an evidence-based, clinical perspective. This information is not offered as medical advice or treatment recommendations from Pain Treatment Topics. See also, Disclaimer below.

Documents are listed in logical categories by treatment modality and, within those, in the order of their publication dates – most recent at the top. All URL links were valid at the time of posting. Please notify us of any broken links at:
Info@Pain-Topics.org.

Researchers: Winnie Dawson, MA, RN, BSN; Stewart B. Leavitt, MA, PhD.

Some items listed on this page are from sources not in accord with the Pain Treatment Topics Open Access Policy and require purchase at the source to view the full documents.

• General Pain Relief - Nondrug, Complementary, Alternative
• Acupuncture
• Adjuvant Drugs
• Biofeedback
• Botulinum Toxin (BOTOX) Injections
• Cold or Heat Therapy
• Electroanalgesia (incl. CES, PENS, SCS, TENS, & Others)
• Exercise Therapy
• Headache - Drug & Non-Drug Therapies
• Herbal Medicines & Dietary Supplements
• Interventional Pain Management
• NSAIDs & OTC Analgesics
• Nuclear Medicine
• Physical Therapies (plus Massage & Shockwave Therapy)
• Psychological Interventions (plus Hypnosis & Music)
• Topical Analgesia

Also see the following sections for additional documents of interest:

• Non-Opioid/Alternative Therapies Clinical Guidelines: <Click Here>
• Non-Opioid/Alternative Therapies Systematic Reviews: <Click Here>
• Non-Opioid Therapies Position/Policy Statements: <Click Here>
• Non-Opioid/Alternative Therapies CME Courses: <Click Here>

Please register for e-Notifications to be alerted by e-mail of when this section is updated or there are other announcements..

= entry added or changed during latest update.

General Pain Relief - Nondrug, Complementary, Alternative

A Complementary Approach to Pain Management

Khatta M. Medscape Ob/Gyn & Women’s Health. 2007(May). Accessed November 26, 2008.

See text at: http://www.medscape.com/viewarticle/556408?src=mp

Integrative Oncology: Complementary Therapies for Pain, Anxiety, and Mood Disturbance

Deng G, Cassileth BR. CA: Cancer J Clin. 2005;55(2):109-116.
Multiple therapeutic modalities are reviewed and a summary of evidence is provided for the efficacy of each for chronic cancer pain relief and improved mental well-being. Accessed November 26, 2008.

Download PDF: http://caonline.amcancersoc.org/cgi/reprint/55/2/109

Nonpharmacologic and Complementary Approaches to Cancer Pain Management

Menefee JA, et al. Journal of the American Osteopathic Association. 2005(Nov);105(11 Suppl 5):S15-S20. Accessed November 26, 2008.

Download PDF: http://www.jaoa.org/cgi/reprint/105/suppl_5/S15

Complementary and Alternative Medicine Approaches for Pediatric Pain. A Review of the State-of-the-Science

Tsao JCI, et al. Evidence-Based Complementary and Alternative Medicine. 2005(Jun);2(2):149-159. Accessed November 26, 2008.

See text at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1142204

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Acupuncture

Effectiveness of Acupuncture for Low Back Pain: A Systematic Review

Yuan J, Purepong N, Kerr DP, et al. Medscape, 2008 [from Spine. 2008;33(23):E887-E900].
The addition of acupuncture to conventional care showed potentially strong evidence for efficacy in the treatment of nonspecific low back pain; moderate evidence of effectiveness was demonstrated when compared with no treatment. Accessed November 25, 2008.

See text at: http://www.medscape.com/viewarticle/583148 (Free registration required.)

Acupuncture and Related Techniques for Postoperative Pain: a Systematic Review of Randomized Controlled Trials

Sun Y, Gan TJ, Dubose JW, Habib AS. Medscape, 2008 [from Br J Anaesth. 2008;101(2):151-160].
Compared with sham therapy, acupuncture reduced opioid consumption and pain intensity, and lowered incidence of opioid-related adverse effects. Accessed November 25, 2008.

