Albert Science International Organization

“No pain no gain” still is one of the most widely used inspiring quote. With that spirit, chronic pain sufferers should find heaven on earth at some point of life. However, chronic pain is a widespread and complex set of conditions that are often difficult and expensive to treat. The Institute of Medicine (US) estimated that chronic pain affects over 100 millionAmericans [1] and is associated with $874 billion in healthcare costs annually [2]. Of this, close to 10% ($78 billion) is associated with the economic burdenof prescription opioid overdose, abuse and dependency [3]. Pain increases depression 3-5-fold [4-6] and 50–90% of chronic pain patients report insomnia that warrants clinical attention [7-10].Conventional pain killers are usually associated with a variety of adverse side effects, such as constipation, urinary retention, nausea, sedation, respiratory depression, low platelet count, sexual dysfunction and hyperalgesia [11-14].

Pain affects more than 65% cancer patients [15], distressing or intolerable in more than one?third of patients [16].Although, WHO described opioids as essential medicines for pain control but distribution shows substantial inequity, 10% of the world’s population consuming more than 90% of the world’s supply [17], 80% opioids consumed by US alone [18-23]. Famous celebrities like Bruce Lee, Chris Penn, Elvis Presley, Heath Ledger, Anna Nicole Smith died from opioid overdose. Also, some 85% of primary care physicians perceived their training in pain management to be inadequate in a Pan-European survey [24,25]. Along with these, fear of dependence, prescription diversion, regulatory scrutiny, withdrawal symptoms, opioid-related adverse events and deaths limit its use. Although, abuse and availability of medical cannabis are big issues, several studies support use of cannabis/marijuana in cancer pain management [26-36]. Its social acceptability is gradually increasing around the world [37], but many studies oppose it’s use or at least demand further investigation of benefit risk ratio [38-46]. Long-term use of non-steroidal anti-inflammatory drugs(NSAIDs, like ibuprofen, naproxen) is often associated with many serious cardiovascular, gastrointestinal, renal, and other side effects [47-53]. However, association of NSAIDs with cancer is not true [54-58].

Mild-to-moderate pain may be relieved by non-drug techniques alone. Moderate-to-severe pain may require medication in addition to nondrug techniques [6].Neuropathic pain estimates of 60% among those with chronic pain [59]. Non-drug techniques can decrease pain intensity and can decrease awareness of pain to enable better coping some have been proven to work.Physical activity is the most basic, simple and well-known preventive and therapeutic measure for low back pain, particularly when the problem is caused by sedentary behavior. A study on arthritic patients revealed that walking 1000 more steps/day was associated with 16% to 18% less risk of developing functional limitation two years later [60,61].Regular exercise can reduce physical impairments and improve participation in social, domestic, occupational, and recreational activities [62]. Additional benefits of exercise include improvementsin mobility, riskof falls, body weight, mental health, and metabolic abnormalities among arthritis patients63-65].Approximately 70 to 85% of the western population will develop low back pain at least once during their lifetime [66].An 8-week moderate intensity aerobic exercise at 40%–60% of heart rate reserve combined with conventional physiotherapy, significantly reduced nearly 50% non-specific chronic low back pain (NSCLBP) [67].

Figure 1. Music Therapy in Pain or Distress Management.In the UK, music therapists are trained to master’s level and are registered with Health and Care Professions Council as allied health professionals [68].

Pain causes stress, and stress affects pain control chemicals in the brain, such as norepinephrine and serotonin [69-71]. Behavioral approaches /relaxation training can help reduce muscle tension and stress, lower blood pressure, and control pain [72-75].Physical therapy should strongly be considered for the management of chronic pain to gradually increase flexibility and strength. Adding cognitive behavioral treatment (CBT) component to routine physical therapyreducesNSCLBP, disability and depression, fear of movement with enhanced of self-efficacy, enhancing functional capacity and QoL [76]. Companion of choice at birth increases the likelihood of vaginal births, reduces the need for caesarean sections, the use of forceps or vacuum during vaginal births, need to use pain medications during labor, shortens the duration of labor, improves women’s satisfaction with care and improves Apgar scores [77].Music therapy, in general, was effective in reducing pain intensity, fatigue, anxiety, and analgesic consumption in gynecological patients during the postoperative period [78-80].

