Complementary Approaches to Postoperative Pain Management: A Review of Non-pharmacological Interventions

Abstract

Postoperative pain significantly affects many surgical patients. While opioids are crucial for pain management, they come with unwanted side effects. Alternatives like nonsteroidal anti-inflammatory drugs, N-methyl-d-aspartate (NMDA) receptor antagonists, and regional anesthesia techniques such as nerve blocks are utilized, but these also have limitations. This underscores the need for complementary non-pharmacological interventions to enhance postoperative pain control and reduce opioid dependence. This study aimed to synthesize evidence on the efficacy of nondrug approaches for managing postoperative pain. The study examined the effects of non-pharmacological interventions such as preoperative patient education, mind–body modalities, and physical therapies. Findings suggest that these approaches can reduce pain intensity, decrease opioid consumption, and enhance recovery outcomes. The study also highlighted the pivotal role of healthcare professionals in implementing these strategies. However, it identified workload constraints and insufficient training as barriers to effective utilization in clinical practice. Integrating non-pharmacological interventions into multimodal pain management regimens can improve postoperative pain control and reduce reliance on opioids. Further research is crucial to definitively establish the efficacy of individual interventions and optimize their combined use in clinical practice. Additionally, enhanced training programs for nurses and initiatives to facilitate the implementation of these strategies are necessary for their successful adoption.

Key Summary Points

Postoperative pain management poses a significant challenge, requiring strategies that effectively relieve pain while mitigating opioid-related risks. Additionally, preoperative factors play a crucial role in influencing postoperative pain outcomes.

This review synthesizes evidence on the efficacy of non-pharmacological interventions, such as preoperative education, physical therapy, and psychological support, in enhancing postoperative pain management within multimodal analgesia frameworks.

Findings indicate that non-pharmacological approaches can significantly reduce pain intensity and opioid consumption, highlighting their potential as effective complements to traditional pain management methods.

These interventions are not only cost-effective and associated with fewer side effects, but they also promote faster recovery and improved patient satisfaction, underscoring the importance of integrating them into standard care practices.

The successful implementation of nondrug pain management strategies relies heavily on the training and support of healthcare professionals, necessitating the development of targeted educational programs and resources.

Future research should focus on identifying the most effective non-pharmacological interventions for diverse patient populations, evaluating their cost-effectiveness compared to traditional pain modalities, and establishing comprehensive guidelines for their integration into postoperative care protocols. While our current study briefly explores transcutaneous electrical nerve stimulation (TENS) therapy, we plan to delve deeper into its application and efficacy in various postoperative contexts in future research.

Introduction

Annually, 100 million surgical procedures are conducted in the United States, with around 60% being outpatient procedures [1]. Over 80% of surgical patients experience postoperative pain, and 39% experience "severe" to "extreme" postoperative pain [1, 2]. Pain control is crucial for patient satisfaction and recovery, but it requires balancing risks and benefits. While pain medication is important, excessive use, particularly opioids, can lead to dependence [3]. A study found that 72% of surgery patients on pain pumps became overly sedated within the first 12 h [2]. Opioid challenges are a significant public health concern, with over 10 million Americans misusing prescription opioids in 2018, contributing to the opioid epidemic [4]. Pain management after surgery, especially for older adults undergoing hip surgery, can be complex. They are more susceptible to confusion caused by pain or pain medication, and both uncontrolled pain and excessive medication can worsen outcomes [4]. Postoperative pain can lead to confusion, hinder recovery, and contribute to chronic pain. Combining non-opioid and opioid medications is often recommended [5].

The World Health Organization (WHO) emphasizes the global need for better rehabilitation services, highlighting its importance in pain management [6]. Regional anesthesia offers options for pain management during surgery including hip surgery, alongside other pain relief methods such as multimodal analgesia. While epidural anesthesia is preferred, other techniques like quadratus lumborum block (QLB) and psoas compartment block can also be effective. These injections spread medication near the lumbar plexus nerves, providing pain relief [7]. Current best practices recommend a multimodal approach to postoperative pain management, aiming to reduce opioid dependence [8]. Traditional pain management options like oral or intravenous medications, surgical site infiltration, and single-shot nerve blocks may not always be sufficient and can have side effects. For instance, acetaminophen, a common pain reliever, has limited effectiveness and slow onset of action [9]. Opioids, while effective, come with potentially dangerous slowed breathing [10]. Regional anesthesia can effectively reduce postoperative pain and opioid use, but some patients experience rebound pain after the block wears off, potentially negating the benefits [11, 12]. However, there are non-medicinal options for pain relief after surgery. These approaches offer an alternative for managing pain without the potential drawbacks of medications [13]. Utilizing non-pharmacological methods and non-opioid medication before, during, and after surgery is crucial to reduce opioid use [14]. Despite advancements in pain medications and techniques for managing acute postoperative pain, the impact of integrating non-pharmacological approaches into existing multimodal regimens remains unclear. This study aims to assess the effectiveness of non-pharmacological interventions in postoperative pain management, with a primary focus on their impact on reducing pain intensity, lowering opioid consumption, and improving patient satisfaction and recovery outcomes. Additionally, it will explore the integration of these interventions into multimodal pain management protocols, evaluating their potential to enhance the efficacy of pharmacological treatments while mitigating opioid-related risks. The study further seeks to identify the challenges and barriers healthcare providers face in adopting and implementing non-pharmacological pain management strategies. This study did not involve original research with human participants or animals; therefore, ethical approval was not required.

