[Non-pharmacological treatment of musculoskeletal pain].

Non-pharmacological treatment is important in management of musculoskeletal pain. Therapeutic modalities such as superficial heat or cold agents, therapeutic ultrasound, laser and/or electric currents have been used extensively for various musculoskeletal diseases and conditions. They have many advantages over other pain-modifying interventions. However, relatively few high-quality research studies have been performed to elucidate mechanisms underlying their analgesic properties and there are insufficient controlled efficacy findings supporting the use of various physical agents in the management of pain conditions. The cornerstones of non-pharmacological management of chronic musculoskeletal pain are education, exercise and cognitive-behavioural therapy, ideally in combination through the multidisciplinary treatments programs based on biopsychosocial model of pain. From the available evidence it can not be concluded whether an indivudual patient with chronic pain should be referred to cognitive-behavioural treatment programs or active conservative treatment. There is a need for further studies to clarify the type and manner of non-pharmacological treatments, their intensity, duration and progression according to patient-specific outcomes.