J Can Chiropr Assoc 2025 (Aug); 69 (2): 131–144.

Table 2.

Overview of nociplastic pain management strategies

Non-pharmacological management (first line management) Doctor-patient relationship

  • Foster a trusting relationship involving open and honest communication

  • Validate the patient’s experience

  • Provide reassurance and support

  • Set realistic goals, focused on improving function
Patient education

  • Explain nociplastic pain, while avoiding jargon

  • Promote self-care as the foundation to recovery

  • Explain treatment strategies in non-technical language
Lifestyle modifications

  • Physical activity

  • Healthy diet

  • Sleep hygiene

  • Stress management

  • Smoking cessation

  • Continued participation in work and social activities
Psychological therapies

  • Cognitive-behavioral therapy (CBT)

  • Acceptance and commitment therapy (ACT)

  • Mindfulness strategies

  • Pain reprocessing therapy (PRT)
Rehabilitative and integrative therapies

  • Physical therapy

  • Occupational therapy

  • Chiropractic

  • Acupuncture

  • Massage therapy

  • Yoga, Pilates, or Tai Chi
Pharmacological management Centrally acting medications

  • Tricyclic antidepressants (e.g., amitriptyline, cyclobenzaprine)

  • Serotonin-norepinephrine reuptake inhibitors (e.g., duloxetine, venlafaxine, milnacipran)

  • Gabapentinoids (e.g., gabapentin, pregabalin)
Management of complicating factors Comorbidities

  • Depression

  • Anxiety

  • Post-traumatic stress disorder (PTSD)

  • Insomnia

  • Obesity
Psychosocial risk factors

  • Catastrophizing (i.e., concerns about pain)

  • Fear-avoidance beliefs and behaviors

  • Kinesiophobia

  • Withdrawal from, or absence of, social support network

Adapted from Fitzcharles MA, et al.,14 Kaplan CM, et al.,10 and Ablin JN40