See text at: http://www.medscape.com/viewarticle/581266 (Free registration required.)

Acupuncture for Pain Management

Rapson LM, Banner R. Medscape, 2008 [from Geriatrics & Aging. 2008;11(2):93-97].
The evidence for the benefits of acupuncture treatment for musculoskeletal pain, myofascial pain, back and neck pain, osteoarthritis, neuropathic pain, and cancer pain is reviewed. A theoretical explanation of the neurophysiology of acupuncture analgesia is presented. Accessed November 26, 2008.

See text at: http://www.medscape.com/viewarticle/573858 (Free registration required.)

Meta-Analysis: Acupuncture for Low Back Pain

Manheimer E, White A, Berman B, et al. Annals of Internal Medicine, 2005(Apr);142(8):651-663. Accessed November 26, 2008.

Download PDF: http://www.annals.org/cgi/reprint/142/8/651.pdf

Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee

Berman BM, Lao L, Langenberg P, et al. Annals of Internal Medicine. 2004(Dec);141(12):901-910. Accessed November 26, 2008.

Download PDF: http://www.annals.org/cgi/reprint/141/12/901.pdf

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Adjuvant Drugs

Non-Narcotic Options for Pain Relief With Chronic Neuropathic Conditions

Wright DV. Medscape, 2008 [from Journal for Nurse Practitioners. 2008;4(4):263-270].
Neuropathic pain mechanisms, diagnostic considerations, and the rationale for selecting specific treatment options are reviewed. Accessed November 26, 2008.

See text at: http://www.medscape.com/viewarticle/576064 (Free registration required.)

Antidepressants for Non-Specific Low Back Pain

Urquhart D, Hoving JL, Assendelft WJJ, et al. Cochrane Database. 2008;1.
No significant differences were found between antidepressant therapy and placebo for chronic low back pain (LBP). Of note, the authors state that the evidence does not suggest that patients with depression and LBP avoid antidepressants. Accessed November 25, 2008.

See abstract... >

Antidepressant Agents for the Treatment of Chronic Pain and Depression

Jann MW, Slade JH; Medscape, 2008 [from Pharmacotherapy. 2007;27(11):1571-1587].  See details...>

Perioperative Ketamine for Acute Postoperative Pain

Bell RF, Dahl JB, Moore RA et al. Cochrane Database. 2006;1. Accessed November 26, 2008.

See abstract...>

Systemic Administration of Local Anesthetic Agents to Relieve Neuropathic Pain

Challapalli V, Tremont-Lukats IW, McNicol ED, et al. Cochrane Database. 2005,4. Accessed November 26, 2008.

See abstract...>

Anticonvulsant Drugs for Acute and Chronic Pain

Wiffen P, Collins S, McQuay H, et al. Cochrane Database. 2005;3. Accessed November 26, 2008.

See abstract...>

Antidepressants for neuropathic pain

Saarto T, Wiffen PJ. Cochrane Database. 2005,3. Accessed November 26, 2008.

See abstract...>

Gabapentin for Acute and Chronic Pain

Wiffen PJ, McQuay HJ, Edwards JE, et al. Cochrane Database. 2005,3. Accessed November 26, 2008.

See abstract...>

Recent Advances in Nonopioid Treatment of Pain

Moyer P, Bennett DS. Medscape Ob/Gyn & Women’s Health. 2005(Apr). Accessed November 26, 2008.

See text at: http://www.medscape.com/viewarticle/502030

Antidepressants and Antiepileptic Drugs for Chronic Non-Cancer Pain

Maizels M, McCarberg B. American Family Physician, 2005(Feb);71(3):483-390. Accessed November 26, 2008.

Download PDF: http://www.aafp.org/afp/20050201/483.pdf

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Biofeedback

Biofeedback as an Adjunctive Treatment Modality in Pain Management

Gatchel RJ. American Pain Society Bulletin, 2004. Accessed November 26, 2008.

