Alternative Non-Opioid Therapies for Pain Management

Opioids entail strong drugs that alter the body’s response to pain. They are mostly applied for the treatment of acute pain, and their potential for abuse is high. Today, at least 2 million people are addicted, and 130 die due to overdose every day (Marshall et al., 2019). Unfortunately, the rate of abuse is increasing, and it is necessary to support the development of alternative pain management strategies. Non-pharmacological treatments are becoming more popular such as muscle relaxation to reduce stress and pain. Moreover, the application of therapies such as physical and psychological, massage, acupuncture, yoga, and music are on the rise. This literature review explores the alternative therapies to support pain management and reduce the use of opioid drugs.

Theoretical Framework

Many nursing theories support changes that promote the quality of life and eliminate suffering. The change theory of nursing presents a three-stage model of change, and it has three major concepts, namely equilibrium, driving forces, and restraining forces. Change models act as the driving force that pushes beneficial decisions and encourages the understanding of the existing problem (Sokol et al., 2020). They can influence the evaluation of the negative impact of opioids in the U.S and influence the authority to make the necessary changes. Although opioid drugs are the cheapest and most convenient method of managing acute pain, it is marked by adverse effects, and it is necessary to support alternative strategies.

Review of the Literature

Theme 1: Behavioral Therapies

Subtheme 1: Relaxation Techniques

Article 1

Arthroscopic rotator cuff repair is usually marked with pain necessitating opioid medications. Unfortunately, the medication presents adverse effects, and it is important to consider non-pharmacological methods. Relaxation exercises can help relieve pain and promote the quality of life (Weekes et al., 2021). The title of the article is “Do relaxation exercises decrease pain after arthroscopic rotator cuff repair? A randomized controlled trial”. Its authors are Weekes, Campbell, Wicks, Hadley, Chaudhry, Carter, Pepe, Tucker, Freedman, and Tjoumakaris. The research question states, “Does relaxation exercises reduce pain after the repair of the rotator cuff.” It attempts to evaluate whether they lower opioid consumption and improve patients’ perception of its effectiveness. Samples were 74 adult patients admitted to the facility between June 2017 and April 2018 with rotator cuff tears. The study involved a randomized controlled trial entailing two treatment groups. It was conducted at a private orthopedic institution that had many treatment centers.

The study was marked with various limitations since it only evaluated relaxed breathing exercises and did not consider other methods. Implementation of this approach would require the hiring of trained professionals to teach and lead these exercises (Weekes et al., 2021). Many hospitals may not afford to hire trained therapists for the exercises only. Findings reveal that relaxation exercises can offer an effective, easy-to-use, and inexpensive alternative intervention and play a role in the mitigation of the opioid crisis.

There exists a gap in the study of relaxation exercises, and it is necessary to promote research in a reproducible and practical protocol to assist patients with arthroscopic rotator cuff repair (Weekes et al., 2021). There are many opportunities in the implementation of this approach since it has been shown to reduce the overall narcotic consumption and pain significantly in the second week of its application.

Article 2

Many women are dissatisfied with the invasive and pharmacological pain management methods in labor. The pain is usually intense and presents a moment of challenging emotions, apprehension as well as fear (Smith et al., 2018). The title of this study is “Relaxation techniques for pain management in labor,” and its authors are Smith, Levett, Collins, Armour, Dahlen, and Suganuma. The research question states, “How effective is the relaxation technique in labor pain management?” It attempts to help examine the role of body-mind relaxation techniques in supporting pain management in women during the delivery process and promotes their neonatal and maternal wellbeing. The methodology entailed a research review through consulting multiple databases including the Cochrane central register of controlled trials, Cochrane Pregnancy and childbirth’s trials register, the WHO international clinical trials registry platform, and (Smith et al., 2018). It involved randomized controlled trials, both cluster and quasi trials that offer a comparison between relaxation methods with no treatment, standard care, as well as other alternative pain management methods. The study covered 19 studies entailing 1731 women, and diverse interventions were examined.

