Promising research with growing clinical support from multiple studies
Chronic Pain
Chronic pain is pain lasting beyond normal tissue healing time (often defined as 3 months or more) and affects roughly one in five adults worldwide. It is increasingly understood as a biopsychosocial condition with multiple mechanisms: nociceptive (tissue/inflammatory), neuropathic (nerve injury/dysfunction), and nociplastic/central sensitization (altered pain processing without clear peripheral damage), with many patients exhibiting a mixed picture. Effective care prioritizes function, quality of life, and risk reduction rather than complete pain elimination. Western medicine emphasizes careful assessment: clarifying pain type, ruling out red flags, gauging functional impact and mental health comorbidities, and avoiding unnecessary imaging. First-line nonpharmacologic strategies include education, graded exercise/physical therapy, cognitive behavioral therapy (CBT) and other psychological therapies, and complementary options such as acupuncture and mindfulness with growing evidence for several pain conditions. Pharmacologic therapy is typically stepped: topical agents and NSAIDs or acetaminophen for nociceptive pain; serotonin-norepinephrine reuptake inhibitors (e.g., duloxetine), tricyclics, and gabapentinoids for neuropathic/nociplastic pain; and muscle relaxants short term if spasm is prominent. Interventional procedures (e.g., joint/soft tissue injections, radiofrequency ablation for facet-mediated pain, neuromodulation in select refractory cases) may help carefully selected patients. Opioids are now used far more judiciously due to limited long-term benefit and substantial risks; guidelines emphasize nonopioid and nonpharmacologic care as the foundation. Eastern and traditional approaches add modalities with varying supportive evidence. Acupuncture has one of the stronger evidence bases among complementary therapies, showing clinically meaningful but modest benefits for chronic musculoskeletal pain (low back, neck, shoulder), osteoarthritis, and headaches,,
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.
Western Medicine
Diagnosis
Defined as pain persisting or recurring for ≥3 months. Classify by mechanism: nociceptive (somatic/visceral), neuropathic (e.g., radiculopathy, postherpetic neuralgia), nociplastic/central sensitization (e.g., fibromyalgia), or mixed. Assessment includes history, functional goals, psychosocial factors (depression, anxiety, catastrophizing), sleep, substance use, and risk stratification. Use patient-reported scales (pain intensity, interference). Imaging and labs are targeted to red flags; routine imaging for nonspecific low back pain is discouraged.
Treatments
- Education and self-management; realistic goal-setting focused on function
- Exercise therapy and graded activity; physical therapy; core and hip strengthening; aerobic conditioning
- CBT, acceptance and commitment therapy (ACT), pain coping skills training; mindfulness-based interventions
- Topical therapies (lidocaine, capsaicin; topical NSAIDs for OA)
- Nonopioid pharmacologics tailored to mechanism (NSAIDs/acetaminophen; SNRIs; TCAs; gabapentinoids)
- Interventional options in selected cases (trigger point or bursal injections, epidural or facet injections, radiofrequency ablation for facetogenic pain, peripheral nerve blocks)
- Neuromodulation for refractory focal neuropathic pain (e.g., spinal cord stimulation) after conservative care
- Multidisciplinary rehabilitation programs
- Assistive devices; ergonomics; sleep optimization; weight management; smoking cessation
- Opioids only when benefits meaningfully outweigh risks, at the lowest effective dose with ongoing monitoring; consider buprenorphine where appropriate
Medications
- Acetaminophen
- NSAIDs (e.g., ibuprofen, naproxen); topical diclofenac for OA
- Topical lidocaine 5%
- Topical capsaicin (8% patch for neuropathic pain)
- SNRIs (duloxetine; venlafaxine)
- Tricyclic antidepressants (amitriptyline, nortriptyline)
- Gabapentin, pregabalin
- Muscle relaxants (short-term)
- Tramadol (cautious, limited role)
- Full-agonist opioids (selected cases; risk mitigation)
- Buprenorphine for chronic pain with lower risk profile than full agonists
- In selected settings/emerging: low-dose naltrexone (nociplastic pain), ketamine infusions (refractory neuropathic pain)
Limitations
Benefits of many treatments are modest on average; efficacy varies by mechanism and individual. Long-term effectiveness of some interventional procedures and opioids is limited; opioids carry risks of overdose, dependence, OUD, endocrine and immunologic effects, and hyperalgesia. NSAIDs can cause GI, renal, and cardiovascular adverse effects; gabapentinoids cause sedation/dizziness; antidepressants have anticholinergic or BP effects. Access to multidisciplinary care can be limited by cost and availability.
Sources
- Dowell D et al. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep. 2022.
- Qaseem A et al. Noninvasive treatments for acute, subacute, and chronic low back pain. ACP Guideline. Ann Intern Med. 2017 (and updates).
- NICE Guideline NG193. Chronic pain (primary and secondary) in over 16s. 2021.
- AHRQ Comparative Effectiveness Review No. 227. Noninvasive Nonpharmacologic Treatment for Chronic Pain. 2018/2020 updates.
- Williams ACDC, Eccleston C, Morley S. Psychological therapies for chronic pain in adults (excluding headache). Cochrane Review. 2020.
- Cohen SP, Hooten WM. Advances in the diagnosis and management of chronic pain. Lancet. 2021.
- Chou R et al. Interventional treatments for chronic pain: a review of reviews. Ann Intern Med. 2009 and subsequent updates/reviews.
