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 NICE NG193.
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 NICE CKS.
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 NICE NG193.
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 NICE NG193.
Other physical modalities such as TENS, ultrasound, and interferential therapy are not recommended due to lack of evidence of benefit NICE NG193.
Self-management strategies, including advice on diet, weight, activity, and keeping a pain diary, are encouraged to promote active participation in managing the condition NICE CKS.