Factors Influencing Postoperative Pain

Pain after surgery is a common concern. The amount of pain experienced and its management depend on various factors, including the type and extent of the surgical procedure. More invasive surgeries can cause greater pain and other effects that complicate recovery. Individual pain perception and response also vary [15]. Postoperative pain is influenced by factors including psychological, patient-related, and surgical considerations. Psychological factors, particularly preoperative anxiety, are consistently linked to increased postoperative pain. Studies show that higher anxiety levels before surgery correlate with more intense postoperative pain, leading to higher analgesic requirements and longer hospital stays; however, some studies found no significant association, suggesting that other factors may also play a role in pain outcomes [16]. Psychological distress, including pain catastrophizing and neuroticism, significantly impacts pain tolerance and intensity, with neuroticism and catastrophizing influencing cognitive responses rather than direct pain stimuli [17].

Patient characteristics also play a crucial role in postoperative pain. Female patients tend to experience more severe postoperative pain, while younger patients, those with higher pre-fracture function, and individuals with pre-existing pain or chronic pain conditions, such as opioid use, experience greater pain intensity following surgery [18, 19]. Additionally, the type of surgery and its invasiveness contribute to the severity of pain, with more invasive procedures leading to higher pain intensity and more complicated recoveries [18]. Inadequate treatment of acute postoperative pain is a significant risk factor for developing chronic postoperative pain. Contributing factors include insufficient training for healthcare providers, patient misconceptions about pain and opioids, and opioid tolerance in chronic users, highlighting the need for improved education, patient communication, and evidence-based pain management strategies [20]. Despite these challenges, healthcare providers are obligated to educate patients and prescribe adequate medications for acute pain relief; nevertheless, concerns about pain and pain medications can sometimes result in inadequate management [21]. Effective postoperative pain control is crucial to minimizing the negative consequences of acute pain, reducing the risk of chronic pain, and improving patient satisfaction. Evidence-based, individualized, multimodal approaches to pain management tailored to each patient’s needs, comorbidities, and social factors are recommended [22] (Fig. 1). Such approaches have been shown to reduce opioid consumption, shorten hospital stays, decrease preoperative anxiety, and reduce the need for sedative medications [15, 22]. Ultimately, optimized postoperative pain management improves patient outcomes and ensures better overall care.

Fig. 1.

Complementarity of non-pharmacological techniques for postoperative pain control. Note: This figure illustrates the complementary nature of various pharmacological and non-pharmacological techniques for managing postoperative pain. It emphasizes the importance of a multimodal approach to optimize pain control, minimize opioid use, and improve patient outcomes

Challenges in Surgical Pain Management

Effective postsurgical pain management necessitates a multidisciplinary approach, integrating thorough preoperative planning, precise pain assessment, and a combination of pharmacological and non-pharmacological interventions that address the biological, psychological, and social dimensions of pain, facilitating a more favorable recovery process [23] (Fig. 1). Opioids have historically been the primary agents for pain control; however, their prolonged use is associated with several adverse outcomes, including addiction, tolerance, and hyperalgesia, wherein opioids paradoxically enhance pain perception. Furthermore, evidence suggests that opioids may not offer superior efficacy over nonsteroidal anti-inflammatory drugs (NSAIDs) for specific acute pain conditions, and they are frequently associated with a higher incidence of short-term side effects [24]. Common opioid-related adverse events include postoperative nausea and vomiting, sleep disturbances, urinary retention, respiratory depression, somnolence, and even life-threatening outcomes such as coma. Of particular concern is opioid-induced hyperalgesia, which exacerbates postoperative pain and is further compounded by an increase in opioid prescriptions, contributing to a 50% rise in nonfatal overdoses, predominantly in non-chronic opioid users [10].

