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Home > Non-Opioid Therapies
Documents are listed in logical categories by treatment modality and, within those, in the order of their publication dates – most recent at the top. All URL links were valid at the time of posting. Please notify us of any broken links at: Researchers: Winnie Dawson, MA, RN, BSN; Stewart B. Leavitt, MA, PhD.
General Pain Relief - Nondrug, Complementary, AlternativeA Complementary Approach to Pain Management Khatta M. Medscape Ob/Gyn & Women’s Health. 2007(May). Accessed November 26, 2008.
Deng G, Cassileth BR. CA: Cancer J Clin. 2005;55(2):109-116.
Nonpharmacologic and Complementary Approaches to Cancer Pain Management Menefee JA, et al. Journal of the American Osteopathic Association. 2005(Nov);105(11 Suppl 5):S15-S20. Accessed November 26, 2008.
Complementary and Alternative Medicine Approaches for Pediatric Pain. A Review of the State-of-the-Science Tsao JCI, et al. Evidence-Based Complementary and Alternative Medicine. 2005(Jun);2(2):149-159. Accessed November 26, 2008.
< Back to Top > Acupuncture
Yuan J, Purepong N, Kerr DP, et al. Medscape, 2008 [from Spine. 2008;33(23):E887-E900].
Sun Y, Gan TJ, Dubose JW, Habib AS. Medscape, 2008 [from Br J Anaesth. 2008;101(2):151-160].
Rapson LM, Banner R. Medscape, 2008 [from Geriatrics & Aging. 2008;11(2):93-97].
Meta-Analysis: Acupuncture for Low Back Pain Manheimer E, White A, Berman B, et al. Annals of Internal Medicine, 2005(Apr);142(8):651-663. Accessed November 26, 2008.
Acupuncture for Shoulder Pain Green S, Buchbinder R, Hetrick S. Cochrane Database. 2005;2. Accessed November 26, 2008. Acupuncture and Dry-Needling for Low Back Pain Furlan AD, van Tulder MW, Cherkin DC , et al. Cochrane Database. 2005,1. Accessed November 26, 2008. Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee Berman BM, Lao L, Langenberg P, et al. Annals of Internal Medicine. 2004(Dec);141(12):901-910. Accessed November 26, 2008.
< Back to Top > Adjuvant Drugs
Wright DV. Medscape, 2008 [from Journal for Nurse Practitioners. 2008;4(4):263-270].
Urquhart D, Hoving JL, Assendelft WJJ, et al. Cochrane Database. 2008;1.
Antidepressant Agents for the Treatment of Chronic Pain and Depression Jann MW, Slade JH; Medscape, 2008 [from Pharmacotherapy. 2007;27(11):1571-1587]. See details...>
Perioperative Ketamine for Acute Postoperative Pain Bell RF, Dahl JB, Moore RA et al. Cochrane Database. 2006;1. Accessed November 26, 2008. Systemic Administration of Local Anesthetic Agents to Relieve Neuropathic Pain Challapalli V, Tremont-Lukats IW, McNicol ED, et al. Cochrane Database. 2005,4. Accessed November 26, 2008. Anticonvulsant Drugs for Acute and Chronic Pain Wiffen P, Collins S, McQuay H, et al. Cochrane Database. 2005;3. Accessed November 26, 2008. Antidepressants for neuropathic pain Saarto T, Wiffen PJ. Cochrane Database. 2005,3. Accessed November 26, 2008. Gabapentin for Acute and Chronic Pain Wiffen PJ, McQuay HJ, Edwards JE, et al. Cochrane Database. 2005,3. Accessed November 26, 2008. Recent Advances in Nonopioid Treatment of Pain Moyer P, Bennett DS. Medscape Ob/Gyn & Women’s Health. 2005(Apr). Accessed November 26, 2008.
Antidepressants and Antiepileptic Drugs for Chronic Non-Cancer Pain Maizels M, McCarberg B. American Family Physician, 2005(Feb);71(3):483-390. Accessed November 26, 2008.
< Back to Top > BiofeedbackBiofeedback as an Adjunctive Treatment Modality in Pain Management Gatchel RJ. American Pain Society Bulletin, 2004. Accessed November 26, 2008.
< Back to Top > Botulinum Toxin (BOTOX) InjectionsBotulinum Toxin Type A For Migraine Headaches Sidhu S, Ruddock B. Canadian Pharmacists Journal. 2006(Nov-Dec);139(6):30-31. Accessed November 26, 2008.