See text at: http://www.ampainsoc.org/pub/bulletin/jul04/clin1.htm

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Botulinum Toxin (BOTOX) Injections

Botulinum Toxin Type A For Migraine Headaches

Sidhu S, Ruddock B. Canadian Pharmacists Journal. 2006(Nov-Dec);139(6):30-31. Accessed November 26, 2008.

Download PDF: http://www.pharmacists.ca/content/..

Botulinum Toxin Type A Therapy For Cervical Dystonia

Costa J, Espirito-Santo C, Borges A et al. Cochrane Database. 2005, 1. Accessed November 26, 2008.

See abstract...>

Botulinum Toxin and the Management of Chronic Headaches

Evers S. Curr Opin Otolaryngol Head Neck Surg. 2004;12(3):197-203. Accessed November 26, 2008.

Download PDF: http://robotics.me.jhu.edu/..

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Cold or Heat Therapy

This topic area includes a wide variety of temperature-based treatments. Cold therapy can be used to reduce acute inflammation and relieve muscle spasm. Typically, the application of cold is superficial; an ice pack or cooling fluids are applied to the skin and local tissues. An unrelated treatment, low-level laser therapy, is also called cold laser therapy because it uses a near-infrared laser which is, basically, nonthermal. Heat therapy is most commonly used to increase blood flow and decrease joint stiffness which, in turn, reduces pain and muscle spasms. The application of heat may be superficial (hot packs, paraffin wax baths, hydrotherapy) or deep (diathermy, ultrasound). One example of deep heat therapy is an ablative treatment such as MRgFUS which is a noninvasive thermal ablation technique using high-intensity focused ultrasound.

Superficial Heat or Cold for Low Back Pain

French SD, Cameron M, Walker BF, et al. Cochrane Database. 2006,1. Accessed November 26, 2008.

See abstract...>

A New Look at Heat Treatment for Pain Disorders. Part 2

O’Connor A, et al. American Pain Society Bulletin, 2005. Accessed November 26, 2008.

Download PDF: http://www.ampainsoc.org/pub/bulletin/win05/inno1.htm

A New Look at Heat Treatment for Pain Disorders. Part 1

McCarberg B, et al. American Pain Society Bulletin, 2004. Accessed November 26, 2008.

Download PDF: http://www.ampainsoc.org/pub/bulletin/nov04/inno1.htm

The Use of Heat and Cold in Pain Modulation

Michel T. Pain Relief Connection, 2003. Accessed November 26, 2008.

Download PDF:
http://www2.massgeneral.org/painrelief/pain topics/heat_cold.pdf

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Electroanalgesia (incl. CES, MET, PENS, SCS, TENS, & Others)

The practice of electroanalgesia during the past 15 years has expanded, and even the task of identifying the acronyms can be a challenge. As an aid to understanding techniques available, the first article below (White et al, 2001) provides a brief historical review, a description, and a summary of significant trials in each procedure—from the noninvasive TENS to the minimally invasive PENS and the most invasive DBS.

Electroanalgesia: Its Role in Acute and Chronic Pain Management

White PF, Li S, Chiu JW. Anesthesia & Analgesia. 2001(Feb);92(2);505-513. Accessed November 26, 2008.

Download PDF: http://www.anesthesia-analgesia.org/cgi/reprint/92/2/505

Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Pain

Nnoaham KE, Kumbang J. Cochrane Database. 2008;3.
This review—updated from the original 2001 analysis—could not provide sufficient evidence supporting TENS in chronic pain due to the lack of rigorous studies available for evaluation. Accessed November 25, 2008.

See abstract... >

Transcutaneous Electrical Nerve Stimulation

Kaye V, Brandstater ME. eMedicine from WebMD. Updated Oct 2008. Accessed November 26, 2008.

See text at: http://www.emedicine.com/pmr/topic206.htm

Electromedical Treatment of Headaches [CES]

Kirsch DL. Practical Pain Management. 2006(Nov/Dec):58-65. Accessed November 26, 2008.

