A nurse is caring for a client with chronic pain. Which non-pharmacological pain management approach is MOST supported by evidence?

CHRONIC PAIN management has evolved significantly with recognition that pain is complex — involving biological, psychological, and social factors (the biopsychosocial model). EVIDENCE-BASED NON-PHARMACOLOGICAL APPROACHES: COGNITIVE-BEHAVIORAL THERAPY (CBT) for pain: most evidence-based psychological approach; addresses catastrophizing, maladaptive thoughts, pain behaviors; improves functioning and quality of life even when pain intensity doesn't fully resolve; MINDFULNESS-BASED STRESS REDUCTION (MBSR): meditation-based approach; reduces pain-related distress;

Physical therapy and exercise: counterintuitive but movement is generally beneficial for most chronic pain (including low back pain); reduces deconditioning and muscle atrophy.

Heat therapy: increases blood flow, relaxes muscles; for chronic muscle pain; not for acute inflammation; COLD THERAPY (CRYOTHERAPY): reduces inflammation and acute pain; numbs area; for acute injuries or inflammatory conditions; TENS (Transcutaneous Electrical Nerve Stimulation): low-level electrical current modulates pain signals; evidence moderate; useful adjunct.

Massage: reduces muscle tension; improves mood; evidence for some chronic pain types.

Biofeedback: teaches physiological self-regulation.

Acupuncture: evidence for some pain conditions (low back pain, osteoarthritis, headache).

Distraction: music therapy, guided imagery, virtual reality (newer, emerging evidence).

Positioning and assistive devices: proper positioning, orthotic devices for joint pain.

Multimodal analgesia: the current standard of care combines multiple approaches (pharmacological and non-pharmacological) at lower doses to achieve pain control while minimizing side effects of any single approach.

Pn role: teach and implement non-pharmacological measures; assess pain with validated tools (0-10 numeric, FACES, FLACC for children); document pain assessment and response to interventions; advocate for adequate pain management; avoid stigmatizing chronic pain patients.