Pain Management and Non-Opioid Strategies for Patients

Discover effective pain management with non-opioid strategies that prioritize your health and well-being without the risks of opioids.

Abstract

I am Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST. In this educational post, I guide you through modern, evidence-based strategies for understanding and managing chronic, neuropathic, and myofascial pain, with an emphasis on non-opioid and complementary therapies—including regenerative Platelet-Rich Plasma (PRP) therapy. Drawing from leading research and clinical guidelines, I explain how accurate pain classification and comprehensive biopsychosocial assessment drive precise, mechanism-based treatment selection. I present how our multidisciplinary team at Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic) in El Paso, Texas integrates medical oversight by Dr. Maria Guadalupe Cardenas, MD (Board Certified in Internal Medicine; NPI #1164426749; Texas MD License #J2933), with integrative chiropractic care, functional medicine, rehabilitation, personal injury services, and advanced regenerative interventions such as ultrasound-guided PRP injections. Together we deploy precision diagnostics, targeted non-opioid pharmacology, movement-based care, PRP therapy for tissue healing and pain modulation, and psychosocial support to improve function, reduce opioid exposure, and enhance quality of life. You will learn the pathophysiology of pain (nociceptive visceral, somatic, and neuropathic), common post-injury and post-surgical outcomes, practical assessment tools (DN4, ORT), and stepwise protocols that explain why each intervention—including chiropractic adjustments and PRP—is used, how it works, and the clinical reasoning behind individualized, integrative care.
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My Path in Integrative Pain Care: Less Opioids, More Integration and Regeneration

As a clinician working at the intersection of chiropractic, advanced practice nursing, and functional medicine, I have spent over a decade managing complex pain presentations. Over the years, my practice has evolved toward non-opioid, complementary, and regenerative strategies in chronic pain management. This shift reflects strong evidence that targeted multimodal care—including PRP therapy—can reduce opioid reliance while improving patient-reported outcomes, daily function, and safety.

• Chronic pain is common and multifactorial; it affects a substantial portion of adults and often persists beyond acute injury or surgery.
• Persistent pain frequently disrupts sleep, work, relationships, and mental health.
• My responsibility is to guide patients using the best available science, careful diagnostics, and a unified, mechanism-driven team approach that now incorporates regenerative options like PRP for tissue-level repair.

Clinical observations from my ongoing practice and case reflections are shared on my HealthCoach Clinic and LinkedIn profiles:

• healthcoach.clinic/
• www.linkedin.com/in/dralexjimenez/

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Our Multidisciplinary Model: Medical Direction with Integrative Chiropractic Care and PRP Therapy

At Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic) in El Paso, Texas, we operate a coordinated, multidisciplinary model.

• Medical leadership and oversight: Dr. Maria Guadalupe Cardenas, MD, Board Certified in Internal Medicine (NPI #1164426749; Texas MD License #J2933), serves as our Medical Director and Collaborative Physician. With over 40 years of experience, Dr. Cardenas provides complex medical oversight, pharmacology stewardship, risk stratification, and coordination across specialties.
• Integrative chiropractic, functional medicine, and regenerative care:e I deliver conservative musculoskeletal and neurofunctional strategies, spine and joint optimization, and functional medicine protocols tailored to inflammation, neuropathic sensitization, metabolic resilience, and recovery capacity. We also offer ultrasound-guided PRP therapy to promote tissue healing in tendons, ligaments, joints, and soft tissues contributing to chronic pain.
• Rehabilitation and personal injury services: We provide graded exercise, neuromuscular re-education, proprioceptive training, and trauma-informed care—critical after injury or surgery, or during deconditioning.
• Coordinated care pathways: Joint medical-chiropractic visits, shared decision-making, safety checks (labs, imaging, risk tools), and regenerative interventions ensure the right therapy is delivered at the right time, with clear boundaries around contraindicated regions.