Botulinum Toxin Type A Therapy For Cervical Dystonia Costa J, Espirito-Santo C, Borges A et al. Cochrane Database. 2005, 1. Accessed November 26, 2008. Botulinum Toxin and the Management of Chronic Headaches Evers S. Curr Opin Otolaryngol Head Neck Surg. 2004;12(3):197-203. Accessed November 26, 2008.
< Back to Top > Cold or Heat TherapyThis topic area includes a wide variety of temperature-based treatments. Cold therapy can be used to reduce acute inflammation and relieve muscle spasm. Typically, the application of cold is superficial; an ice pack or cooling fluids are applied to the skin and local tissues. An unrelated treatment, low-level laser therapy, is also called cold laser therapy because it uses a near-infrared laser which is, basically, nonthermal. Heat therapy is most commonly used to increase blood flow and decrease joint stiffness which, in turn, reduces pain and muscle spasms. The application of heat may be superficial (hot packs, paraffin wax baths, hydrotherapy) or deep (diathermy, ultrasound). One example of deep heat therapy is an ablative treatment such as MRgFUS which is a noninvasive thermal ablation technique using high-intensity focused ultrasound. Superficial Heat or Cold for Low Back Pain French SD, Cameron M, Walker BF, et al. Cochrane Database. 2006,1. Accessed November 26, 2008.
A New Look at Heat Treatment for Pain Disorders. Part 2 O’Connor A, et al. American Pain Society Bulletin, 2005. Accessed November 26, 2008.
A New Look at Heat Treatment for Pain Disorders. Part 1 McCarberg B, et al. American Pain Society Bulletin, 2004. Accessed November 26, 2008.
The Use of Heat and Cold in Pain Modulation Michel T. Pain Relief Connection, 2003. Accessed November 26, 2008.
< Back to Top > Electroanalgesia (incl. CES, MET, PENS, SCS, TENS, & Others)The practice of electroanalgesia during the past 15 years has expanded, and even the task of identifying the acronyms can be a challenge. As an aid to understanding techniques available, the first article below (White et al, 2001) provides a brief historical review, a description, and a summary of significant trials in each procedure—from the noninvasive TENS to the minimally invasive PENS and the most invasive DBS. White PF, Li S, Chiu JW. Anesthesia & Analgesia. 2001(Feb);92(2);505-513. Accessed November 26, 2008.
Nnoaham KE, Kumbang J. Cochrane Database. 2008;3.
Transcutaneous Electrical Nerve Stimulation Kaye V, Brandstater ME. eMedicine from WebMD. Updated Oct 2008. Accessed November 26, 2008.
Electromedical Treatment of Headaches [CES] Kirsch DL. Practical Pain Management. 2006(Nov/Dec):58-65. Accessed November 26, 2008.
Microcurrent Electrical Therapy (MET): A Tutorial Kirsch DL. Practical Pain Management. 2006(Oct):59-64. Accessed November 26, 2008.
Transcutaneous Electrical Nerve Stimulation (TENS) For the Treatment of Rheumatoid Arthritis in the Hand Brosseau L, Yonge KA, Robinson V, et al. Cochrane Database. 2006,1. Accessed November 26, 2008. Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low-Back Pain Khadilkar A, Milne S, Brosseau L, et al. Cochrane Database. 2005,3. Accessed November 26, 2008. Comparison of Percutaneous Electrical Nerve Stimulation With Transcutaneous Electrical Nerve Stimulation for Long-Term Pain Relief in Patients With Chronic Low Back Pain Yokoyama M, Sun X, Oku S, et al. Anesthesia & Analgesia. 2004;98(6):1552-1556. Accessed November 26, 2008.
Spinal Cord Stimulation (SCS) for Chronic Pain Mailis-Gagnon A, Furlan AD, Sandoval JA, et al. Cochrane Database. 2004,3. Accessed November 26, 2008. < Back to Top > Exercise Therapy
Oldfield V, Felson DT. Medscape, 2008 [from Curr Opin Rheumatol. 2008;20(3):353-359].
Busch AJ, Barber KAR, Overend TJ, et al. Cochrane Database. 2007;4.
Systematic Review: Strategies for Using Exercise Therapy to Improve Outcomes in Chronic Low Back Pain Hayden JA, et al. Annals of Internal Medicine. 2005(May);142(9):776-785. Accessed November 26, 2008.