The limitation of the study is that it is marked by the fear of losing control, intrusive thoughts, and increased anxiety. The research findings revealed that relaxation plays a role in the reduction of pain among women in labor, marked by high satisfaction with the pain relief method (Smith et al., 2018). Opportunities for the implementation of the strategy are wide. It has proven to be an effective, safe and reliable method. Many women are likely to prefer it to pharmaceutical approaches since it has no side effects.

Article 3

Pain is a distressing response, especially during the early postoperative period. Patients experiencing postoperative pain have different responses to opioids, where pain sensitivity is seen to be higher in females than in males. The title of this article is “Effectiveness of Jacobson’s progressive muscle relaxation technique for pain management in post-cesarean women,” authored by Devmurari and Nagrale. It aims at researching postoperative pain among women and the effectiveness of Jacobson’s relaxation technique (Devmurari & Nagrale, 2018). The study is based on the research question, “is Jacobson’s relaxation technique effective in managing pain in Post-cesarean section?”

During cesarean section, women experience pain as a result of operative trauma. Releasing the pain in most parts of the body can have a significant effect on the rest of the body. Jacobson’s relaxation technique involves a hypothalamus response in decreasing muscle tone and sympathetic arousal (Devmurari & Nagrale, 2018). The objective of the study aims at finding out the postoperative pain relief between controlled and experimental groups. The study based its research on 34 subjects involving a randomized controlled design. The intervention took place for five days where analgesics dose was obtained from medical records. The controlled group was only given instructions on pre-operative while the experimental one performed Jacobson’s relaxation technique.

The limitation of the study is that progressive muscle relaxation can sometimes cause an increase in anxiety and cause many challenges. Moreover, the process is time-consuming and requires the input of a trained physical therapist (Devmurari & Nagrale, 2018). The conclusions drawn from this study indicated that pain is decreased in the experimental group than in the controlled one. Jacobson’s progressive muscle relaxation technique has many opportunities because it offers an effective alternative strategy for pain management. This is because it can improve early postoperative recovery and functional activity.

Subtheme 2: Physical and Psychological Therapies

Article 1

Musculoskeletal (MSK) pains are the leading causes of disability and are highly prevalent around the globe. Unfortunately, most of the affected people are usually given opioid treatment, which does not align with the best practices. Physical therapists are encouraged to apply non-pharmacological treatments for initial pain management (George & Goode, 2020). They have a role to play in boosting exposure and accessibility to alternative treatments to manage MSK pain conditions. The title of the article states, “physical therapy and opioid use for musculoskeletal pain management: Competitors or companions?” while its authors are Steven and Adam.

The research question is, “is physical therapy better than opioid use in the management of musculoskeletal pain.” It attempts to compare and explain whether physical therapy offers an effective alternative to opioid use and whether it can enhance the fight against the existing crisis. The study involved the investigation of observational evidence for early treatment using physical therapy as well as subsequent impact on the opioid application. It presented diverse clinical questions to guide clinical trials and health services research to support alternative strategies for MSK pain management (George & Goode, 2020). The limitation of the study is that it is marked with devastating unintended consequences. Boosting the usage of physical therapy is likely to influence changes in the healthcare systems and create many problems. This would necessitate an evaluation of the dangers against the obtained benefits of lowering the use of opioids.

The study findings show that physical therapy can boost the availability of non-pharmacological treatment and support MSK pain conditions. This will become the central component of the future alternative treatment for pain management to reduce the opioid crisis. There exist many opportunities for the implementation of this intervention since an updated evidence base, new care delivery models, as well as better payment policies would support them (George & Goode, 2020). Collaboration and rigorous designs can influence progress and support the implementation of better pain treatment options.

Article 2

Pain management for cancer patients is complex and necessitates interdisciplinary care. It is important to balance analgesia while limiting the use of opioids to avoid negative implications in the future. Non-pharmacological intervention can help manage pain through participating in shared decisions. Positive discussions with the patients can explain the causes of the pain and possible duration and motivate them to cope (Goodlev et al., 2019). Creating room for open communication improves the understanding of the condition and appreciation of the treatment process.

The title of the paper is “Managing cancer pain, monitoring for cancer recurrence, and mitigating risk of opioid use disorders: A team-based, interdisciplinary approach to cancer survivorship,” and its authors are Goodlev, Discala, Darnall, Hanson, Petok, and Silverman. The research question states, why is it important to mitigate the risk of opioid disorder during the management of cancer pain? The article offered a comprehensive narrative review through consulting diverse, reliable databases and experts.