Figure 2. Therapy-dog visits for kids with cancer: A safe way to induce smiles[81].

Postoperative pain is not adequately managed in greater than 80% of patients in the US [82]. Cryotherapy, should be widely used in the same because it is a noninvasive, very cost-effective, devoid of complication, and a very favorable patient report [83].Up to 85% of patients with low back pain cannot be given a definitive diagnosis, the cause or mechanism of injury is often unknown and there is little consensus on appropriate management [84]. 75% of patients with low back pain are treated with heating therapy and7% withcooling therapy. Cooling therapy decreases tissue blood flow dueto vasoconstriction, and that it also reduces tissue metabolism,oxygen utilization, and inflammation [85].Transcutaneous electrical nerve stimulation (TENS) as an adjunct is effective in reducing lower limb spasticity when applied for more than 30 minutes over nerve or muscle belly in chronic stroke survivors [86-88].In France,work productivity loss contributed almost 90% of the total costs incurred by patients with fibromyalgia [89], with an economic cost of 13000 million euros annually [90,91] which is around $100 billion in US [92]. Low FODMAP (fermentable oligo-, di-, mono-saccharidesand polyols) and neurofeedback reduce pain intensity, improve attentionand QoLmore successfully than otherpsychological or multicomponent programs [93,94].Meditation–based interventions improve pain symptomology across a wide spectrum of pain-related disorders, including fibromyalgia, migraine, chronic pelvic pain [95]. Aromatherapy with orange oil can relieve pain in patients with fractured limbs. A study has shown that edible oil of orange can reduce breast pain caused by premenstrual syndrome [96]. Pets provide companionship, unconditional love, and joy.An average 12 minutes exposure to a therapy dog reduces anxiety in 34% of fibromyalgia patients, together with reductions in pain and improvements in mood. Pet therapy significantly increases patients’ overall feeling of wellbeing and reduces anxiety about future uncertainty [97,98]. There are three elements in hypnosis; absorption, dissociation, and suggestibility.Alleviation of pain with hypnosis, especially for patients who experienced obvious pain during the first-eye surgery also reported [99]. Hypnosis session during subcutaneous venous port implantation under local anesthesia in cancer patients significantly improved patient satisfaction [100]. Acupuncture and yogafound to be effective at reducing lymphoedema and pain in patients after breast cancer treatment [101,102].

1. Tompkins, D Andrew et al. “Providing chronic pain management in the "Fifth Vital Sign" Era: Historical and treatment perspectives on a modern-day medical dilemma.” Drug and alcohol dependence vol. 173 Suppl 1,Suppl 1 (2017): S11-S21. doi:10.1016/j.drugalcdep.2016.12.002
2. Malik, Khalid M et al. “Musculoskeletal Disorders a Universal Source of Pain and Disability Misunderstood and Mismanaged: A Critical Analysis Based on the U.S. Model of Care.” Anesthesiology and pain medicine vol. 8,6 e85532. 15 Dec. 2018, doi:10.5812/aapm.85532
3. Shipton, Edward A et al. “A Review of the Opioid Epidemic: What Do We Do About It?.” Pain and therapy vol. 7,1 (2018): 23-36. doi:10.1007/s40122-018-0096-7
4. Barman, Diplina et al. “Association Between Depression and Acute Pain in Adults Attending a Tertiary Care Hospital in Bhubaneswar.” Journal of clinical and diagnostic research: JCDR vol. 9,7 (2015): CC08-11. doi:10.7860/JCDR/2015/12008.6179
5. Al-Maharbi, Sameeh et al. “Prevalence of depression and its association with sociodemographic factors in patients with chronic pain: A cross-sectional study in a tertiary care hospital in Saudi Arabia.” Saudi journal of anaesthesia vol. 12,3 (2018): 419-425. doi:10.4103/sja.SJA_771_17
6. Mohiuddin AK.Non-drug pain management: opportunities to explore (e-Book). BiomedGrid LLC, USA May 09, 2019 ISBN: 978-1-946628-01-5.
