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Review
. 2023 Sep 29;21(1):372.
doi: 10.1186/s12916-023-03076-2.

Multimodal non-invasive non-pharmacological therapies for chronic pain: mechanisms and progress

Affiliations
Review

Multimodal non-invasive non-pharmacological therapies for chronic pain: mechanisms and progress

Yu Shi et al. BMC Med. .

Abstract

Background: Chronic pain conditions impose significant burdens worldwide. Pharmacological treatments like opioids have limitations. Non-invasive non-pharmacological therapies (NINPT) encompass diverse interventions including physical, psychological, complementary and alternative approaches, and other innovative techniques that provide analgesic options for chronic pain without medications.

Main body: This review elucidates the mechanisms of major NINPT modalities and synthesizes evidence for their clinical potential across chronic pain populations. NINPT leverages peripheral, spinal, and supraspinal mechanisms to restore normal pain processing and limit central sensitization. However, heterogeneity in treatment protocols and individual responses warrants optimization through precision medicine approaches.

Conclusion: Future adoption of NINPT requires addressing limitations in standardization and accessibility as well as synergistic combination with emerging therapies. Overall, this review highlights the promise of NINPT as a valuable complementary option ready for integration into contemporary pain medicine paradigms to improve patient care and outcomes.

Keywords: CBT; Complementary and alternative therapies; Non-invasive non-pharmacological therapies; Pain; Physical modalities; Psychological interventions; TENS; TMS; VR.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Ascending pain pathway from periphery to central. Note: PAG = periaqueductal gray
Fig. 2
Fig. 2
Modulation of pain signals in the spinal dorsal horn
Fig. 3
Fig. 3
Interactions between pain modulatory brain regions. Note: The red lines represent the ascending nociceptive pathways that transmit pain signals, while the blue lines represent the descending anti-nociceptive pathways that modulate pain. PFC = prefrontal cortex; ACC = anterior cingulate cortex; IC = insula cortex; PAG = periaqueductal gray; RVM = rostral ventromedial medulla
Fig. 4
Fig. 4
Overview of non-pharmacological therapies for chronic pain. Note: TENS: transcutaneous electrical nerve stimulation; CBT: cognitive-behavioral therapy; VR: virtual reality

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