The limitation of the study is that cancer is a progressive disease that keeps on worsening with time. This implies that strategies for pain management need to be improved as the disease advancement. Alternative interventions adopted need to be changed from time to time to achieve desired results. Moreover, recurrence of cancer symptoms tends to complicate the balancing necessitating the need for additional opioid dosages. The article helped reveal that clinical management of cancer survivors requires the application of an effective interdisciplinary approach that ameliorates and recognizes sufferings and pain from side effects while lowering the risk of opioid misuse (Goodlev et al., 2019). There are many opportunities in the application of this approach since it can help eliminate the side effects of opioid drugs among cancer patients and promote their quality of life.

Article 3

The recommendation by the Centers for Disease Control and Prevention to adopt non-pharmacological therapies in pain management presents a challenging transition period for both practitioners and patients. The objective of the study is to establish other strategies apart from the use of opioids to reduce pain while improving the quality of life (Wenger et al., 2018). Although it may be difficult to eliminate pain, physical therapists must work closely with the interdisciplinary team to achieve the best outcome and address the patients’ needs.

The title of the article is “reducing opioid use for patients with chronic pain: An evidence-based perspective,” and its authors are Wenger, Drott, Fillipo, Findlay, Genung, Heiden, and Bradt. The research question states, “what is the importance of lowering opioid use during the management of chronic pain?” The article presents a framework to offer guidance and enable health care providers to develop better reasoning and enhance their collaboration to establish an effective approach to meet the unique needs of patients. The methodology entails reviews of diverse scholarly sources to establish an effective approach to the transition process from opioids to alternative pain management methods. The strategy is marked with various limitations because it is sometimes difficult to eliminate chronic pain by administering opioid drugs (Wenger et al., 2018). Physical therapists and other practitioners need training and motivation to support the new directive.

Findings reveal that interdisciplinary coordination and communication are necessary for the establishment of a cohesive plan of care. There is a need to support interdisciplinary treatment programs and pain rehabilitation programs to support the management of chronic pain. There are many opportunities for the implementation of alternative interventions since connections, networks, as well as collaborations can promote the framework (Wenger et al., 2018). A patient-centered treatment approach, as well as improved communication between patients and health care providers, can help achieve desirable results.

Subtheme 3: Massage

Article 1

The elderly people in residential aged care are vulnerable to many ailments that contribute to pain. This means that they need assistance in the management of pain that comes with chronic diseases (Ellis et al., 2019). Opioids are common medications for pain management, but they are marked with adverse effects. The title of the article is ”Non-pharmacological approaches to pain management in residential aged care: A pre-post-test study” and it is authored by Ellis, Wells, and Ong. The research question states, “Are non-pharmacological approaches effective in managing pain among the residential-aged individuals?” The article aims at evaluating a pain management program using alternative approaches other than pharmacological interventions.

The project focuses on five different residential facilities for the elderly in Australia. The pain management program was carried out in four sessions per week during the treatment process. It included massage therapy and stretching exercises as well as their combinations. The sample entailed 95 participants with an average age of 83 years who were involved in a 10 minutes session (Ellis et al., 2019). The resident’s pain was documented using a 5-point scale before and after each treatment session. Each participant received the intervention for the first eight consecutive weeks.

The results obtained from these interventions indicated a significant decrease in the need to use medications for pain management. Moreover, the intervention recorded decreased average pain rating from pre-and post-session with a rating scale of 2.4 before and 1.1 after the session. Further, those suffering from dementia recorded a lower pain rating as compared to those without. Findings indicated that non-pharmacological interventions are effective for managing pain in elderly residential care settings (Ellis et al., 2019). Caregivers in these residential care settings should identify the best practices and rely on them to manage pain, especially in dementia patients. There is also a need to train caregivers on pain management and assessment, more so on the residents with dementia.