7. Tang, Nicole K Y et al. “Nonpharmacological Treatments of Insomnia for Long-Term Painful Conditions: A Systematic Review and Meta-analysis of Patient-Reported Outcomes in Randomized Controlled Trials.” Sleep vol. 38,11 1751-64. 1 Nov. 2015, doi:10.5665/sleep.5158
8. Jank, Robert et al. “Chronic Pain and Sleep Disorders in Primary Care.” Pain research and treatment vol. 2017 (2017): 9081802. doi:10.1155/2017/9081802
9. Emery, Patricia C et al. “Major depressive disorder and sleep disturbance in patients with chronic pain.” Pain research & management vol. 19,1 (2014): 35-41. doi:10.1155/2014/480859
10. Ferini-Strambi, Luigi. “Neuropathic Pain and Sleep: A Review.” Pain and therapy vol. 6,Suppl 1 (2017): 19-23. doi:10.1007/s40122-017-0089-y
11. Cazacu, Irina et al. “Safety issues of current analgesics: an update.” Clujul medical (1957) vol. 88,2 (2015): 128-36. doi:10.15386/cjmed-413
12. Machelska, Halina, and Melih Ö Celik. “Advances in Achieving Opioid Analgesia Without Side Effects.” Frontiers in pharmacology vol. 9 1388. 29 Nov. 2018, doi:10.3389/fphar.2018.01388
13. Kapur BM, Lala PK, Shaw JL. Pharmacogenetics of chronic pain management. Clin  Biochem. 2014 Sep;47(13-14):1169-87. doi: 10.1016/j.clinbiochem.2014.05.065. Epub 2014 Jun 7. Review. PubMed PMID: 24912048.
14. Kaye, Alan David et al. “Update on the pharmacogenomics of pain management.” Pharmacogenomics and personalized medicine vol. 12 125-143. 3 Jul. 2019, doi:10.2147/PGPM.S179152
15. Caraceni, Augusto, and Morena Shkodra. “Cancer Pain Assessment and Classification.” Cancers vol. 11,4 510. 10 Apr. 2019, doi:10.3390/cancers11040510
16. Gupta, Mayank et al. “The Prevalence and Characteristics of Pain in Critically Ill Cancer Patients: A Prospective Nonrandomized Observational Study.” Indian journal of palliative care vol. 21,3 (2015): 262-7. doi:10.4103/0973-1075.164894
17. Bhadelia, Afsan et al. “Solving the Global Crisis in Access to Pain Relief: Lessons From Country Actions.” American journal of public health, vol. 109,1 e1-e3. 29 Nov. 2018, doi:10.2105/AJPH.2018.304769
18. Rose, Mark Edmund. “Are Prescription Opioids Driving the Opioid Crisis? Assumptions vs Facts.” Pain medicine (Malden, Mass.) vol. 19,4 (2018): 793-807. doi:10.1093/pm/pnx048
19. Manchikanti L, Singh A. Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician. 2008 Mar;11(2 Suppl):S63-88.
20. Tolba, Reda et al. “The Opioid Epidemic and Pain Medicine Specialists: Where to Begin and What Is Next?.” The Ochsner journal vol. 18,1 (2018): 20-22.
21. Manchikanti L, Fellows B, Ailinani H, Pampati V. Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective. Pain Physician. 2010 Sep-Oct;13(5):401-35.
22. Gauger EM, Gauger EJ, Desai MJ, Lee DH. Opioid Use After Upper Extremity Surgery. J Hand Surg Am. 2018 May;43(5):470-479. doi: 10.1016/j.jhsa.2018.02.026.
23. Wiese, Beth, and Adrianne R Wilson-Poe. “Emerging Evidence for Cannabis' Role in Opioid Use Disorder.” Cannabis and cannabinoid research vol. 3,1 179-189. 1 Sep. 2018, doi:10.1089/can.2018.0022
24. Johnson, Martin et al. “The challenges of pain management in primary care: a pan-European survey.” Journal of pain research vol. 6 393-401. 22 May. 2013, doi:10.2147/JPR.S41883
25. Shipton, Elspeth Erica et al. “Pain medicine content, teaching and assessment in medical school curricula in Australia and New Zealand.” BMC medical education vol. 18,1 110. 11 May. 2018, doi:10.1186/s12909-018-1204-4
26. Byars T, Theisen E, Bolton DL. Using Cannabis to Treat Cancer-Related Pain. Semin Oncol Nurs. 2019 Jun;35(3):300-309. doi: 10.1016/j.soncn.2019.04.012. Epub  2019 Apr 30. Review. PubMed PMID: 31053395.
