What are the best strategies for managing chronic pain without opioids?

Effective strategies for managing chronic pain without opioids include non-pharmacological approaches such as exercise therapy, which has been shown to reduce pain and improve quality of life, and should be offered as part of management ².

Participation in structured pain management programmes that include physical and psychological components can be beneficial, although evidence of their effectiveness is limited and benefits are small ¹.

Psychological therapies such as acceptance and commitment therapy (ACT) or cognitive behavioural therapy (CBT) are recommended for people with chronic primary pain, delivered by trained healthcare professionals ².

Acupuncture or dry needling may be considered within specific boundaries, delivered in community settings by trained professionals, but should be limited to no more than 5 hours of healthcare professional time ².

Other physical modalities such as TENS, ultrasound, and interferential therapy are not recommended due to lack of evidence of benefit ².

Self-management strategies, including advice on diet, weight, activity, and keeping a pain diary, are encouraged to promote active participation in managing the condition ¹.