Download PDF:
http://www.alpha-stim.com/repository/assets/pdf/kirsch-headache.pdf

Microcurrent Electrical Therapy (MET): A Tutorial

Kirsch DL. Practical Pain Management. 2006(Oct):59-64. Accessed November 26, 2008.

Download PDF:
http://www.alpha-stim.com/repository/assets/pdf/kirsch-MET.pdf

Transcutaneous Electrical Nerve Stimulation (TENS) For the Treatment of Rheumatoid Arthritis in the Hand

Brosseau L, Yonge KA, Robinson V, et al. Cochrane Database. 2006,1. Accessed November 26, 2008.

See abstract...>

Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low-Back Pain

Khadilkar A, Milne S, Brosseau L, et al. Cochrane Database. 2005,3. Accessed November 26, 2008.

See abstract...>

Comparison of Percutaneous Electrical Nerve Stimulation With Transcutaneous Electrical Nerve Stimulation for Long-Term Pain Relief in Patients With Chronic Low Back Pain

Yokoyama M, Sun X, Oku S, et al. Anesthesia & Analgesia. 2004;98(6):1552-1556. Accessed November 26, 2008.

Download PDF: http://www.anesthesia-
analgesia.org/cgi/reprint/98/6/1552.pdf

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Exercise Therapy

Exercise Therapy and Orthotic Devices in Rheumatoid Arthritis: Evidence-Based Review

Oldfield V, Felson DT. Medscape, 2008 [from Curr Opin Rheumatol. 2008;20(3):353-359].
Aerobic exercise and/or strengthening exercises demonstrate evidence for improved physical functionality and a reduction in fatigue and depression. Additionally, foot orthotics and wrist splints showed substantial reductions in pain and improvement in physical function. Accessed November 26, 2008.

See text at: http://www.medscape.com/viewarticle/573646 (Free registration required.)

Exercise for Treating Fibromyalgia Syndrome

Busch AJ, Barber KAR, Overend TJ, et al. Cochrane Database. 2007;4.
Supervised 12-week aerobic exercise and strength training programs show a high level of evidence for improvement of physical function and a reduction in pain, tender points, and depression (respectively). Accessed November 26, 2008.

See abstract... >

Systematic Review: Strategies for Using Exercise Therapy to Improve Outcomes in Chronic Low Back Pain

Hayden JA, et al. Annals of Internal Medicine. 2005(May);142(9):776-785. Accessed November 26, 2008.

Download PDF: http://www.annals.org/cgi/reprint/142/9/776.pdf

Exercises for Mechanical Neck Disorders

Kay TM, Gross A, Goldsmith C, et al. Cochrane Database. 2005;3. Accessed November 26, 2008.

See abstract...>

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Headache - Drug & Non-Drug Therapies

Also see: Electroanalgesia and BOTOX Injections.

Emerging Drugs for Migraine Prophylaxis and Treatment

Bigal ME, Krymchantowski AV. Medscape General Medicine. 2006(May);5(10). Accessed November 26, 2008.

See text at: http://www.medscape.com/viewarticle/528452

Selective Serotonin Re-Uptake Inhibitors (SSRIs) for Preventing Migraine and Tension-Type Headaches

Moja PL , Cusi C, Sterzi RR, et al. Cochrane Database. 2005,3. Accessed November 26, 2008.

See abstract...>

Non-Invasive Physical Treatments for Chronic/Recurrent Headache

Bronfort G, Nilsson N, Haas M, et al. Cochrane Database. 2004,3. Accessed November 26, 2008.

See abstract...>

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Herbal Medicines and Dietary Supplements

VITAMIN D – A ‘New’ Therapy for Chronic Pain

Stewart B. Leavitt, MA, PhD, Pain Treatment Topics, June 2008.

