Chronic Pain

Chronic pain may have a clear original cause, an ongoing cause, or none that can be found, so a medical assessment comes first. Acupuncture, spinal manipulation, massage, yoga and mindfulness show modest, mostly short-term benefits that vary by condition.

When to see a medical doctor first

MedlinePlus lists no general urgent warning signs for chronic pain, but warning signs specific to the type of pain still apply. For example:

• Back pain with unexplained fever, a history of cancer, or pain that wakes you at night needs a prompt visit (MedlinePlus). The NHS also lists unexplained weight loss.
• Back pain with new loss of bladder or bowel control, numbness in the groin or buttocks, or leg weakness that is getting worse needs care right away (MedlinePlus). With new bladder or bowel changes, go to an emergency room rather than waiting for an appointment.
• A sudden, severe headache that reaches full intensity within seconds or minutes needs emergency care right away (AAFP). See our page on migraines.

Pages for back pain, neck pain and sciatica list their own warning signs.

What a medical workup usually checks first

According to MedlinePlus, a doctor takes a history, asks what the pain is like and how it affects daily life, does a physical exam, and orders blood or other tests if needed. Typical first-line care combines medicines, physical therapy, lifestyle changes (sleep, stress, weight and low-impact exercise) and mental health support.

What the evidence says about holistic options

The NCCIH clinical digest on chronic pain (September 2022) says benefits of these approaches are modest and vary by condition.

Therapy	Evidence	Notes
Acupuncture	Mixed/limited	Chronic low back pain: low-to-moderate evidence. Fibromyalgia: better than no treatment, but no different from sham for pain or fatigue.
Chiropractic or spinal manipulation	Mixed/limited	Small improvements in chronic low back pain, from low-to-moderate quality evidence (NCCIH). For neck pain, the NCCIH digest says it may help, though much of the research is low quality. For headaches, including migraine, the digest says it may help, but the evidence is limited.
Massage	Mixed/limited	Evidence for pain is weak and mostly short-term (NCCIH).
Mind-body (yoga, mindfulness)	Mixed/limited	Short-term benefit for low back pain. Mindfulness-based stress reduction showed no benefit for fibromyalgia pain (NCCIH).
Naturopathic or functional medicine	Unconfirmed	No source found.
Supplements	Mixed/limited	The NCCIH digest reports that topical cayenne may help low back pain and fish oil may modestly ease rheumatoid arthritis symptoms. Riboflavin, coenzyme Q10, butterbur and feverfew show early promise for migraine. It raises serious safety concerns about thunder god vine. It gives no overall rating for supplements in chronic pain.

Unconfirmed means we found no source in this review. It is not a verdict either way.

Who people see for chronic pain on this site

• Hands-on care: physical therapists, chiropractors, osteopaths and massage therapists.
• Acupuncture clinics.
• Integrative medicine doctors, who are licensed MDs or DOs.
• Mental health services, since mental health support is part of standard chronic pain care.

In New York, a licensed physical therapist with enough experience can treat without a referral for up to 10 visits or 30 days, whichever comes first (Education Law §6731).

Questions to ask a practitioner

• How do you work out the source of the pain, and what evidence supports the approaches you use?
• Are your recommendations meant to go alongside prescribed medicines and physical therapy, or instead of them?
• What goals and timeline will you use to decide whether a treatment is working?

Last reviewed: October 2026

Sources

• MedlinePlus, Chronic pain (updated 19 June 2025)
• MedlinePlus, Low back pain - acute (reviewed 27 June 2026)
• American Family Physician, Diagnosis and treatment of acute low back pain (February 2012) and Acute headache in adults (September 2022)
• NHS, Back pain (reviewed 5 March 2026)
• NCCIH, Complementary health approaches for chronic pain (clinical digest, September 2022)
• NCCIH, Low back pain tips (page date not confirmed)
• NCCIH, Massage therapy: what you need to know (May 2019)
• NCCIH, Meditation and mindfulness: in depth (June 2022)
• New York Education Law §6731 (physical therapy)