What non-pharmacological management strategies should I consider for patients with chronic pain?

For patients with chronic primary pain, several non-pharmacological management strategies should be considered, alongside a comprehensive discussion about their care and support plan ¹, ².

• Care and Support Planning: It is important to discuss the patient's priorities, abilities, goals, and what they are already doing that is helpful ¹, ². Explain the evidence for possible benefits, risks, and uncertainties of all management options ¹, ². Provide advice and information to help them make decisions about managing their condition, including self-management ¹. Discuss the likelihood of symptom fluctuations, the possibility that a reason for pain may not be identified, and that pain may not improve, but quality of life can ¹.
• Exercise Programmes and Physical Activity: Offer a supervised group exercise programme, taking into account the patient's specific needs, preferences, and abilities ¹, ². Encourage patients to remain physically active for longer-term general health benefits ¹, ². Evidence indicates that exercise can reduce pain and improve quality of life ¹.
• Psychological Therapies: Consider Acceptance and Commitment Therapy (ACT) or Cognitive Behavioural Therapy (CBT) for pain, delivered by healthcare professionals with appropriate training ¹, ².
• Acupuncture: A single course of acupuncture or dry needling, within a traditional Chinese or Western acupuncture system, can be considered ¹, ². This should be delivered in a community setting by a Band 7 (or lower) healthcare professional with appropriate training, and comprise no more than 5 hours of professional time, or be delivered for equivalent or lower cost ¹, ².
• Pain Management Programmes (PMPs): While NICE did not make a recommendation for or against PMPs, they noted a very small improvement in quality of life in some studies ¹. The Scottish Intercollegiate Guidelines Network (SIGN) recommends considering referral to a pain management programme ¹. The British Pain Society states that PMPs based on cognitive behavioural principles are the treatment of choice for people with persistent pain that significantly impacts their quality of life and function ¹.
• Strategies Not Recommended: Do not offer biofeedback, interferential therapy, Transcutaneous Electrical Nerve Stimulation (TENS), or ultrasound to manage chronic primary pain, as there is no evidence of benefit ¹, ².