Moving Beyond Medications PDF

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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.



1) 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

2) 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

3) 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

4) Develop a Treatment Plan with the Patient; Assess Potential Challenges

  • 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

5) Follow Up, Troubleshoot and Modify Treatment Plan as Needed

  • See the patient regularly; assess progress toward identified goals at each
  • 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



About the Author:

Dr Oshidar, Burlington County Chiropractor / Advanced Back & Neck Care 227 Madison Ave Lumberton NJ 08048 / (609)261-7562
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