27. Dzier?anowski T. Prospects for the Use of Cannabinoids in Oncology and Palliative Care Practice: A Review of the Evidence. Cancers (Basel). 2019 Jan 22;11(2). pii: E129. doi: 10.3390/cancers11020129. Review. PubMed PMID: 30678303; PubMed Central PMCID: PMC6406915.
28. Carr, Daniel, and Michael Schatman. “Cannabis for Chronic Pain: Not Ready for Prime Time.” American Journal of Public Health vol. 109,1 (2019): 50–51. doi:10.2105/AJPH.2018.304593. PMCID: PMC6301389
29. Sharafi G, He H, Nikfarjam M. Potential Use of Cannabinoids for the Treatment  of Pancreatic Cancer. J Pancreat Cancer. 2019 Jan 25;5(1):1-7. doi: 10.1089/pancan.2018.0019. eCollection 2019. Review. PubMed PMID: 30706048; PubMed Central PMCID: PMC6352507.
30. Campbell G, Stockings E, Nielsen S. Understanding the evidence for medical cannabis and cannabis-based medicines for the treatment of chronic non-cancer pain. Eur Arch Psychiatry Clin Neurosci. 2019 Feb;269(1):135-144. doi: 10.1007/s00406-018-0960-9. Epub 2019 Jan 11. Review. PubMed PMID: 30635715.
31. Stockings E, Campbell G, Hall WD, Nielsen S, Zagic D, Rahman R, Murnion B, Farrell M, Weier M, Degenhardt L. Cannabis and cannabinoids for the treatment of  people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies. Pain. 2018 Oct;159(10):1932-1954. doi: 10.1097/j.pain.0000000000001293. PubMed PMID: 29847469.
32. Wang J, Wang Y, Tong M, Pan H, Li D. New Prospect for Cancer Cachexia: Medical Cannabinoid. J Cancer. 2019 Jan 1;10(3):716-720. doi: 10.7150/jca.28246. eCollection 2019. Review. PubMed PMID: 30719170; PubMed Central PMCID: PMC6360413.
33. Turgeman I, Bar-Sela G. Cannabis for cancer - illusion or the tip of an iceberg: a review of the evidence for the use of Cannabis and synthetic cannabinoids in oncology. Expert OpinInvestig Drugs. 2019 Mar;28(3):285-296. doi: 10.1080/13543784.2019.1561859. Epub 2018 Dec 29. Review. PubMed PMID: 30572744.
34. Urits I, Borchart M, Hasegawa M, Kochanski J, Orhurhu V, Viswanath O. An Update of Current Cannabis-Based Pharmaceuticals in Pain Medicine. Pain Ther. 2019 Jun;8(1):41-51. doi: 10.1007/s40122-019-0114-4. Epub 2019 Feb 5. Review. PubMed PMID: 30721403; PubMed Central PMCID: PMC6514017.
35. Lossignol D. Cannabinoids: a new approach for pain control? CurrOpin Oncol. 2019 Jul;31(4):275-279. doi: 10.1097/CCO.0000000000000523. PubMed PMID: 30789867.
36. Steele G, Arneson T, Zylla D. A Comprehensive Review of Cannabis in Patients with Cancer: Availability in the USA, General Efficacy, and Safety. Curr Oncol Rep. 2019 Feb 1;21(1):10. doi: 10.1007/s11912-019-0757-7. Review. PubMed PMID: 30707319.
37. Mead A. Legal and Regulatory Issues Governing Cannabis and Cannabis-Derived Products in the United States. Front Plant Sci. 2019 Jun 14;10:697. doi: 10.3389/fpls.2019.00697. eCollection 2019. Review. PubMed PMID: 31263468; PubMed Central PMCID: PMC6590107.
38. Shi S, Brant AR, Sabolch A, Pollom E. False News of a Cannabis Cancer Cure. Cureus. 2019 Jan 19;11(1):e3918. doi: 10.7759/cureus.3918. PubMed PMID: 30931189; PubMed Central PMCID: PMC6426557.
39. Wilkinson ST. Medical and recreational marijuana: commentary and review of the literature. Mo Med. 2013 Nov-Dec;110(6):524-8. Review. PubMed PMID: 24564006; PubMed Central PMCID: PMC6179811.
