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Chronic Pain: Non-Pharmacological Treatments and Rehabilitation Strategies

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Rehabilitation".

Deadline for manuscript submissions: 30 December 2025 | Viewed by 7645

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Special Issue Editor

Dr. Matteo Ponzano

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Guest Editor

Division of Health, Kinesiology and Sport Studies, Wayne State University, Detroit, MI 48208, USA
Interests: exercise; health behavior change; pain; disability; public health

Special Issue Information

Dear Colleagues,

This Special Issue aims to collect the latest developments and cutting-edge research on the management of chronic pain. Musculoskeletal and neuropathic pain affect many people across different populations regardless of its etiology. Pharmacological therapies commonly represent the first line of treatment, but they are not always effective. This Special Issue will focus on the latest research on different non-pharmacological strategies to manage chronic pain and reduce its negative impact on both physical and mental health. Interventions of interest include but are not limited to exercise, physical therapy, health behavior change and cognitive behavioral therapies, administered alone or combined with pharmacotherapy. We accept submissions of interventions studies, reviews, and qualitative studies that explore patients and clinicians’ perspectives on the non-pharmacological strategies to manage chronic pain. The goal of this Special Issue is to increase awareness of the options for the non-pharmacological management of chronic pain and highlight the existing gaps and future research directions.

Dr. Matteo Ponzano
Guest Editor

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Keywords

pain
neuropathies
musculoskeletal health
biopsychosocial management
physical therapy
cognitive behavioral therapies

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Published Papers (5 papers)

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13 pages, 261 KB

Open AccessArticle

Musculoskeletal Pain Among University Students and Its Correlations with Risk Factors: A Cross-Sectional Study

by Sultan Ayyadah Alanazi and Faizan Zaffar Kashoo

J. Clin. Med. 2025, 14(17), 6076; https://doi.org/10.3390/jcm14176076 - 28 Aug 2025

Viewed by 799

Abstract

Background: Several studies have examined the prevalence of musculoskeletal pain (MSP) among university students internationally. We aimed to assess the prevalence, pattern, and potential risk factors for MSP among Majmaah University students in Saudi Arabia. Methods: A cross-sectional questionnaire was administered to students from different faculties at Majmaah University. We collected data via the validated Arabic versions of the Standardized Nordic Musculoskeletal Questionnaire, the International Physical Activity Questionnaire, and the Perceived Stress Scale. Bivariate and multivariate logistic regression analyses were performed to explore associations between MSP and demographic, ergonomic, lifestyle, and psychosocial variables. Results: A total of 257 students (n = 195, 75.9% female; n = 62, 24.1% male) were included in this study. The 12-month prevalence of MSP was 225 (87.5%), with the lower back (n = 119, 46.3%) and neck (n = 113, 44.0%) regions being the most affected. Compared with male students, female students reported a higher MSP prevalence (90.3% vs. 79.0%, p = 0.035). The multivariable model was significant (likelihood-ratio χ² = 26.042, df = 7, p < 0.001), accounted for Nagelkerke R² = 0.182 of variance, and showed good calibration (Hosmer–Lemeshow χ² = 8.505, df = 8, p = 0.386). Perceived stress was the only independent predictor of 12-month MSP (β = 0.084, adjusted OR = 1.087, 95% CI 1.034–1.143, Wald χ² = 10.732, p = 0.001), while sex, smoking, academic workload, and sleep duration were non-significant (all p > 0.127). Conclusions: MSP appears to be prevalent among Majmaah University students, with psychological stress emerging as a key independent risk factor. Preventive strategies should include stress management prioritization and ergonomic and physical activity education to support university student well-being. Full article

(This article belongs to the Special Issue Chronic Pain: Non-Pharmacological Treatments and Rehabilitation Strategies)

22 pages, 533 KB

Open AccessArticle

Exploring Emotional Conflicts and Pain Experience in Patients with Non-Specific Chronic Neck Pain: A Qualitative Study

by Yolanda Pérez-Martín, Milagros Pérez-Muñoz, Beatriz Martín-Castro, Susana Nunez-Nagy, Belén Díaz-Pulido and Isabel Rodríguez-Costa