Vitamin D – A Neglected ‘Analgesic’ for Musculoskeletal Pain

   > Practitioner Briefing (7 pages)

   > Full Report (50 pages)

Vitamin D: A Champion of Pain Relief

   > Patient Brochure (6-pages)

See details and download all 3 papers...>

Use of Herbal Therapies to Relieve Pain: A Review of Efficacy and Adverse Effects

Wirth JH, Hudgins JC, Paice JA. Medscape Ob/Gyn & Women’s Health, 2006(Jan). Similarly published in Pain Manage Nurs. 2005(Dec);6(4):145-167. Accessed November 26, 2008.

See text at: http://www.medscape.com/viewarticle/519761

What You Should Know About Your Patients’ Use of Herbal Medicines and Other Dietary Supplements

American Society of Anesthesiologists (ASA), 2003. Accessed November 26, 2008.

Download brochure PDF:
http://www.asahq.org/patientEducation/herbPhysician.pdf

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Interventional Pain Management

Interventional pain management is an emerging medical discipline devoted to the diagnosis and treatment of pain and related disorders. Interventional techniques include minimally invasive procedures, such as percutaneous precision needle placement, with placement of drugs in targeted areas or ablation of targeted nerves; and some surgical techniques, such as laser or endoscopic discectomy, intrathecal infusion pumps and spinal cord stimulators, for the diagnosis and management of chronic, persistent, or intractable pain.

Interventional Approaches to the Management of Spinal Pain [Lower Back]

Trescot A. Pain Medicine News (Special Ed.). 2009(June);7(6).

This article provides a summary of evidence-based guidelines from the American Society of Interventional Pain Physicians (ASIPP), with a focus on the treatment of lower back pain. Descriptions of the various tools and techniques employed by interventionists should be of interest to all healthcare providers. Accessed June 25, 2009.
 

Access article at: http://www.painmedicinenews.com/index.asp..

(Free registration and/or login required.)

Interventional Techniques: Evidence-Based Practice Guidelines in the Management of Chronic Spinal Pain

Boswell MV, Trescot AM, Datta S, et al. Pain Physician. 2007(Jan);10(1):7-111. Accessed November 26, 2008.

Download PDF:
http://www.painphysicianjournal.com/2007/january/2007;10;7-111.pdf

Local Anesthetic Sympathetic Blockade for Complex Regional Pain Syndrome

Cepeda MS, Carr DB, Lau J. Cochrane Database. 2005;4. Accessed November 26, 2008.

See abstract...>

The Evolving Role of Interventional Pain Management in Oncology

Sloan PA. Journal of Supportive Oncology. 2004(Nov-Dec);2(6):491-500,503. Accessed November 26, 2008.

Download PDF:
http://www.supportiveoncology.net/journal/articles/0206491.pdf

Prolotherapy Injections for Chronic Low-Back Pain

Yelland MJ , Del Mar C, Pirozzo S, et al. Cochrane Database. 2004,2. Accessed November 26, 2008.

See abstract...>

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NSAIDs & OTC Analgesics

Pearls & Perils of Over-the-Counter (OTC) Analgesics

The Pharmacist’s Role in the Appropriate Selection of a Nonprescription Product for Pain Relief

US Pharmacist, September 2008. Accessed November 26, 2008.

Go to details and the link to this document...>

NSAIDs: Rx Considerations, Concerns, and Cautions

Management of Chronic Nonmalignant Pain with Nonsteroidal Anti-inflammatory Drugs

Herndon CM, Hutchison RW, Hildegarde JB, et al. Pharmacotherapy. 2008;28(6):788-805. Accessed November 26, 2008.

Use of Nonsteroidal Anti-inflammatory Drugs. An Update for Clinicians. A Scientific Statement From the American Heart Association
Antman EM, et al. Circulation 2007, published online Feb 26, 2007.

Choosing Non-Opioid Analgesics for Osteoarthritis: Clinician's Guide
U.S. Agency for Healthcare Research and Quality; January 2007.

