Moving Beyond Medications: Non-Pharmacological Approaches to Pain Management and Well-Being
In response to the current public health crisis of opioid abuse, overdose, and death, many organizations have issued guidelines and
recommendations for treating pain, including the former Surgeon General’s “Turn the Tide” campaign. Similar to other guidelines,
this campaign recommends non-pharmacological approaches as first line pain treatment, with opioids to be considered only if these
and non-opioid pharmacological treatments are ineffective. This document expands upon those recommendations to help primary
care clinicians and their patients with this approach.
Assess Patient’s Pain and Well-Being
Perform a thorough assessment of the patient’s pain condition, treatments, lifestyle and
overall health status.
Ask the patient to describe the pain, including word descriptors, location, duration,
aggravating and alleviating factors, intensity, and functional impact.
Ask about the patient’s psychological status (e.g., depression, anxiety, ineffective
coping styles), nutritional health, sleep pattern, and social and environmental
contributors to the pain experience
Set Goals Jointly with the Patient
Ask the patient what he or she would like to do, if pain treatment is successful.
Jointly decide on 2-3 SMART (Specific, Measurable, Attainable, Relevant, Time
Bound) goals as measures of progress. Set goals for outcomes important to
patient, not for pain intensity alone.
Educate the Patient about Integrative Pain Management Options
Describe evidence-informed non-pharmacological and self-care approaches to managing
pain and promoting wellness, including but not limited to:
Acupuncture.
Chiropractic, Osteopathic and Myofascial Manipulation, Massage Therapy, and
Physical Therapy.
Cognitive Behavioral Therapy, Stress Management, and other psychological therapies
Mind-Body Approaches, Meditation, Biofeedback, Guided Imagery.
Yoga, Tai Chi, and other movement therapies.
Develop a Treatment Plan with the Patient; Assess Potential Challenge
Based on your clinical assessment and discussion with the patient, develop a
treatment plan.
Discuss potential challenges, and ways to overcome them, with the patient.
Reinforce that 1) chronic pain is a complex problem with no simple solutions;
2) each patient’s path is a little different and you will be there to support your
patient along their path; 3) just as the tide causes all boats to rise, getting
healthier overall helps all medical conditions improve–even chronic pain.
Obtain patient’s commitment to carry out the treatment plan.
Follow Up, Troubleshoot and Modify Treatment Plan as Needed
See the patient regularly; assess progress toward identified goals at each
appointment.
Encourage changes they have made and urge them to continue the good work.
Problem-solve to help overcome barriers to treatment plan adherence.
Modify treatment plan to maximize progress toward goals.
Resources for Information on Nonpharmacological Approaches to Pain Management and Wellbeing
www.integrativehealth.org
www.imconsortium.org
www.aihm.org
www.ihpc.org