J. Clin. Med. 2025, 14(13), 4748; https://doi.org/10.3390/jcm14134748 - 4 Jul 2025

Viewed by 685

Abstract

Background/Objective: Non-specific chronic neck pain (CNP) greatly affects the social dynamics, the work performance, and the personal independence of patients. Research emphasizes the significant role of sociological factors, psychological stress, and emotional conflicts in the development, regulation, and endurance of chronic pain. This study aims to explore the influence of emotional conflicts on pain experience among CNP patients, drawing from their experiences. Methods: A phenomenological investigation was conducted, grounded in Heideggerian philosophy, involving CNP patients and healthcare professionals in Madrid, Spain. Participants were recruited from Primary Health Care centers. Data collection methods included semi-structured in-depth interviews, focus groups with patients, focus groups with healthcare providers, participant observation, and reflective diaries. Hermeneutic phenomenology guided the data interpretation. Thematic analysis was applied to transcribed audio recordings. Results: This study included 12 patients with CNP who participated in two in-depth interviews conducted at different time points—before and after receiving physiotherapy treatment. Additionally, 23 CNP patients took part in four focus groups, and 46 healthcare professionals (including physicians, nurses, and physiotherapists) participated in three focus groups. A hermeneutic analysis revealed the following three main categories: “Self-concept and pain experience”, “Daily life obligations and pain perception”, and “Emotional conflicts related to CNP”. Patients described themselves as nervous, having communication difficulties, and often prioritizing family or work tasks, leading to stress. They indicated that their interpersonal conflicts with close relations intensified their perceived pain in the neck, head, shoulders, and arms. Conclusions: From the perspective of the participants in this study, interpersonal and emotional conflicts appear to influence their perception of CNP. Full article

(This article belongs to the Special Issue Chronic Pain: Non-Pharmacological Treatments and Rehabilitation Strategies)

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17 pages, 454 KB

Open AccessArticle

Keeping It Simple—Pain Science Education for Patients with Chronic Pain Referred to Community-Based Rehabilitation: Translation, Adaptation, and Clinical Feasibility Testing of PNE4Adults

by Bettina Eiger, Michael Skovdal Rathleff, Kelly Ickmans, Emma Rheel and Christian Lund Straszek

J. Clin. Med. 2025, 14(3), 771; https://doi.org/10.3390/jcm14030771 - 24 Jan 2025

Viewed by 1659

Abstract

Background/Objectives: Pain science education accommodating low health literacy is needed for people with chronic pain. The purpose of this study was to translate PNE4Kids, contextually adapt it into PNE4Adults, and test the feasibility of the newly developed pain science education program (PNE4Adults) for adult patients with chronic musculoskeletal pain in the municipality. Methods: A three-step approach was used to (1) translate PNE4Kids into Danish, (2) adapt to age and context (PNE4Adults), and (3) test the feasibility. (1) Translation was performed by a native Dane fluent in Dutch. (2) Two think-aloud group sessions were held, with therapists and end users. (3) Feasibility was tested amongst twenty adult patients with chronic musculoskeletal pain consecutively referred for rehabilitation in the municipality. The a priori success criteria were determined to be 70% acceptability and 70% understandability. Prior to inclusion of the first patient, the study was pre-registered on clinicaltrial.gov [NCT05140031]. Results: Translation was successfully performed. Both the therapist and end users found the program easy to grasp, the simplicity and interactive nature of the program ingenious, and the program to be well suited to an adult population. All patients (100%), across health literacy levels, found PNE4Adults comprehensible and acceptable. Conclusions: The aims were successfully met. Progression to a full trial is warranted and is underway. Full article

(This article belongs to the Special Issue Chronic Pain: Non-Pharmacological Treatments and Rehabilitation Strategies)

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24 pages, 3412 KB

Open AccessArticle

Effects of Different Transcranial Direct Current Stimulation Intensities over Dorsolateral Prefrontal Cortex on Brain Electrical Activity and Heart Rate Variability in Healthy and Fibromyalgia Women: A Randomized Crossover Trial

by Mari Carmen Gomez-Alvaro, Narcis Gusi, Ricardo Cano-Plasencia, Juan Luis Leon-Llamas, Alvaro Murillo-Garcia, Maria Melo-Alonso and Santos Villafaina