Exercises for Mechanical Neck Disorders Kay TM, Gross A, Goldsmith C, et al. Cochrane Database. 2005;3. Accessed November 26, 2008. Exercise Prescription for Older Adults With Osteoarthritis Pain: Consensus Practice Recommendations American Geriatrics Society (AGS), 2001. Accessed November 26, 2008.
< Back to Top > Headache - Drug & Non-Drug Therapies
Emerging Drugs for Migraine Prophylaxis and Treatment Bigal ME, Krymchantowski AV. Medscape General Medicine. 2006(May);5(10). Accessed November 26, 2008.
Selective Serotonin Re-Uptake Inhibitors (SSRIs) for Preventing Migraine and Tension-Type Headaches Moja PL , Cusi C, Sterzi RR, et al. Cochrane Database. 2005,3. Accessed November 26, 2008.
Non-Invasive Physical Treatments for Chronic/Recurrent Headache Bronfort G, Nilsson N, Haas M, et al. Cochrane Database. 2004,3. Accessed November 26, 2008.
Oral Sumatriptan for Acute Migraine McCrory DC , Gray RN. Cochrane Database. 2003,3. Accessed November 26, 2008. < Back to Top > Herbal Medicines and Dietary Supplements
VITAMIN D – A ‘New’ Therapy for Chronic Pain Stewart B. Leavitt, MA, PhD, Pain Treatment Topics, June 2008. Vitamin D – A Neglected ‘Analgesic’ for Musculoskeletal Pain > Practitioner Briefing (7 pages) > Full Report (50 pages) Vitamin D: A Champion of Pain Relief > Patient Brochure (6-pages)
Use of Herbal Therapies to Relieve Pain: A Review of Efficacy and Adverse Effects Wirth JH, Hudgins JC, Paice JA. Medscape Ob/Gyn & Women’s Health, 2006(Jan). Similarly published in Pain Manage Nurs. 2005(Dec);6(4):145-167. Accessed November 26, 2008.
What You Should Know About Your Patients’ Use of Herbal Medicines and Other Dietary Supplements American Society of Anesthesiologists (ASA), 2003. Accessed November 26, 2008.
< Back to Top > Interventional Pain ManagementInterventional pain management is an emerging medical discipline devoted to the diagnosis and treatment of pain and related disorders. Interventional techniques include minimally invasive procedures, such as percutaneous precision needle placement, with placement of drugs in targeted areas or ablation of targeted nerves; and some surgical techniques, such as laser or endoscopic discectomy, intrathecal infusion pumps and spinal cord stimulators, for the diagnosis and management of chronic, persistent, or intractable pain. Interventional Techniques: Evidence-Based Practice Guidelines in the Management of Chronic Spinal Pain Boswell MV, Trescot AM, Datta S, et al. Pain Physician. 2007(Jan);10(1):7-111. Accessed November 26, 2008.
Local Anesthetic Sympathetic Blockade for Complex Regional Pain Syndrome Cepeda MS, Carr DB, Lau J. Cochrane Database. 2005;4. Accessed November 26, 2008. The Evolving Role of Interventional Pain Management in Oncology Sloan PA. Journal of Supportive Oncology. 2004(Nov-Dec);2(6):491-500,503. Accessed November 26, 2008.
Prolotherapy Injections for Chronic Low-Back Pain Yelland MJ , Del Mar C, Pirozzo S, et al. Cochrane Database. 2004,2. Accessed November 26, 2008. Corticosteroid Injections for Shoulder Pain Buchbinder R, Green S, Youd JM. Cochrane Database. 2003,1. Accessed November 26, 2008. Radiofrequency Denervation for Neck and Back Pain Niemisto L, Kalso E, Malmivaara A, et al. Cochrane Database. 2003,1. Accessed November 26, 2008. < Back to Top > NSAIDs & OTC Analgesics
Pearls & Perils of Over-the-Counter (OTC) AnalgesicsThe Pharmacist’s Role in the Appropriate Selection of a Nonprescription Product for Pain Relief US Pharmacist, September 2008. Accessed November 26, 2008. Go to details and the link to this document...>
NSAIDs: Rx Considerations, Concerns, and Cautions
Herndon CM, Hutchison RW, Hildegarde JB, et al. Pharmacotherapy. 2008;28(6):788-805. Accessed November 26, 2008. Use of Nonsteroidal Anti-inflammatory Drugs. An Update for Clinicians. A Scientific Statement From the American Heart Association Choosing Non-Opioid Analgesics for Osteoarthritis: Clinician's Guide Medication Guide for Nonsteroidal Anti-inflammatory Drugs (NSAIDS) Go to details and links to these documents...>
< Back to Top > Nuclear MedicineNuclear Medicine is commonly used as a diagnostic tool, but it can also be administered therapeutically to provide pain relief from certain types of bone cancers. Very small amounts of radiopharmaceuticals can treat targeted bone cancer tumors locally without affecting other parts of the body. Radioactive drugs act on the metastatic bone tumor directly to reduce the effects of the cancer and, therefore, the associated pain. Radiopharmaceutical Therapy for Palliation of Bone Pain From Osseous Metastases Pandit-Taskar N, et al. Journal of Nuclear Medicine. 2004(Aug);45(8):1358-1365. Accessed November 26, 2008.
