Supporting Research in Pain Management for Veterans and Military Service Members
Supporting Research in Pain Management for Veterans and Military Service Members

Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update 2020

Comparative Effectiveness Review
Number 227

April 2020

Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services  

Prepared by:
Pacific Northwest Evidence-based Practice Center


This review focuses on noninvasive nonpharmacological treatment for chronic pain including exercise, mind-body practices, psychological therapies, multidisciplinary rehabilitation, mindfulness practices, manual therapies, physical modalities, and acupuncture, and updates our prior Agency for Healthcare Research and Quality (AHRQ) review. Many trials have examined the impact of these interventions on outcomes during or immediately after the course of treatment reporting improved function and reduced pain. However, given the persistence of chronic pain, understanding whether the benefits are durable would be very helpful for informing selection of therapies. Therefore, this report focuses on durability of treatment effects, defined as at least one month following the end of a course of treatment.

Purpose of Review

To assess noninvasive nonpharmacological treatments for common chronic pain conditions.

Key Messages—

  • Interventions that improved function and/or pain for ≥1 month:
    • Low back pain: Exercise, psychological therapy, spinal manipulation, low-level laser therapy, massage, mindfulness-based stress reduction, yoga, acupuncture, multidisciplinary rehabilitation (MDR)
    • Neck pain: Exercise, low-level laser, mind-body practices, massage, acupuncture
    • Knee osteoarthritis: Exercise, cognitive behavioral therapy (CBT)
    • Hip osteoarthritis: Exercise, manual therapies
    • Fibromyalgia: Exercise, CBT, myofascial release massage, mindfulness practices, tai chi, qigong, acupuncture, MDR
    • Tension headache: Spinal manipulation
  • Some interventions did not improve function or pain.
  • Serious harms were not observed with the interventions.

Access the full report here.