Eastern & Traditional Medicine
Traditional Chinese Medicine – Acupuncture
Views pain as stagnation or imbalance in qi/blood; treatment aims to restore flow, modulate peripheral and central nociceptive processing, and reduce inflammation via neuromodulatory effects.
Techniques
- Manual body acupuncture
- Electroacupuncture
- Auricular acupuncture
- Trigger/tender point needling (overlap with dry needling)
- Moxibustion adjunct in some cases
Traditional Chinese Medicine – Herbal formulas and topicals
Pattern-based prescribing (e.g., wind-cold-damp bi syndrome) using multi-herb formulas to address pain, stiffness, and inflammation; topical plasters/liniments for localized pain.
Techniques
- Classical formulas (e.g., Du Huo Ji Sheng Tang for OA/low back pain)
- Patent medicines/topical plasters (e.g., menthol/camphor, capsicum)
- Individualized decoctions
Ayurveda
Assesses doshic imbalance (vata often implicated in pain) and uses herbs, diet, detoxifying and local therapies to reduce pain and improve function.
Techniques
- Herbal remedies (e.g., Boswellia serrata, curcumin/turmeric, ashwagandha)
- External therapies: Abhyanga (oil massage), Kati basti (localized oil pooling), pinda sweda (bolus fomentation)
- Panchakarma protocols (select cases)
Manual therapies – Tui Na (Chinese) and Thai massage
Soft-tissue and mobilization techniques to relieve myofascial tension, improve circulation and range of motion, and downregulate pain via mechanoreceptor and central effects.
Techniques
- Tui Na (pressing, rolling, acupressure)
- Thai massage (assisted stretching, acupressure along sen lines)
- Myofascial release elements
Sources
- Vickers AJ et al. Acupuncture for chronic pain: update of an individual patient data meta-analysis. J Pain. 2018.
- Cochrane reviews on acupuncture for chronic low back pain, neck pain, tension-type headache/migraine, and knee OA (various, 2012–2020).
- AHRQ 2018/2020 Noninvasive Nonpharmacologic Treatment for Chronic Pain.
- NCCIH (NIH). Acupuncture for Pain: Evidence Summary.
- Cochrane Review: Chinese herbal medicine for osteoarthritis (e.g., Liu et al., 2016).
- NCCIH. Traditional Chinese Herbal Products: Safety and Evidence overview.
- Systematic reviews of topical herbal plasters for musculoskeletal pain (mixed-quality evidence).
- Systematic reviews: Boswellia for osteoarthritis pain and function (multiple meta-analyses, ~2018–2021).
- Systematic reviews of curcumin for knee osteoarthritis (e.g., Daily et al., J Med Food, 2016; later meta-analyses).
- Small RCTs of ashwagandha for osteoarthritis and generalized pain (emerging evidence).
- NCCIH. Ayurvedic Medicine: In Depth; Herb monographs and safety notes.
- Furlan AD et al. Massage for low-back pain. Cochrane Review. 2015 (updates show short-term benefit).
- Systematic reviews of Thai massage for musculoskeletal pain (small RCTs; short-term improvements).
Integrative Perspective
A pragmatic multimodal plan begins with mechanism-based assessment and shared functional goals. Core elements with the best risk–benefit profile include education, graded exercise/physical therapy, and psychological therapies (CBT/ACT or MBSR). Consider early adjunctive acupuncture (6–12 sessions) for chronic musculoskeletal pain or headaches. For osteoarthritis, combine exercise/weight management with topical NSAIDs; add duloxetine if central features are present. Neuropathic components may benefit from gabapentinoids or TCAs/SNRIs plus desensitization therapy; consider topical lidocaine or capsaicin. Add yoga or tai chi 1–3 times weekly to improve function and pain coping; qigong is reasonable where available. Manual therapy (Tui Na/Thai massage) can provide short-term relief as a bridge to active rehab. Herbal options such as Boswellia or curcumin may be tried as adjuncts for OA after reviewing drug–herb interactions (e.g., anticoagulants, antiplatelets) and sourcing high-quality, third-party-tested products; avoid multi-ingredient proprietary blends with undisclosed components. Use opioids only if benefits demonstrably outweigh risks, at the lowest dose, with clear exit criteria and monitoring; consider buprenorphine in higher-risk patients. Reserve interventional procedures for focal, well-phenotyped pain generators with guideline-concordant indications. Screen and address sleep, depression, anxiety, PTSD, and social factors; incorporate pacing, flare plans, and return-to-activity strategies. Reassess every 4–12 weeks; continue what helps function with acceptable safety and de-implement what does not.
Sources
- Dowell D et al. CDC Opioid Prescribing Guideline. 2022.
- NICE NG193: Chronic pain in over 16s. 2021.
- ACP Guideline for Low Back Pain. 2017 (and updates).
- AHRQ Noninvasive Nonpharmacologic Treatment for Chronic Pain. 2018/2020.
- Vickers AJ et al. J Pain. 2018 IPD meta-analysis of acupuncture for chronic pain.
- Williams ACDC et al. Cochrane Review: Psychological therapies for chronic pain. 2020.
- Cherkin DC et al. JAMA. 2016. MBSR and CBT for chronic low back pain.
- Cochrane Reviews: Massage for low back pain (2015), Yoga for chronic low back pain (2017/2020 updates), Tai chi for knee OA (multiple RCTs incl. Ann Intern Med 2016).
- NCCIH (NIH) resources on acupuncture, yoga, tai chi, and herbs for pain.
Health Disclaimer
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.