40. Boehnke KF, Gangopadhyay S, Clauw DJ, Haffajee RL. Qualifying Conditions Of Medical Cannabis License Holders In The United States. Health Aff (Millwood). 2019 Feb;38(2):295-302. doi: 10.1377/hlthaff.2018.05266. Erratum in: Health Aff (Millwood). 2019 Mar;38(3):511. PubMed PMID: 30715980; PubMed Central PMCID: PMC6398594.
41. Stuyt E. The Problem with the Current High Potency THC Marijuana from the Perspective of an Addiction Psychiatrist. Mo Med. 2018 Nov-Dec;115(6):482-486. PubMed PMID: 30643324; PubMed Central PMCID: PMC6312155.
42. Kansagara D, O'Neil M, Nugent S, et al. Benefits and Harms of Cannabis in Chronic Pain or Post-traumatic Stress Disorder: A Systematic Review [Internet]. Washington (DC): Department of Veterans Affairs (US); 2017 Aug. RESULTS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK476452/
43. Pacula RL, Smart R. Medical Marijuana and Marijuana Legalization. Annu Rev Clin Psychol. 2017 May 8;13:397-419. doi: 10.1146/annurev-clinpsy-032816-045128.  Review. PubMed PMID: 28482686; PubMed Central PMCID: PMC6358421.
44. Dariš B, Tancer Verboten M, Knez Ž, Ferk P. Cannabinoids in cancer treatment:  Therapeutic potential and legislation. Bosn J Basic Med Sci. 2019 Feb 12;19(1):14-23. doi: 10.17305/bjbms.2018.3532. Review. PubMed PMID: 30172249; PubMed Central PMCID: PMC6387667.
45. Gonçalves J, Rosado T, Soares S, Simão AY, Caramelo D, Luís Â, Fernández N, Barroso M, Gallardo E, Duarte AP. Cannabis and Its Secondary Metabolites: Their Use as Therapeutic Drugs, Toxicological Aspects, and Analytical Determination. Medicines (Basel). 2019 Feb 23;6(1). pii: E31. doi: 10.3390/medicines6010031. Review. PubMed PMID: 30813390; PubMed Central PMCID: PMC6473697.
46. Cooke AC, Knight KR, Miaskowski C. Patients' and clinicians' perspectives of co-use of cannabis and opioids for chronic non-cancer pain management in primary  care. Int J Drug Policy. 2019 Jan;63:23-28. doi: 10.1016/j.drugpo.2018.09.002. Epub 2018 Nov 23. PubMed PMID: 30472467; PubMed Central PMCID: PMC6353665.
47. Varga, Zoltan et al. “Cardiovascular Risk of Nonsteroidal Anti-Inflammatory Drugs: An Under-Recognized Public Health Issue.” Cureus vol. 9,4 e1144. 8 Apr. 2017, doi:10.7759/cureus.1144
48. Harirforoosh S, Asghar W, Jamali F. Adverse effects of nonsteroidal antiinflammatory drugs: an update of gastrointestinal, cardiovascular and renal complications. J Pharm Pharm Sci. 2013;16(5):821-47.
49. Wongrakpanich, Supakanya et al. “A Comprehensive Review of Non-Steroidal Anti-Inflammatory Drug Use in The Elderly.” Aging and disease vol. 9,1 143-150. 1 Feb. 2018, doi:10.14336/AD.2017.0306
50. Goldstein, Jay L, and Byron Cryer. “Gastrointestinal injury associated with NSAID use: a case study and review of risk factors and preventative strategies.” Drug, healthcare and patient safety vol. 7 31-41. 22 Jan. 2015, doi:10.2147/DHPS.S71976
51. Al-Saeed, Abdulwahed. “Gastrointestinal and Cardiovascular Risk of Nonsteroidal Anti-inflammatory Drugs.” Oman medical journal vol. 26,6 (2011): 385-91. doi:10.5001/omj.2011.101
52. Grosser, Tilo et al. “The Cardiovascular Pharmacology of Nonsteroidal Anti-Inflammatory Drugs.” Trends in pharmacological sciences vol. 38,8 (2017): 733-748. doi:10.1016/j.tips.2017.05.008
53. Ho, Kok Yuen et al. “Nonsteroidal anti-inflammatory drugs in chronic pain: implications of new data for clinical practice.” Journal of pain research vol. 11 1937-1948. 20 Sep. 2018, doi:10.2147/JPR.S168188
54. Wong, Rebecca S Y. “Role of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in Cancer Prevention and Cancer Promotion.” Advances in pharmacological sciences vol. 2019 3418975. 31 Jan. 2019, doi:10.1155/2019/3418975
55. Zhao, Xiaoping et al. “NSAIDs Use and Reduced Metastasis in Cancer Patients: results from a meta-analysis.” Scientific reports vol. 7,1 1875. 12 May. 2017, doi:10.1038/s41598-017-01644-0