J. Clin. Med. 2024, 13(24), 7526; https://doi.org/10.3390/jcm13247526 - 11 Dec 2024

Viewed by 1926

Abstract

People with fibromyalgia (FM) exhibit alterations in brain electrical activity and autonomic modulation compared to healthy individuals. Objectives: This study aimed to investigate transcranial direct current stimulation (tDCS) effects on brain electrocortical activity and heart rate variability (HRV), specifically targeting the dorsolateral prefrontal cortex in both healthy controls (HC) and FM groups, to identify potential differences in the responses between these groups, and to compare the effectiveness of two distinct tDCS intensities (1 mA and 2 mA) against a sham condition. Methods: Electroencephalography and electrocardiogram signals were recorded pre- and post-tDCS intervention. All participants underwent the three conditions (sham, 1 mA, and 2 mA) over three separate weeks, randomized in order. Results: No statistically significant baseline differences were found in the investigated HRV variables. In the FM group, 1 mA tDCS induced significant increases in LF, LF/HF, mean HR, SDNN, RMSSD, total power, SD1, SD2, and SampEn, and a decrease in HF, suggesting a shift toward sympathetic dominance. Additionally, 2 mA significantly increased SampEn compared to sham and 1 mA. In the HC group, sham increased DFA1 compared to 1 mA, and 2 mA induced smaller changes in SampEn relative to sham and 1 mA. No significant differences were found between FM and HC groups for any tDCS intensity. Conclusions: The effects of dlPFC-tDCS on HRV are intensity- and group-dependent, with the FM group exhibiting more pronounced changes at 1 mA and 2 mA. These findings emphasize the need for individualized stimulation protocols, given the variability in responses across groups and intensities. Full article

(This article belongs to the Special Issue Chronic Pain: Non-Pharmacological Treatments and Rehabilitation Strategies)

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23 pages, 3060 KB

Open AccessSystematic Review

Effects of Virtual Reality-Based Interventions on Pain Catastrophizing in People with Chronic Pain: A Systematic Review and Meta-Analysis

by Claudio Carvajal-Parodi, Pedro O. Rossel, Alejandra Rodríguez-Alvarado, Francisco Guede-Rojas and Jesús G. Ponce-González

J. Clin. Med. 2025, 14(11), 3782; https://doi.org/10.3390/jcm14113782 - 28 May 2025

Viewed by 1692

Abstract

Background: Chronic pain affects millions worldwide, influenced by biological, psychological, and social factors. Catastrophizing predicts chronic pain outcomes, increased pain intensity, and worsening recovery. Virtual reality (VR) interventions offer innovative pain management strategies, but their effects on catastrophizing remain unclear. Methods: This systematic review and meta-analysis followed the PRISMA guidelines. Studies involving adults with chronic musculoskeletal pain, VR-based interventions, and randomized controlled trials were included. The primary outcome was pain catastrophizing. Searches were conducted in PubMed, CINAHL, Scopus, WoS, and PEDro until May 2025. The risk of bias was assessed using Cochrane RoB-2. Meta-analysis calculated effect sizes using mean differences (MD) and standardized mean differences (SMD) with fixed and randomized-effects models. Results: Of 306 records, 244 were screened, 19 underwent full-text review, and two additional studies were identified via Google Scholar. Nine studies were included, eight of which were meta-analyzed. The interventions included eight immersive and one non-immersive VR studies, lasting 3 to 12 weeks. A small but statistically significant effect was found when comparing VR-based interventions with controls (SMD = −0.26 [−0.48; −0.04]). Psycho-cognitive VR-based interventions had a significant effect (SMD = −0.32 [−0.56; −0.09]), while exercise-based VR did not (MD = −0.11 [−4.36; 4.14]). Immersive VR showed a small but significant effect when compared to non-intervention or sham controls (SMD = −0.37 [−0.75; −0.00]). However, when compared to all types of comparators, the effect was not statistically significant (SMD = −0.25 [−0.51 to −0.00]). Heterogeneity was moderate and not significant (p > 0.05). Conclusions: VR-based interventions, particularly immersive with psycho-cognitive approaches, show potential in reducing pain catastrophizing. Future randomized trials are needed to elucidate VR’s efficacy in managing pain catastrophizing. Full article

(This article belongs to the Special Issue Chronic Pain: Non-Pharmacological Treatments and Rehabilitation Strategies)

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