There is clear research that shows exercise improves chronic pain conditions. There is probably a component of greater functionality that leads to a greater sense of well-being, but also physical activity is thought to decrease the progression of pain conditions. For example, in studies of low back pain, aquatic exercise was shown to improve chronic back pain, aerobic and strength training has been shown to reduce pain in patients with fibromyalgia, and t'ai chi was helpful in the treatment of osteoarthritis. No matter which regimen is chosen, the evidence is that consistency is the major contributor to decreased pain. Increasingly, daily low impact physical activity is recommended by national guidelines for the management of chronic pain.

Our diet impacts our physical, emotional, and mental well-being, thus it is no surprise that it can affect our experience of pain. Deficiencies in vitamin D and vitamin B12 have been linked with certain neuropathies such as diabetic neuropathy and alcoholic peripheral neuropathy. In patients with autoimmune disease, iron deficiency can be common and worsen chronic pain. There are a few studies that show supplements such as Omega-3 and palmitoylethanolamide (PEA), or vitamin C might improve some forms of pain. While the research on dietary supplements and their effects on pain is still in early stages, they are a relatively safe and accessible method. Nonetheless, it is important to discuss with a doctor the safe dosages because supplement overdoses are possible.

Overall, maintaining a healthy weight and daily physical activity improve pain syndromes. Osteoarthritis, or age-related changes in the joints or bones, is one of the most common causes of chronic pain among adults and is improved with weight loss.

There is a reason that the first step in management of chronic back pain is physical therapy. For most patients, there is an imbalance in posture or musculature that leads to pain in the setting of age-related spine changes. Physical therapy and strength training can improve muscle mechanics, improve functionality, and return to physical activity. Ultimately, it is the increased activity that improves chronic pain.

Studies have shown that decreasing physical activity can actually worsen pain syndromes. It is important to remain as active as possible in the midst of pain flares.

There is an interdependent relationship between stress and pain due to its emotional component. Just as pain can cause stress in an individual, high stress levels can worsen the development of pain. Studies have shown stress level at work is an independent risk factor for the development of neck or shoulder pain⁷. Behavioral therapies that maximize emotional awareness and wellbeing, mindfulness techniques, etc can aid in the treatment of pain flares.

Heat: Topical heat, or heat packs on the skin, may provide relief in several painful conditions, especially for treatment of muscle tension or spasms (e.g., back, neck, menstrual pain), joint stiffness (e.g., osteoarthritis, carpal tunnel syndrome), and postoperative pain. Heat works by increasing tissue temperature and stimulating blood flow. 

Cold: Cold works for pain by producing partial or even complete numbness. Topical application of cold, or placing a cold pack on the skin, may also provide benefit for muscle spasms (e.g., back pain, aching muscles) and joint stiffness (e.g., rheumatoid arthritis). It is also recommended for migraine headaches, pain in acute trauma, inflammation, and surgical incision pain.