Article 2

Therapeutic massage is effective in supporting pain management through relaxing painful tendons, muscles, and joints. It influences the reduction of anxiety, stress, and stimulation of nerve fibers that sends messages from and to the brain. The title of the article is “Massage for pain: an evidence map,” authored by Miake-Lye, Mak, Lee, Luger, Taylor, Shanman, and Shekelle. The research question states, “Is therapeutic massage effective in the management of pain over opioid medication?”

The study evaluated diverse databases, including Embase, PubMed, as well as Cochrane, for systematic reviews that explained massage therapy for pain management. The process involved assessing the quality of all reviews through the Assessment of Methodological Quality of Systematic Reviews (AMSTAR) criteria (Miake-Lye et al., 2019). A bubble plot was used to depict the number of articles included in pain indication, the effect the massage had on pain management as well as the depth of each systematic review’s findings. The limitation of the study is that therapeutic massage can cause physical injuries, requires a lot of time, and is costly. Accredited and trained therapists are expensive to hire since they are specially trained. The study identified 49 reviews, and 32 of them showed high-quality findings (Miake-Lye et al., 2019). The systematic reviews were based on low back pain, neck pain, and cancer pain.

The study concluded that there lacks in-depth evidence on pain management through massage since the current reviews conduct few primary studies using large samples. This leaves evidence gaps, especially on specific massage for a particular pain (Miake-Lye et al., 2019). Primary studies lack adequate details on pain management through massage therapy, implying that there is a limitation of reviews for concluding the research question. There are many opportunities for the implementation of therapeutic massage since it is effective in the treatment of chronic back pains, fatigue, stress, and other health conditions such as type2 diabetes and high blood pressure.

Article 3

Dementia is a devastating and challenging health concern marked by a decline in cognitive potential. This affects memory and mood and causes frequent pain because of changes in the functioning of the brain. The title of the article is “Effect of therapeutic massage on pain in patients with dementia,” and Kapoor and Orr wrote it. The research question is “How effective is therapeutic massage in the management of pain among dementia patients?” The sample entailed ten dementia patients, and they were assigned to either a control or an intervention group (Kapoor & Orr, 2017). This was a randomized controlled study in an aged care facility. It was conducted by offering a ten minutes massage to the intervention group 4 times every week and repeated for four weeks.

The poor ability of these patients to express themselves was the main limitation of the study since it was difficult to measure the outcome. Moreover, the time-consuming exercise required much concentration and input from trained therapists. Findings revealed that therapeutic massage was an effective method of pain management among dementia patients. This means that it can offer a reliable alternative to opioid medication and play a role in the elimination of the existing crisis (Kapoor & Orr, 2017). Opportunities exist in the implementation of the option because it is effective in reducing anxiety, easing tension, and eliminating depression.

Theme 2: Occupational, Mind, and Body Techniques

Subtheme 1: Music Therapy

Article 1

Music is one of the effective behavioral interventions that can support pain management, and it describes a neurologic mechanism of action. It is considered an abstract of every art form since it depicts events, people, or places through sounds (Chai et al., 2017). The article title is “Music as an adjunct to opioid-based analgesia,” and the authors are Peter R. Chai, Stephanie Carreiro, Megan L. Ranney, Ketki Karanam, Marko Ahtisaari, and Robert Edwards, Kristin L. Schreiber, Lubabah Ben-Ghaly, Timothy B. Erickson, and Edward W. Boyer.

The research question states, “Is music an effective adjunct to patients with opioid-based analgesia?” This forms the basis of the research and supports the evaluation of characteristics of music that helps relieve or manage pain. The research sample entailed opioid users in the USA who requires assistance in pain management (Chai et al., 2017). The research methodology is descriptive since it explains the facts and characteristics of an area of interest. It draws ideas from many sources to make an informed conclusion. It reveals that automated discovery is beneficial and appealing to these patients because it offers exciting content to chronic pain patients (Chai et al., 2017). Moreover, patients can easily receive the amount and quality of music they deserve.

The limitations of the study are that it relies on previous research, implying that past mistakes can be replicated and influence misleading results. Moreover, collecting data from old sources means that outdated results would be obtained. Many limitations exist because the ability of music to obstruct pain varies widely among patients (Chai et al., 2017). The exact point where the intervention is viable remains unclear, affecting its deployment. The efficacy of music is affected by the fact that its effect can be augmented since it occurs through instrumental ensembles, singing, or circles.