This integrated MD-DC collaboration, enhanced by PRP therapy, ensures appropriate use of non-opioid adjuvants, timely interventional referrals when needed, and safe opioid stewardship when opioids are warranted.
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Understanding Pain: Mechanisms That Guide Treatment

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is not just a tissue signal; it is a biopsychosocial phenomenon shaped by nervous system processing, immune signaling, cognition, and context.

• Nociceptive pain mechanisms: Visceral nociception: Achy, gnawing, diffuse pain from organ involvement due to stretch, inflammation, adhesions, or ischemia. Somatic nociception (soft tissue/bone): Localized deep pain aggravated by movement. Trauma, fractures, osteoarthritis, or repetitive strain can trigger local inflammation, tissue damage, and periosteal or capsular sensitization.
• Neuropathic pain mechanisms:s Damage to peripheral nerves, dorsal root ganglia, or central pathways via trauma, surgery, compression (e.g., disc herniation, entrapment), or metabolic factors produces burning, tingling, electric-shock sensations. This reflects axonal injury, ion channel upregulation, microglial activation, cytokine signaling, and central sensitization.
• Chronic pain neuroplasticity: Acute pain involves inflammatory mediators and tissue damage. Chronic pain (?90 days) involves synaptic potentiation in the spinal dorsal horn, disinhibition, increased descending facilitation, and psychological factors. These changes can reduce opioid effectiveness and increase adverse effects.

Why classification matters: Treatment is mechanism-dependent. Somatic nociceptive pain may respond to NSAIDs, physical modalities, and PRP for tissue repair, whereas neuropathic pain requires antineuropathic agents (SNRIs, gabapentinoids, TCAs) and nerve-focused rehabilitation. Misclassification leads to undertreatment or opioid overreliance.

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Prevalence and the Burden of Persistent Pain

Chronic pain affects approximately 24.3% of U.S. adults, with 8.5% experiencing high-impact chronic pain that frequently limits life or work activities (CDC, 2023 data). Persistent pain commonly follows injuries, surgeries, and trauma, affecting sleep, function, mood, and relationships.

Clinical observations: Patients often present months to years after injury or surgery with myofascial trigger points, scar adhesions, altered movement patterns, and sensory changes, compounded by sleep disruption and anxiety. Addressing these contributors early reduces long-term pain trajectories and improves return to work and daily life.
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The Biopsychosocial Model: Whole-Person Care Improves Outcomes

Pain intensity and disability reflect the interplay of physical, psychological, social, and spiritual factors.

• Physical: Tissue injury, inflammation, nerve irritation, weakness, stiffness.
• Psychological: Catastrophizing, depression, anxiety, trauma history—these amplify central sensitization.
• Social and spiritual: Caregiver resources, cultural beliefs, socioeconomic stress, existential distress.

Our approach: Screen for psychological distress, social disruptions, and existential concerns at intake. Integrate psychosocial support, psychotherapy when indicated, and support groups. Build therapeutic alliance through clear goal-setting aligned with realistic functional milestones.

Rationale: Treating nociception without addressing cognitive-affective components is insufficient. By reducing fear, improving coping, and restoring agency, patients often report lower pain with fewer medications.

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Comprehensive Assessment: Precision Guides Therapy

A thorough assessment combines patient report, clinical exam, and targeted diagnostics.

• History and descriptors: Visceral—deep, gnawing; Somatic—deep ache, worse with movement; Neuropathic—burning, tingling, shocks.
• Chronicity and trajectory: Differentiate acute post-injury or postoperative pain from persistent pain beyond 90 days that warrants non-opioid strategies, rehabilitation, and regenerative options.
• Function-focused outcomes: Measure impact on sleep, ADLs, ambulation, therapy tolerance, and mood.
• Risk tools: Opioid Risk Tool (ORT) for baseline risk; DN4 for neuropathic features.
• Special populations: Use pictorial scales for children or cognitively impaired patients.
• Cultural competence: Recognize cultural norms influencing pain expression.