56. Ahnen DJ. Colon cancer prevention by NSAIDs: what is the mechanism of action? Eur J Surg Suppl. 1998;(582):111-4.
57. Cooper TE, Heathcote LC, Anderson B, Grégoire MC, Ljungman G, Eccleston C. Non-steroidal anti-inflammatory drugs (NSAIDs) for cancer-related pain in children and adolescents. Cochrane Database Syst Rev. 2017 Jul 24;7:CD012563. doi: 10.1002/14651858.CD012563.pub2.
58. Zhang Z, Chen F, Shang L. Advances in antitumor effects of NSAIDs. Cancer Manag Res. 2018 Oct 15;10:4631-4640. doi: 10.2147/CMAR.S175212. eCollection 2018. Review.
59. Udall, Margarita et al. “Epidemiology of physician-diagnosed neuropathic pain in Brazil.” Journal of pain research vol. 12 243-253. 7 Jan. 2019, doi:10.2147/JPR.S160504
60. White, Daniel K et al. “Daily walking and the risk of incident functional limitation in knee osteoarthritis: an observational study.” Arthritis care & research vol. 66,9 (2014): 1328-36. doi:10.1002/acr.22362
61. Kelly JC. Knee Osteoarthritis: daily walking maintains function. Atlas Physical Therapy, June 23, 2014.
62. Schmid, Simone M et al. “Physical Activity & People with Disabilities - A Qualitative Process and Outcome Pilot Evaluation of the Non-Profit Organization AccesSurf Hawai'i.” Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health vol. 78,2 (2019): 52-60.
63. Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015 Dec;25 Suppl 3:1-72. doi: 10.1111/sms.12581.
64. Gilani, Seyed Reza Mousavi, and AbdurrashidKhazaeiFeizabad. “The effects of aerobic exercise training on mental health and self-esteem of type 2 diabetes mellitus patients.” Health psychology research vol. 7,1 6576. 11 Mar. 2019, doi:10.4081/hpr.2019.6576
65. Ravalli, Silvia et al. “Exercise as medicine to be prescribed in osteoarthritis.” World journal of orthopedics vol. 10,7 262-267. 18 Jul. 2019, doi:10.5312/wjo.v10.i7.262
66. Geurts, José W et al. “The Impact of Chronic Discogenic Low Back Pain: Costs and Patients' Burden.” Pain research & management vol. 2018 4696180. 1 Oct. 2018, doi:10.1155/2018/4696180
67. Gordon, Rebecca, and Saul Bloxham. “A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain.” Healthcare (Basel, Switzerland) vol. 4,2 22. 25 Apr. 2016, doi:10.3390/healthcare4020022
68. McConnell, Tracey et al. “Evaluation of the effectiveness of music therapy in improving the quality of life of palliative care patients: a randomised controlled pilot and feasibility study.” Pilot and feasibility studies vol. 2 70. 29 Nov. 2016, doi:10.1186/s40814-016-0111-x
69. Marks, David M et al. “Serotonin-norepinephrine reuptake inhibitors for pain control: premise and promise.” Current neuropharmacology vol. 7,4 (2009): 331-6. doi:10.2174/157015909790031201
70. Crofford, Leslie J. “Chronic Pain: Where the Body Meets the Brain.” Transactions of the American Clinical and Climatological Association vol. 126 (2015): 167-83.