Research findings of the study show that digitized music obtained through mobile devices and automated discovery algorithms can be applied to offer a tailored music list that can help decrease opioid use and modulate pain. Music tends to augment beneficial and positive rewards pathways where they promote healthy engagement. It offers an emotional reward and promotes social cohesion and communication. The anthropologic history reveals that music was applied to support the healing process, and every culture appreciated the importance of listening to music (Chai et al., 2017). It is believed to have the ability to influence pleasurable responses that support pain management. It has positive valence stimuli similar to sexual encounters, money, psychoactive drugs, and food.

Music is a reliable pain intervention approach because it improves mood and affects since it alters the evaluation and perception of pain. The article presents various opportunities to enhance practice implementation since it explains an effective and safe alternative therapy for pain management and subsequent prevention of the opioid crisis (Chai et al., 2017). This can help lower postoperative pain, anger, stress, and other signs of depression.

Article 2

The abuse and overuse of opioid medications have turned into an epidemic in the U.S today. Prolonged application of the medication increases the chances of developing chronic opioid pain. The government is making an effort to discourage people from using these drugs because of their side effects. The title of the article is “Music as a postoperative pain management intervention,” and its authors are Poulsen, M. J., Coto, J., and Cooney, M. F. The research question states; “can adjunctive pain management therapies lower the use of opioids and hinder long-term negative effects” (Poulsen et al., 2019). The research sample was six crossover trials and 24 randomized controlled trials. The research methodology involved searching for randomized controlled trials, prospective studies as well as systematic reviews that studied adjunctive pain management strategies.

Limitations in the study are that adjunctive nonpharmacologic and analgesics strategies failed to show a significant reduction in the number of consumed opioids even after recording a considerable pain scores decline. These strategies require a back again and bedside-to-bench cycle, as well as a complete pain characterization. This research revealed that the treatment of burns is associated with long-lasting pain that necessitates an improved management strategy. Individualized analgesic treatment plans need to cover multiple modalities to deal with breakthrough, background as well as neuropathic pain. This study presents many opportunities for practice implementations, particularly in the reduction of the overuse of opioid drugs and the associated side effects (Poulsen et al., 2019). The suggested strategies can help relieve the burden on these drugs by establishing other effective methods of managing pain.

Article 3

Pain management is marked by psychological and physiological outcomes in burn patients and is a rising problem around the globe. Music therapy is an effective strategy that can be applied to reduce the level of anxiety and pain and lower the use of opioid drugs (Rohilla et al., 2018). The title of the article is “Effect of music therapy on pain perception, anxiety, and opioid use during dressing change among patients with burns in India: A quasi-experimental, crossover pilot study.” Its authors are Latika Rohilla, Meenakshi Agnihotri, Sukhpal Kaur Trehan, Ramesh Kumar Sharma, and Sandhya Ghai. The research question states, “Can music therapy help relieve anxiety and pain when changing burn dressing?” The research sample involved ten patients entailing eight men and two women who were treated at the tertiary care burn unit. The research method was quasi-experimental, involving a crossover design.

Limitations in the study are that there was no blinding between the patient and observer. The sample size was too small, and a higher population was necessary to boost the power of the study. Patients requiring ventilator or inotropic support were not included in the study because most of them had severe burn injuries, and their pain and anxiety perception could not be determined. The limited scope and small sample size affected its reliability. This study revealed that music therapy is an effective method of managing pain and anxiety and can play a role in the reduction of the use of opioid drugs (Rohilla et al., 2018). Opportunities for practice implementation are many because music is easily available and a cheap alternative. The increased accessibility of the internet implies that patients can play their favorite music anytime they find it appropriate.

Subtheme 2: Yoga Therapy

Article 1

A hatha yoga program has high acceptability and feasibility level, and it can be designed to relieve pain among patients with opioid use disorder. The title of the article is “A pilot study assessing acceptability and feasibility of hatha yoga for chronic pain in people receiving opioid agonist therapy for opioid use disorder,” and its authors are Lisa A.Uebelacker, DonnellVan Noppena, GeoffreyTremont, Genie Bailey, Ana Abrantes, and MichaelSteina.