Rationale: Mechanism-informed diagnosis and risk-adjusted planning prevent opioid overuse and tailor effective regimens, including PRP candidacy assessment.

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When and Why Opioids Are Used: Clear Indications and Stewardship

While our goal is less opioids,” certain severe acute or persistent pain scenarios warrant their use under strict oversight.

• Severe acute injury or postoperative nociceptive pain: May require short-term opioids for relief; combine with non-opioid adjuvants, regional techniques, and early rehabilitation.
• Breakthrough pain in select chronic cases: Short-acting agents for episodic flares in carefully monitored patients.

Safety rationale: Long-term opioid use can induce hypogonadism, osteopenia, cognitive/mood changes, and opioid-induced hyperalgesia. We limit dose and duration, monitor closely, and prioritize tapering with non-opioid and regenerative alternatives as the driver is controlled.

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Postoperative and Post-Traumatic Pain: Preventing New Persistent Opioid Use

A notable subset of opioid-naïve patients develop new persistent opioid use after surgery or significant trauma, with risk influenced by procedure complexity, preoperative pain, and psychological factors. Studies show persistent postsurgical use– 50%+ of cases depending on the procedure- and prolonged opioid use in a meaningful percentage of patients.

Clinical implications: Initiate non-opioid analgesia early (scheduled acetaminophen, NSAIDs when safe, regional pathways, local infiltration). Educate on timelines: acute pain often improves in days to weeks; beyond 90 days requires chronic pain strategies. Begin rehabilitation early to prevent compensatory patterns and myofascial pain. Monitor bone and endocrine health with prolonged exposure.

Our integrated post-op/injury model:

• Medical oversight by Dr. Cardenas ensures safe pharmacology and comorbidity management.
• Chiropractic care: Restore mobility near but not over surgical or injured sites; address adjacent segment dysfunction, thoracic expansion, diaphragmatic breathing, and gentle joint mobilization to reduce guarding.
• Functional medicine: Support inflammation modulation, wound healing nutrition, sleep optimization, and gut recovery.
• Regenerative PRP: Considered for suitable candidates to enhance soft tissue and joint healing, potentially accelerating recovery and reducing reliance on medications.

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Non-Opioid Pharmacologic Strategies: Mechanism-Targeted Choices

We employ adjuvant analgesics based on mechanism and evidence.

• Neuropathic pain agents: SNRIs (duloxetine): Enhance descending inhibition; effective for neuropathic and comorbid musculoskeletal pain, with mood benefits. Gabapentinoids (gabapentin, pregabalin): Reduce neuronal excitability; careful titration and renal adjustment required. TCAs (nortriptyline, amitriptyline): Useful for sleep and neuropathic pain; monitor anticholinergic burden and QTc.
• Topical agents: ts Lidocaine 5% patches for focal neuropathic pain; capsaicin for desensitization in some cases.
• Anti-inflammatory agents NSAIDs/COX-2 inhibitors for somatic pain flares; manage risks under medical oversight.
• Sleep and mood support: Target insomnia and anxiety to reduce central amplification with agents that minimize cognitive impairment or dependence.

Rationale: Targeting ion channels, neurotransmitter systems, and inflammatory pathways aligned with pain mechanism yields analgesia with lower risk than long-term opioids. We emphasize careful titration, monitoring, and, when feasible, deprescribing.

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Regenerative PRP Therapy: Enhancing Healing in Pain Management

PRP therapy harnesses the patient’s own blood, concentrated to deliver growth factors (e.g., PDGF, TGF-?, VEGF) that promote tissue repair, reduce inflammation, and modulate pain. It is particularly valuable for chronic musculoskeletal and soft tissue pain generators that often coexist with or perpetuate neuropathic and myofascial components.

