Nonpharmacologic Management of Pain

Introduction and Explanation of Need

Pain is the condition for which adults in the United States most often use complementary and integrative health approaches. This includes musculoskeletal pain (back pain, neck pain, joint pain, etc.), and pain associated with specific conditions (e.g., arthritis). Although pain is a normal, vital response to actual or potential tissue injury, in some cases acute pain can become chronic and a condition unto itself, leading to biological changes in the central nervous system as well as changes in peripheral tissues.

Chronic pain is a debilitating condition with high societal and economic costs. Growing evidence indicates that some complementary health approaches may help in its treatment and management. Now that self-management of chronic pain is recognized as a component of an overall treatment strategy, it is important to better understand how to best integrate effective complementary approaches into care and how to optimize interventions for individuals and groups. Discovering the mechanisms by which a complementary approach exerts its effects could help in the design of better treatments and predict which people are most likely to respond. Hence, there is a need for rigorous research on complementary and integrative health approaches for pain that spans basic, mechanistic, translational, and clinical domains.

What Does Success Look Like?

There is increased understanding of the approaches for pain management that are most efficacious or effective for various conditions and populations, and which can best be integrated into overall pain treatment and management strategies. Thus, when possible, opioid use as a first-line treatment for pain management might be reduced.
There is increased understanding of the mechanisms by which these approaches exert their effects.
Research standards for studies on chronic low-back pain are broadly accepted and used, as shown by their inclusion in grant applications and research publications.

Objectives

Elucidate biological targets and pathways by which complementary health approaches (e.g., natural products, mind and body interventions) have clinical benefits, including analgesic effects for chronic pain conditions, as well as preventing the transition from acute to chronic pain.
Conduct basic and clinical research aimed at understanding the role of nonspecific effects (e.g., expectancy, context, placebo) and whether they can be used to enhance the effectiveness of pain management.
Improve understanding of the higher order neural mechanisms underlying pain perception and pain modulation by the environment, emotional and cognitive states, expectation, and context in both animal models and humans.
Develop further understanding of the mechanisms of action and the biophysical characteristics of noninvasive neuromodulation (e.g., transcranial direct current stimulation and ultrasound) in preclinical model systems and in human laboratory studies.
Develop understanding of brain-gut-microbiome signaling pathways that may be involved in chronic pain conditions and functional pain syndromes (e.g., functional abdominal pain syndrome).
Examine interactions of nonpharmacologic and pharmacologic interventions for potential additive effects, possible synergy, and potential for safe reduction of opioids and other analgesics.
Examine interactions of multiple nonpharmacologic interventions (e.g., meditation and probiotics) to determine whether they can increase effect size and enhance resilience.
Conduct large, pragmatic studies of pain management addressing important clinical or health systems questions.
Develop and validate objective pain measures for complementary and integrative health approaches in the treatment of pain.

Areas of Low Programmatic Priority

Research comparing clinical outcomes of verum and sham acupuncture.
Research comparing individualized to standardized acupuncture treatment protocols.
Research on antioxidants and pain.
Preclinical studies of voluntary exercise for mitigating acute pain and/or nerve injury.