The research question states, “What is the effectiveness of hatha yoga in the management of chronic pain among patients?” The research sample entailed 40 chronic pain patients, where 20 were receiving buprenorphine and the other 20 methadone. They were assigned to weekly health education or hatha yoga classes for three months, and feasibility was observed (Uebelacker et al., 2020). The limitation of the study is that the sample size was too small and could fail to generate reliable results. It was necessary to consider a larger size to boost the strength of the study.

The findings of the research confirm that a hatha yoga program is an effective approach to pain management, and it can be provided on-site during the opioid agonist treatment program (Uebelacker et al., 2020). There are various opportunities for the implementation of the practice in an attempt to limit the use of opioid drugs. This could offer a reliable, accessible, and affordable alternative to pain management and play a role in the reduction of the opioid burden.

Article 2

Yoga therapy offers an effective solution in comprehensive integrative pain management (CIPM) and plays a role in the improvement of patient outcomes. It attempts to reduce the burden of poorly managed pain and public health crisis (Pearson et al., 2020). The title of the article is “White paper: Yoga therapy and pain-how yoga therapy serves in comprehensive integrative pain management, and how it can do more,” and the authors are Pearson, Prosko, Sullivan, and Taylor. The research states, “What is the role of yoga therapy in supporting comprehensive integrative pain management?”

The study involved the review of literature and research to enhance the understanding of the role of yoga therapy on the CIPM. It explains the existing pain crisis and the contribution of yoga therapists in addressing the problem (Pearson et al., 2020). The limitation of the study is that it failed to define the recommended dosage or extent of yoga therapy based on the patient’s needs and other surrounding tissues. It was not clear whether the program could offer the best effects in addressing persistent pain (Pearson et al., 2020). However, the research findings explain that yoga therapy is beneficial and offers an efficient and low-cost solution to pain management. It impacts the body and mind positively while promoting the quality of life and well-being and promoting success in life circumstances (Pearson et al., 2020). There are many opportunities for practice implementation since the approach is cheap, effective, convenient, and accessible to many people.

Article 3

The dependence on drugs is a major issue of concern in public health since it contributes to disability. It impairs diverse domains, including occupational, social, physical, psychological, financial, legal, as well as familial. Yoga therapy can help reduce dependence on drugs and address all the affected domains (Kuppili et al., 2018). The title of the article is “Role of yoga in the management of substance-use disorders: A narrative review,” and its four authors are Kuppili, Parmar, Gupta, and Balhara. The research question states, “What is the role of yoga in enhancing the management of substance use disorder?”

The study involved a narrative review of peer-reviewed journals that covered yoga-based interventions. Sources were sourced from Google Scholar, PubMed Central, and PubMed databases using key terms. A structured pro forma was applied to facilitate the gathering of data and synthesizing of literature (Kuppili et al., 2018). The study was marked with limitations because of the low sample size. Although about 314 studies were identified, the study only used 16 because they were irrelevant or not in English.

The study revealed that yoga is an effective intervention in the management of the substance-use disorder. It offers promising interventions since it targets different domains, especially in the management of nicotine-use disorders (Kuppili et al., 2018). There are many opportunities for its implementation since it can offer a long-lasting solution to substance-use disorder. It presents an effective, affordable and reliable intervention to address the opioid crisis.

Subtheme 3: Acupuncture

Article 1

Opioid has become an epidemic in the U.S due to increased usage, and the medical systems must consider alternative methods of managing pain to limit opioid dependence. Acupuncture offers an evidence-based, powerful, accessible, cost-effective, and safe pain management strategy (Fan, 2017). It is appropriate for the management of diverse types of pain conditions and enhances drug dependence. The title of the article is “Acupuncture’s role in solving the opioid epidemic: Evidence, cost-effectiveness, and care availability for acupuncture as a primary, non-pharmacologic method for pain relief and management,” and its authors are Fan, Miller, Bolash, Bauer, McDonald, Faggert, He, Ming, Matecki, Camardella, Koppelman, Stone, Mateck, and Pang. The research question is, “What is the role of acupuncture in addressing the opioid epidemic?”