Radioisotopes for Metastatic Bone Pain Roqué i Figuls M, Martinez MJ, Alonso-Coello Pl. Cochrane Database. 2003;4. Accessed November 26, 2008. < Back to Top > Physical Therapies (incl. Massage, Shockwave Therapy, and Others)
So PS, Jiang Y, Qin Y. Cochrane Database. 2008;4.
Tsao JCI. Evid Based Complement Alternat Med. 2007(Jun);4(2):165-179.
Shock Wave Therapy for Lateral Elbow Pain Buchbinder R, Green SE, Youd JM, et al. Cochrane Database. 2005;4. Accessed November 26, 2008. Traction for Low-Back Pain With or Without Sciatica Clarke JA, van Tulder MW, Blomberg SEI, et al. Cochrane Database. 2005,4. Accessed November 26, 2008. Spinal Manipulative Therapy for Low-Back Pain Assendelft WJJ, Morton SC, Yu Emily I, et al. Cochrane Database. 2004,1. Accessed November 26, 2008. Stabilisation Splint Therapy for Temporomandibular Pain Dysfunction Syndrome Al-Ani MZ, Davies SJ, Gray RJM, et al. Cochrane Database. 2004,1. Accessed November 26, 2008. Physiotherapy Interventions for Shoulder Pain Green S, Buchbinder R, Hetrick S. Cochrane Database. 2003;2. Accessed November 26, 2008. Massage for Low-Back Pain Furlan AD, Brosseau L, Imamura M, et al. Cochrane Database. 2002,2. Accessed November 26, 2008. < Back to Top > Psychological Interventions (plus Hypnosis & Music Therapy)
Rogovik AL, Goldman RD. Canadian Family Physician. 2007(May);53(5):823-825.
Music for Pain Relief Cepeda MS, Carr DB, Lau J, et al. Cochrane Database. 2006,2. Accessed May 28, 2007.
Psychological Interventions for Needle-Related Procedural Pain and Distress in Children and Adolescents Uman LS, Chambers CT , McGrath PJ, et al. Cochrane Database. 2005,1. Accessed November 26, 2008. Psychological Interventions for Symptomatic Management of Non-Specific Chest Pain in Patients With Normal Coronary Anatomy Kisely S, Campbell LA , Skerritt P. Cochrane Database. 2005,1. Accessed November 26, 2008.
Psychological Therapies for the Management of Chronic and Recurrent Pain in Children and Adolescents Eccleston C, Yorke L, Morley S, et al. Cochrane Database. 2003,1. Accessed November 26, 2008. Psychological Therapies for Sickle Cell Disease and Pain Anie KA, Green J. Cochrane Database. 2002,2. Accessed November 26, 2008. < Back to Top > Topical AnalgesiaTopical NSAIDs for Acute Pain: A Meta-Analysis Mason L, Moore RA, Edwards JE, et al. BMC Fam Pract. 2004(May);5(10). Accessed November 26, 2008.
Topical Agents or Dressings for Pain in Venous Leg Ulcers Briggs M, Nelson EA. Cochrane Database. 2003,1. Accessed November 26, 2008. Principles of Office Anesthesia: Part II. Topical Anesthesia Kundu S, et al. American Family Physician. 2002(Jul);66(1):99-102. Accessed November 26, 2008.
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This page was last updated 12/30/08 |









This section of Pain Treatment Topics focuses on the variety of non-opioid therapies -- both pharmacologic and non-pharmacologic -- from an evidence-based, clinical perspective. This information is not offered as medical advice or treatment recommendations from Pain Treatment Topics. See also, 