Recent systematic reviews and meta-analyses of randomized controlled trials demonstrate that PRP provides statistically significant and sustained pain reduction in chronic noncancer pain conditions, often outperforming corticosteroids and hyaluronic acid injections, with stronger effects at follow-up> 3 months. Benefits are notable in knee osteoarthritis and rotator cuff tendinopathy/tears. Emerging data also suggest promise as a non-surgical option for certain peripheral neuropathic and radicular pain presentations.

In our practice: Ultrasound-guided PRP is integrated for appropriate candidates with tendinopathy, ligamentous injuries, osteoarthritis, or post-traumatic soft tissue damage. It supports healing at the tissue level while chiropractic care optimizes biomechanics and loading to protect and enhance regenerative outcomes. Medical clearance by Dr. Cardenas ensures safety (screening for infection, bleeding disorders, and other contraindications).

Rationale: PRP addresses the biological healing deficit in chronic injuries, offering a bridge between conservative care and more invasive options while aligning with our goal of reducing opioid exposure and restoring function.

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Integrative Chiropractic Care: Movement, Modulation, and Synergy with Regenerative Therapies

Chiropractic care, integrated with medical oversight and PRP, offers safe, graded, and targeted interventions.

• Spinal and joint mobilization: Gentle, region-appropriate techniques to restore biomechanics; mechanotransduction improves perfusion and reduces guarding.
• Myofascial release and trigger point therapy: Address secondary generators from compensatory postures, scar tissue, and altered movement.
• Neuromuscular re-education and graded exercise: Retrain patterns, improve proprioception, and build capacity.
• Breathing and rib mechanics: Thoracic mobility and diaphragmatic breathing reduce sympathetic overdrive and aid recovery.

Synergy with PRP: Post-PRP rehabilitation emphasizes protected loading, alignment correction, and progressive strengthening to maximize healing and prevent re-injury or compensatory strain. Chiropractic adjustments near (but not directly over) recent injection sites help maintain joint mobility and optimal force distribution.

Safety and coordination: Dr. Cardenas reviews imaging/labs to clear regions, identifies red flags, and guides timing. We maintain strict boundaries around acute injury or post-procedural sites.

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Functional Medicine Integration: Inflammation, Recovery, and Resilience

Chronic pain is amplified by systemic physiology. Functional medicine addresses upstream drivers.

• Inflammation modulation: Nutrition emphasizing omega-3 fatty acids, polyphenols, and adequate protein supports repair.
• Mitochondrial and micronutrient support: Individualized (magnesium, B vitamins, etc.) to comorbidities.
• Sleep architecture and gut-brain axis: Optimize sleep and address dysbiosis to lower systemic inflammation and improve pain perception and mood.

Rationale: Integrating nutrition, sleep, and metabolic support with pharmacology, chiropractic, and PRP creates synergistic reductions in pain and improvements in energy and adherence.

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Psychosocial and Cultural Care: Reducing Amplification, Building Capacity

Early screening for depression, anxiety, and distress prevents disproportionate pain escalation. Cognitive-behavioral strategies, mindfulness, and paced activity enhance self-efficacy. Cultural alignment improves trust and outcomes.

Rationale: Psychological and social dimensions modulate pain experience; addressing them is central to durable relief.

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Persistent Post-Surgical Traumatic Pain Syndromes: A Common Challenge

Persistent pain after surgery or trauma is common and multifactorial, often involving nerve irritation or injury (e.g., intercostal neuralgia after chest wall trauma or procedures), scar adhesions, and secondary biomechanical changes leading to myofascial pain.

Evidence-supported interventions: Topical lidocaine patches and TENS have shown benefits for focal post-procedural or chest wall pain in various contexts.

Integrative plan:

• Adjuvant analgesics guided by mechanism and DN4 screening.
• Topical analgesia and TENS for daily modulation.
• Chiropractic rib/thoracic mobilization (medically cleared) and diaphragmatic breathing.
• PRP for localized tissue repair or adjacent MSK contributors when imaging and clinical findings support.
• Psychosocial support for catastrophizing and mood.

