Chronic Pain: What You Need To Know

February 26, 2023 Joe Brady

The National Center for Complementary and Integrative Health (NIH) has created an updated fact sheet on chronic pain and complementary health approaches to include new scientific evidence. 

Chronic pain (pain that lasts for a long time) is a very common problem. National survey data from 2019 showed that about 20 percent of U.S. adults had chronic pain. It is more common in older people than younger ones and in those from rural areas compared to those from urban areas. Military veterans are another group at increased risk for chronic pain. 

The scientific evidence suggests that some complementary health approaches, such as acupuncture, hypnosis, massage, mindfulness meditation, music-based interventions, spinal manipulation, tai chi, qigong, and yoga, may help people manage chronic pain.

What’s the Bottom Line?

How much do we know about the effectiveness of complementary health approaches for chronic pain?

  • A growing body of evidence suggests that some complementary approaches, such as acupuncture, hypnosis, massage, mindfulness meditation, music-based interventions, spinal manipulation, tai chi, qigong, and yoga, may help to manage some painful conditions.

For more information go to the fact sheet or read on

What Is Chronic Pain and Why Is It Important?

Chronic pain is pain that lasts more than several months (variously defined as 3 to 6 months, but longer than “normal healing”). It’s a very common problem. Results from the 2019 National Health Interview Survey (NHIS) show that:

  • About 20.4 percent of U.S adults had chronic pain (defined as pain on most days or every day in the past 3 months).
  • About 7.4 percent of U.S. adults had high-impact chronic pain (defined as chronic pain that limited their life or work activities on most days or every day for the past 3 months).

What the Science Says About Complementary Health Approaches for Chronic Pain

The scientific evidence suggests that some complementary health approaches may help people manage chronic pain. 

A comprehensive description of scientific research on all the complementary approaches that have been studied for chronic pain is beyond the scope of this fact sheet. This section highlights the research status of some approaches used for common kinds of pain.

Chronic Pain in General

Some recent research has looked at the effects of complementary approaches on chronic pain in general rather than on specific painful conditions. 

  • A 2017 review looked at complementary approaches with the opioid crisis in mind, to see which ones might be helpful for relieving chronic pain and reducing the need for opioid therapy to manage pain. There was evidence that acupuncture, yoga, relaxation techniques, tai chi, massage, and osteopathic or spinal manipulation may have some benefit for chronic pain, but only for acupuncture was their evidence that the technique could reduce a patient’s need for opioids.
  • Products containing substances from cannabis (marijuana), which typically include both tetrahydrocannabinol (THC) and cannabidiol (CBD), have been tested for their effects on chronic pain in short-term studies. Oral products with high THC/CBD ratios and sublingual (under-the-tongue) products with roughly equal amounts of THC and CBD may reduce chronic pain in the short term but may also have side effects including dizziness and sleepiness. Not much is known about other cannabinoid formulations or the effects of long-term use.
  • Hypnosis may reduce chronic pain if patients participate in enough sessions (at least eight), according to a few studies.
  • Studies on chronic pain showed that mindfulness-based interventions and cognitive behavioral therapy are both helpful in decreasing pain intensity and improving physical functioning, with no important difference between the two approaches. Cognitive behavioral therapy is the prevailing psychological intervention for chronic pain.
  • Studies have shown that music-based interventions can reduce self-reported pain and depression symptoms in people with chronic pain. Effects were greater when the patient, rather than the researcher, chose the music.

Back and Neck Pain

  • A large review of individual data from multiple studies showed that acupuncture was more effective than either no treatment or sham (fake) acupuncture for back or neck pain. The difference between acupuncture and no treatment was greater than the difference between acupuncture and sham acupuncture. A 2017 clinical practice guideline (guidance for health care providers) from the American College of Physicians (ACP) included acupuncture among the nondrug treatment options for the management of both acute and chronic low-back pain.
  • Evaluations of massage therapy for low-back pain have found weak evidence that it may be helpful. The ACP guideline recommends massage as an option for acute low-back pain, based on low-quality evidence, but does not recommend massage for chronic low-back pain. Massage therapy may be helpful for neck pain, but the benefits may only last for a short time.
  • Studies show that mindfulness-based stress reduction is associated with a small improvement in chronic low-back pain. The ACP guideline recommends mindfulness-based stress reduction as an option for chronic low-back pain, based on moderate-quality evidence.
  • Progressive muscle relaxation is one of several nondrug approaches suggested as the first step in treating chronic low-back pain in the ACP treatment guideline. There is evidence that this technique can lead to moderate improvements in low-back pain and back function.
  • Biofeedback may moderately improve low-back pain. It is one of the nondrug approaches suggested as the first step in treating chronic low-back pain in the ACP treatment guideline.
  • The 2017 ACP guideline includes spinal manipulation as an option for treating both acute and chronic low-back pain. There is low-to-moderate quality evidence that spinal manipulation can reduce pain and improve function in people with chronic nonspecific neck pain.
  • Tai chi, either alone or in addition to physical therapy, may decrease the intensity of pain and improve everyday function in people with low-back pain. The ACP guideline includes tai chi as an option for the treatment of chronic low-back pain.
  • Studies of yoga for low-back pain have shown yoga to be helpful in both the short-term (1 to just under 6 months) and intermediate-term (6 to just under 12 months). The effects of yoga are similar to those of other types of exercise. The 2017 ACP guideline included yoga as an option for the initial treatment of chronic but not acute low-back pain. Practicing yoga has been shown to reduce both the intensity of neck pain and disability related to neck pain.
  • Several types of herbal preparations have been evaluated for low-back pain. There is evidence that topical products containing the herb cayenne, such as creams and plasters, can reduce pain. Topical products that contain two other herbs, comfrey and lavender essential oil, and two herbs used orally, white willow bark and devil’s claw, may also be helpful, but the evidence for these herbs is not as strong as that for cayenne.

For more information, see the National Center for Complementary and Integrative Health (NCCIH) fact sheet on low-back pain

Key References


NCCIH thanks David Shurtleff, Ph.D., NCCIH, for his review of the 2023 update of this publication.

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.

Last Updated: January 2023