Medication Guide for Nonsteroidal Anti-inflammatory Drugs (NSAIDS)
U.S. Food & Drug Administration, February 2007

Go to details and links to these documents...>

Also see: Topical Analgesia <below>

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Nuclear Medicine

Nuclear Medicine is commonly used as a diagnostic tool, but it can also be administered therapeutically to provide pain relief from certain types of bone cancers. Very small amounts of radiopharmaceuticals can treat targeted bone cancer tumors locally without affecting other parts of the body. Radioactive drugs act on the metastatic bone tumor directly to reduce the effects of the cancer and, therefore, the associated pain.

Radiopharmaceutical Therapy for Palliation of Bone Pain From Osseous Metastases

Pandit-Taskar N, et al. Journal of Nuclear Medicine. 2004(Aug);45(8):1358-1365. Accessed November 26, 2008.

Download PDF: http://jnm.snmjournals.org/cgi/reprint/45/8/1358

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Physical Therapies (incl. Massage, Shockwave Therapy, and Others)

Touch Therapies for Pain Relief in Adults

So PS, Jiang Y, Qin Y. Cochrane Database. 2008;4.
In a review of a small number of existing studies, sufficient support is demonstrated for modest efficacy in pain relief. Accessed November 25, 2008.

See abstract... >

Effectiveness of Massage Therapy for Chronic, Non-Malignant Pain: A Review

Tsao JCI. Evid Based Complement Alternat Med. 2007(Jun);4(2):165-179.
Support for efficacy in non-specific low back pain is strong, while efficacy for shoulder pain and headache is moderate. Modest preliminary evidence in fibromyalgia, mixed chronic pain, neck pain and carpal tunnel syndrome suggest the need for future studies. Accessed November 26, 2008.

Download PDF: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1876616&blobtype=pdf

Shock Wave Therapy for Lateral Elbow Pain

Buchbinder R, Green SE, Youd JM, et al. Cochrane Database. 2005;4. Accessed November 26, 2008.

See abstract...>

Traction for Low-Back Pain With or Without Sciatica

Clarke JA, van Tulder MW, Blomberg SEI, et al. Cochrane Database. 2005,4. Accessed November 26, 2008.

See abstract...>

Spinal Manipulative Therapy for Low-Back Pain

Assendelft WJJ, Morton SC, Yu Emily I, et al. Cochrane Database. 2004,1. Accessed November 26, 2008.

See abstract...>

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Psychological Interventions (plus Hypnosis & Music Therapy)

Hypnosis for Treatment of Pain in Children

Rogovik AL, Goldman RD. Canadian Family Physician. 2007(May);53(5):823-825.
Evidence is reviewed for the benefits of hypnosis—as complementary therapy or alone—for painful medical procedures in pediatric oncology, and for chronic pain and headache. Accessed November 26, 2008.

Download PDF: http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1949166...

Music for Pain Relief

Cepeda MS, Carr DB, Lau J, et al. Cochrane Database. 2006,2. Accessed May 28, 2007.

See abstract...>

Psychological Interventions for Needle-Related Procedural Pain and Distress in Children and Adolescents

Uman LS, Chambers CT , McGrath PJ, et al. Cochrane Database. 2005,1. Accessed November 26, 2008.

See abstract...>

Psychological Interventions for Symptomatic Management of Non-Specific Chest Pain in Patients With Normal Coronary Anatomy

Kisely S, Campbell LA , Skerritt P. Cochrane Database. 2005,1. Accessed November 26, 2008.

See abstract...>

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Topical Analgesia

Topical NSAIDs for Acute Pain: A Meta-Analysis

Mason L, Moore RA, Edwards JE, et al. BMC Fam Pract. 2004(May);5(10). Accessed November 26, 2008.

See text at: http://www.pubmedcentral.gov/articlerender.fcgi?
tool=pubmed&pubmedid=15147585

Principles of Office Anesthesia: Part II. Topical Anesthesia

Kundu S, et al. American Family Physician. 2002(Jul);66(1):99-102. Accessed November 26, 2008.

Download PDF: http://www.aafp.org/afp/20020701/99.pdf

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