The study entailed a summary of healthcare professionals, academic scholars, policymakers, administrators, and the public to gather available information on acupuncture as an alternative treatment for an opiate dependency and different pain conditions. Research obtained between March 2013 and September 2016, available in the Cochrane and PubMed library regardless of the language, was analyzed. It covered network meta-analyses, meta-analyses, systematic reviews, and several narrative reviews (Fan, 2017). The conducted meta-analysis covered 62 non-Cochrane systematic reviews where data was gathered from at least a thousand randomized controlled trials (RCTs). Although the intervention is effective, it is affected by some limitations.

Insertion of a needle is not an option for patients with bleeding disorders since it can influence massive loss of blood. Moreover, unsterilized needles can cause infections or damage to internal organs. The findings of the study show that acupuncture is an effective strategy for treating different types of pain, particularly involving osteoarthritis, chronic headache, shoulder, neck, and back (Fan, 2017). The application of this intervention comes with many opportunities since it is effective, cheap, and easy to apply.

Article 2

Opioids have caused a negative impact across the United States, hindering effective management of pain. Acupuncture practitioners and researchers can extensively contribute to the elimination of the crisis, and it is necessary to explore the significance of the intervention (Kong, 2018). The title of the article is “Exploring the Multiple Roles of Acupuncture in Alleviating the Opioid Crisis,” and the author is Jiang-Ti Kong. The research question is, “What roles can acupuncture play in the reduction of the opioid crisis?”

The study gathered opinions from multiple experts in different disciplines to explore the benefits of acupuncture. It obtained information on the deaths and other health issues emerging from an opioid overdose. The limitation of the study is that it failed to define the opioid-sparing effect and determine the most appropriate dose depending on the extent of pain. The study revealed that many factors influence the prescription of opioids, including untreated medical conditions and ignorance regarding alternative pain management options. It explains that increased consumption of these drugs can influence long-term dependence (Kong, 2018). Opportunities in the implementation are many since it can help manage acute pain. Practitioners and researchers need to provide more information to the public and encourage them to consider using the intervention.

Article 3

The Center for Medicare and Medicaid Services (CMS) confirmed its decision to consider acupuncture as part of its response to the opioid crisis in 2020. This was focused on offering an alternative pain management strategy among patients with older adults who were suffering from chronic back pains (Liou et al., 2021). CMS is concerned about the risk that opioid drugs pose, and it intends to promote non-pharmacological treatment options. The title of the article is “Medicare coverage of acupuncture for chronic low back pain: Does it move the needle on the opioid crisis?” Liou, Korenstein, and Mao did a study in 2021 and played a significant role in adding to the available literature on alternative therapies to address the opioid crisis.

The research question was; “Can acupuncture offer an effective alternative pain management therapy to lower the opioid crisis?” The article offers a descriptive analysis of the decision that CMS has taken based on the previous research explaining that acupuncture is cost-effective, safe, and efficient in the management of chronic low back pain. CMS revealed that it would cover twelve acupuncture treatments as well as an extra eight treatments for patients showing clinical improvements. Several limitations in the study were evident, including poor availability of acupuncture, particularly for communities that were extensively affected by the crisis (Liou et al., 2021). The lack of adequate acupuncturists across the U.S is a major challenge that CMS has to address to boost the application of the pain management strategy.

The study revealed that the current opioid crisis shows that there is a need to establish a more holistic approach to pain management. The future application of the strategy is promising since CMS has indicated its interest in the expansion of insurance coverage (Liou et al., 2021). The Medicare policy on acupuncture, supported by interprofessional care coordination and workforce training, presents many opportunities for the application of this intervention.


The increasing usage of opioids is an indication that is effectively adjusting therapies are necessary to manage analgesia. Therapies focused on the adjustment of behaviors are meant to reconfigure the response to pain, perception, and anticipation. The multidisciplinary approach to pain, as well as the behavioral perception, tends to promote adherence to pharmacological therapy and frame pain in a context that is easier to manage. Behavioral interventions are usually faced with many shortcomings, including the inability to address unremitting pain and require prolonged time. They have limited context and necessitate periodic refreshers to realize desirable success. These problems mean that there is a need to establish interventions resonating with wide patient populations.


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