71. Sheng, Jiyao et al. “The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain.” Neural plasticity vol. 2017 (2017): 9724371. doi:10.1155/2017/9724371
72. Wippert, Pia-Maria, and Christine Wiebking. “Stress and Alterations in the Pain Matrix: A Biopsychosocial Perspective on Back Pain and Its Prevention and Treatment.” International journal of environmental research and public health vol. 15,4 785. 18 Apr. 2018, doi:10.3390/ijerph15040785
73. Roditi, Daniela, and Michael E Robinson. “The role of psychological interventions in the management of patients with chronic pain.” Psychology research and behavior management vol. 4 (2011): 41-9. doi:10.2147/PRBM.S15375
74. Norelli SK, Krepps JM. Relaxation Techniques. [Updated 2019 Jun 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513238/
75. Smith, Karen E, and Greg J Norman. “Brief relaxation training is not sufficient to alter tolerance to experimental pain in novices.” PloS one vol. 12,5 e0177228. 11 May. 2017, doi:10.1371/journal.pone.0177228
76. Hajihasani A, Rouhani M, Salavati M, Hedayati R, Kahlaee AH. The Influence of  Cognitive Behavioral Therapy on Pain, Quality of Life, and Depression in Patients Receiving Physical Therapy for Chronic Low Back Pain: A Systematic Review. PM R.  2019 Feb;11(2):167-176. doi: 10.1016/j.pmrj.2018.09.029.
77. Kabakian-Khasholian, Tamar, and AnaydaPortela. “Companion of choice at birth: factors affecting implementation.” BMC pregnancy and childbirth vol. 17,1 265. 31 Aug. 2017, doi:10.1186/s12884-017-1447-9
78. “C. Preparing for an Optimal Birth Experience: Consider All Birthplace Options, Recognizing that Birth Experiences Are Enhanced in Home, Birth Center, or Hospital Settings that Support Parents' Informed Choices for the Labor, Birthing, and Postpartum Process.” The Journal of perinatal education vol. 10,4 (2001): 19-34. doi:10.1624/105812401X88426
79. Hodnett, Ellen D et al. “Continuous support for women during childbirth.” The Cochrane database of systematic reviews vol. 10 CD003766. 17 Oct. 2012, doi:10.1002/14651858.CD003766.pub4
80. Afulani, Patience et al. “Companionship during facility-based childbirth: results from a mixed-methods study with recently delivered women and providers in Kenya.” BMC pregnancy and childbirth vol. 18,1 150. 10 May. 2018, doi:10.1186/s12884-018-1806-1
81. Chubak J. Therapy-dog visits for kids with cancer: A safe way to induce smiles?Kaiser Permanente Washington Health Research Institute July 6, 2017
82. Gan, Tong J. “Poorly controlled postoperative pain: prevalence, consequences, and prevention.” Journal of pain research vol. 10 2287-2298. 25 Sep. 2017, doi:10.2147/JPR.S144066
83. Chumkam, Apisada et al. “Cryotherapy Reduced Postoperative Pain in Gynecologic Surgery: A Randomized Controlled Trial.” Pain research and treatment vol. 2019 2405159. 4 Mar. 2019, doi:10.1155/2019/2405159
84. McIntosh, Greg, and Hamilton Hall. “Low back pain (acute): non-drug treatments.” BMJ Clinical Evidence vol. 2015 1102. 25 Aug. 2015
85. Kim, Eun-Jung et al. “Effect of heating and cooling combination therapy on patients with chronic low back pain: study protocol for a randomized controlled trial.” Trials vol. 16 285. 26 Jun. 2015, doi:10.1186/s13063-015-0800-4
86. Mahmood A, Veluswamy SK, Hombali A, Mullick A, N M, Solomon JM. Effect of Transcutaneous Electrical Nerve Stimulation on Spasticity in Adults With Stroke:  A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2019 Apr;100(4):751-768. doi: 10.1016/j.apmr.2018.10.016.
87. Kwong PW, Ng GY, Chung RC, Ng SS. Transcutaneous electrical nerve stimulation  improves walking capacity and reduces spasticity in stroke survivors: a systematic review and meta-analysis. Clin Rehabil. 2018 Sep;32(9):1203-1219. doi: 10.1177/0269215517745349.
88. Marcolino MAZ, Hauck M, Stein C, Schardong J, Pagnussat AS, Plentz RDM. Effects of transcutaneous electrical nerve stimulation alone or as additional therapy on chronic post-stroke spasticity: systematic review and meta-analysis of randomized controlled trials. DisabilRehabil. 2018 Oct 16:1-13. doi: 10.1080/09638288.2018.1503736.