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Peripheral Neuropathy: Mechanisms and Management in Injury and Chronic Pain

Peripheral neuropathy presents as sensory changes (numbness, tingling, burning, shocks) in stocking-glove or radicular distributions. Common contributors in our population include traumatic nerve stretch or compression (e.g., from accidents, disc herniation, or entrapment), chronic postural/ergonomic stress, metabolic factors (diabetes), and post-surgical irritation.

Risk factors: Older age, obesity, diabetes, prior neuropathy, nutritional deficiencies, and high mechanical stress.

Management:

• Duloxetine and gabapentinoids (with appropriate titration and monitoring).
• Topical lidocaine for focal symptoms.
• Balance, proprioceptive training, and chiropractic care to address gait/postural compensations and reduce secondary nerve compression or strain.
• Emerging evidence supports PRP as a potential adjunct in certain radicular or peripheral neuropathic pain presentations by modulating local inflammation and supporting repair.

Rationale: Matching interventions to mechanisms while addressing coexisting MSK contributors improves outcomes and function.

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Neuropathic Pain Identification: The DN4 Tool and Multimodal Strategy

An accurate neuropathic diagnosis guides the rational use of adjuvants.

• DN4 questionnaire: Ten items (seven symptom descriptors + three sensory tests). Score> 4 supports neuropathic pain diagnosis with good sensitivity/specificity.
• Multimodal therapy: Combine agents at lower doses targeting different pathways. Patient education and close follow-up accelerate safe optimization.
• Anticonvulsants, antidepressants (duloxetine, venlafaxine, TCAs with caution), short-term corticosteroids (when appropriate for acute inflammatory neural pain), and topicals are used as in standard neuropathic protocols.

Rationale: Mechanism-matched therapy improves outcomes and reduces opioid necessity.

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Myofascial Pain Syndrome: Hidden Agony in Chronic Pain and Injury Recovery

Myofascial pain syndrome (MPS) is frequently encountered after injury, surgery, or with chronic postural stress, manifesting as deep aching pain with trigger points in taut muscle bands.

Common patterns: Post-whiplash or neck/shoulder trauma (sternocleidomastoid, trapezius, levator); post-spine or extremity injury/surgery (paraspinal, chest wall, shoulder girdle); desk or repetitive strain patterns.

Risk factors: Trauma/surgery, poor posture/ergonomics, structural imbalances, systemic issues (e.g., vitamin D or iron deficiency, hypothyroidism), psychological stress, and insomnia.

Diagnosis (Travell & Simons framework): Taut band with exquisite tenderness; referred pain reproduction; local twitch response.

Treatment strategy:

• Muscle rehabilitation cornerstone: stretching, posture correction, strengthening, cardiovascular fitness.
• Chiropractic adjustments restore joint mechanics and complement rehab; upper cervical work can reduce suboccipital/trapezius tension.
• Trigger point interventions (dry needling or injections when appropriate) with oncologic/medical safety boundaries observed.
• Adjuncts: Topicals, TENS, modalities (shockwave, laser), kinesio taping; short-term muscle relaxants (avoid benzodiazepines with opioids).
• Self-care: Thera Cane or similar tools for sustained pressure.
• PRP: Considered for refractory enthesopathy or associated tendon/ligament contributors to enhance repair.

Rationale: MPS is a major, often overlooked generator. Integrative physical and regenerative strategies are essential for durable relief.

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Why Less Opioids Works: Neurobiology and Outcomes

Chronic opioid exposure can downregulate endogenous analgesia, induce hyperalgesia, suppress hormones, and impair sleep/cognition. Non-opioid and regenerative strategies engage natural inhibitory systems, reduce peripheral drivers, promote tissue healing (via PRP), and build resilience through movement, metabolic support, and coping skills. Patients gain autonomy and sustained function.
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Collaboration in Practice: Roles, Responsibilities, and Safety

• Dr. Maria Guadalupe Cardenas, MD: Oversees medical safety, diagnostics, pharmacology, comorbidity management, PRP candidacy clearance, and inter-specialty communication.
• Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST: Delivers chiropractic care, functional medicine planning, rehabilitation coordination, patient education, and ultrasound-guided PRP injections; aligns manual therapy and regenerative timing with medical guidance.
• Team wraparound: Psychosocial services, nutrition, and rehabilitation professionals coordinate a unified plan that evolves with the patient’s course.

This structure ensures therapies are appropriate, timely, mechanism-driven, and regenerative where indicated, minimizing opioid use while maximizing functional outcomes.

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Practical Protocols: Stepwise, Mechanism-Guided Care

• Initial visit: Classify pain (nociceptive visceral/somatic, neuropathic, mixed, or myofascial predominant). Evaluate chronicity; screen risks (ORT), distress, cultural factors; apply DN4. Assess for regenerative candidacy (imaging, labs, contraindications). Set functional goals.
• Early interventions: Non-opioid agents aligned with mechanism. Begin chiropractic mobilization in cleared regions; introduce graded exercise and breathing. Activate functional medicine and psychosocial supports. Consider PRP for suitable MSK/soft tissue pain generators.
• Reassess at 2–4 weeks: Adjust dosing/titration; consider interventional referrals or PRP if not already used for refractory focal MSK contributors. If persistent severe nociceptive pain, cautious opioid therapy with exit strategy and monitoring.
• Ongoing care: Track function and quality of life; deprescribe when possible. Maintain close coordination; update imaging/labs as needed. Optimize biomechanics post-PRP to support healing.

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Key Takeaways for Clinicians

• Classify pain mechanism first; treatment follows mechanism.
• Use non-opioid adjuvants early; explain rationale transparently.
• Integrate chiropractic movement care under medical oversight for safe functional gains.
• Consider regenerative PRP therapy for tissue-level healing in appropriate chronic MSK, post-injury, and post-surgical conservative care is insufficient.
• Screen for psychosocial factors—they are essential for success.
• Be patient with titrations and regenerative timelines; educate that good pain control and healing take time.
• In selected scenarios, opioids are appropriate; apply stewardship principles and plan for taper.

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References*

• Ballantyne, J. C., & Mao, J. (2003). Opioid therapy for chronic pain. New England Journal of Medicine.
• Bouhassira, D., et al. (2005). DN4 questionnaire. Pain.
• Calder, P. C. (2013). Omega-3 fatty acids and inflammatory processes. British Journal of Clinical Pharmacology.
• Centers for Disease Control and Prevention. (2022). CDC Clinical Practice Guideline for Prescribing Opioids for Pain.
• Ferreira, G. E., et al. (2023). Antidepressants for pain in adults: Overview of systematic reviews. BMJ.
• Finnerup, N. B., et al. (2015). Pharmacotherapy for neuropathic pain. Lancet Neurology.
• Gatchel, R. J., et al. (2007). Biopsychosocial approach to chronic pain. Psychological Bulletin.
• Kennedy, P. J., et al. (2025). Systematic review of PRP for peripheral neuropathic pain.
• Lawal, O. D., et al. (2020). Prolonged opioid use after surgery. JAMA Network Open.
• Raja, S. N., et al. (2020). Revised IASP definition of pain. Pain.
• Solomon, S. D., et al. (2005). Cardiovascular risk with celecoxib. New England Journal of Medicine.
• Thu, A. C., et al. (2022). PRP in management of chronic low back and radicular pain.
• Travell, J. G., & Simons, D. G. (1999). Myofascial Pain and Dysfunction: The Trigger Point Manual.
• Wang, F., et al. (2025). PRP for treating chronic noncancer pain: Systematic review and meta-analysis. Pain and Therapy.
• Williams, A. C. de C., & Craig, K. D. (2016). Updating the definition of pain. Pain.
• Additional general chronic pain prevalence data from CDC National Health Interview Survey, 2023.

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