89. Hadjiat, Yacine et al. “Pain associated with health and economic burden in France: results from recent National Health and Wellness Survey data.” ClinicoEconomics and outcomes research : CEOR vol. 10 53-65. 18 Jan. 2018, doi:10.2147/CEOR.S148405
90. Cabo-Meseguer A, Cerdá-Olmedo G, Trillo-Mata JL. Fibromyalgia: Prevalence, epidemiologic profiles and economic costs. Med Clin (Barc). 2017 Nov 22;149(10):441-448. doi: 10.1016/j.medcli.2017.06.008.
91. Zhang, Xin-Chang et al. “Acupuncture therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials.” Journal of pain research vol. 12 527-542. 30 Jan. 2019, doi:10.2147/JPR.S186227
92. van Eijk-Hustings Y, Kroese M, Creemers A, Landewé R, Boonen A. Resource utilisation and direct costs in patients with recently diagnosed fibromyalgia who are offered one of three different interventions in a randomised pragmatic trial. Clin Rheumatol. 2016 May;35(5):1307-15. doi: 10.1007/s10067-015-3067-y.
93. Marum AP, Moreira C, Tomas-Carus P, Saraiva F, Guerreiro CS. A low fermentable oligo-di-mono-saccharides and polyols (FODMAP) diet is a balanced therapy for fibromyalgia with nutritional and symptomatic benefits. Nutr Hosp. 2017 Jun 5;34(3):667-674. doi: 10.20960/nh.703.
94. Kayiran S, Dursun E, Dursun N, Ermutlu N, Karamürsel S. Neurofeedback intervention in fibromyalgia syndrome; a randomized, controlled, rater blind clinical trial. Appl Psychophysiol Biofeedback. 2010 Dec;35(4):293-302. doi: 10.1007/s10484-010-9135-9.
95. Zeidan, Fadel, and David R Vago. “Mindfulness meditation-based pain relief: a mechanistic account.” Annals of the New York Academy of Sciences vol. 1373,1 (2016): 114-27. doi:10.1111/nyas.13153
96. Hekmatpou, Davood et al. “The Effect of Aromatherapy with the Essential Oil of Orange on Pain and Vital Signs of Patients with Fractured Limbs Admitted to the Emergency Ward: A Randomized Clinical Trial.” Indian journal of palliative care vol. 23,4 (2017): 431-436. doi:10.4103/IJPC.IJPC_37_17
97. Brooks, Helen Louise et al. “The power of support from companion animals for people living with mental health problems: a systematic review and narrative synthesis of the evidence.” BMC psychiatry vol. 18,1 31. 5 Feb. 2018, doi:10.1186/s12888-018-1613-2
98. Marcus, Dawn A et al. “Impact of animal-assisted therapy for outpatients with fibromyalgia.” Pain medicine (Malden, Mass.) vol. 14,1 (2013): 43-51. doi:10.1111/j.1526-4637.2012.01522.x
99. Chen, Xiaofan et al. “Hypnosis intervention for the management of pain perception during cataract surgery.” Journal of pain research vol. 11 1921-1926. 20 Sep. 2018, doi:10.2147/JPR.S174490
100. Hoslin L, Motamed C, Maurice-Szamburski A, Legoupil C, Pons S, Bordenave L. Impact of hypnosis on patient experience after venous access port implantation. AnaesthCrit Care Pain Med. 2019 Mar 1. pii: S2352-5568(18)30482-X. doi: 10.1016/j.accpm.2019.02.013.
101. Chien TJ, Liu CY, Fang CJ. The Effect of Acupuncture in Breast Cancer-Related  Lymphoedema (BCRL): A Systematic Review and Meta-Analysis. Integr Cancer Ther. 2019 Jan-Dec;18:1534735419866910. doi: 10.1177/1534735419866910. Erratum in: Integr Cancer Ther. 2019 Jan-Dec;18:1534735419875326.
102. Panchik D, Masco S, Zinnikas P, Hillriegel B, Lauder T, Suttmann E, Chinchilli V, McBeth M, Hermann W. Effect of Exercise on Breast Cancer-Related Lymphedema: What the Lymphatic Surgeon Needs to Know. J ReconstrMicrosurg. 2019 Jan;35(1):37-45. doi: 10.1055/s-0038-1660832.