Acetaminophen remains an effective and relatively safe analgesic within therapeutic dosages, although excessive doses pose a risk to liver function [25]. NSAIDs are frequently employed for pain relief; however, their use is contraindicated in patients with normal preoperative renal function due to the potential for postoperative renal impairment. Long-term NSAID use is also linked to increased risks of platelet dysfunction and cardiovascular complications, particularly in patients with pre-existing cardiovascular conditions [26–28]. Gabapentinoids, such as gabapentin and pregabalin, offer an alternative treatment modality for neuropathic pain, though their application for short-term postsurgical pain management remains contentious. These agents, when co-administered with opioids, pose significant risks, including exacerbated sedative effects and respiratory depression, with the potential for fatal outcomes [29]. High-dose gabapentin (greater than 300 mg) and opioids (greater than 20 mg oxycodone) have been shown to increase the risk of respiratory complications postoperatively, especially in laparoscopic procedures [30, 31].

For total knee replacement surgery, a multimodal approach incorporating preoperative and intraoperative interventions such as acetaminophen, NSAIDs, adductor canal block, local infiltration analgesia, and dexamethasone is effective. Postoperatively, non-opioid analgesics should be prioritized, with opioids considered as a last resort. Gabapentinoids, ketamine, and certain nerve blocks (e.g., epidural, femoral) may offer limited efficacy and are associated with a higher incidence of adverse effects [32]. Rebound pain (RP) is an important clinical challenge that often arises after discontinuation of peripheral nerve blocks, which offer temporary pain relief. Proactive management and anticipation of RP are crucial to minimize acute discomfort, reduce patient dissatisfaction, and prevent excessive healthcare resource utilization. Failure to adequately address RP can lead to increased analgesic consumption and extended recovery periods [33]. A study involving 21 patients demonstrated that while peripheral nerve blocks effectively managed postoperative pain, their cessation resulted in significant pain spikes, particularly in younger patients. Although older patients experienced less intense rebound pain, their increased use of morphine suggests potential drawbacks in this population [34].

Opioids have long been integral to postoperative pain control; however, their use remains controversial due to concerns regarding short-term side effects and the long-term risk of dependency, particularly in elderly patients who are more susceptible to opioid-related adverse effects [35]. A comprehensive strategy for managing postoperative pain involves employing a multimodal analgesic regimen that integrates pharmacological and non-pharmacological approaches, enhancing overall pain control and mitigating complications such as anxiety, fear, and cognitive dysfunction [36] (Fig. 1). Non-opioid analgesics, including acetaminophen, NSAIDs, and COX-2 inhibitors (coxibs), in conjunction with adjuvant agents such as gabapentin and pregabalin, are key components in modulating nociceptive pathways affected by surgical trauma [10].

Psychological distress, including anxiety, stress, and depression, is prevalent following cardiac surgery, with over 50% of patients reporting such symptoms and approximately 10% meeting clinical diagnostic criteria. These psychological issues may persist for over a year, negatively impacting long-term recovery [37]. Factors such as preoperative education, participation in cardiac rehabilitation, social support, and increased physical activity have been identified as predictors of reduced postoperative distress. Conversely, higher levels of pain and functional impairment are associated with greater distress. Therefore, addressing both the physical and psychological aspects of recovery is essential for optimizing postsurgical outcomes in cardiac surgery patients [37]. Effective surgical pain management faces challenges such as opioid risks, rebound pain, and psychological distress. Multimodal approaches, preoperative education, and non-opioid therapies are crucial for optimizing patient recovery and minimizing complications.

Complementary and Alternative Medicine for Postoperative Pain Management

Nondrug pain management offers a variety of options to manage pain without medication (Tables 1, 2). Physical interventions like massage, heat/cold therapy, and acupuncture target the body to reduce pain sensations. Psychological approaches such as relaxation techniques and meditation address the emotional aspects of pain. Additionally, religious practices, music therapy, and even spiritual reflection can all contribute to pain management [38, 39]. These drug-free methods are cost-effective and have minimal side effects, but implementing them safely and effectively can be challenging in some healthcare settings [38]. Studies indicate that numerous nondrug alternatives can be cost-effective and successful. These options include physical therapy, yoga, educational initiatives, acupuncture, and spinal manipulation. Cognitive-behavioral therapy (CBT) can also be a beneficial approach for specific conditions [40]. The analysis of data from 14,767 patients across 12 European hospitals showed that 44.4% of patients used at least one non-pharmacological method for pain management, but these patients reported slightly lower pain relief (68.6% ± 25.7%) than those who did not use NPMs (71.2% ± 27.9%), a statistically significant difference (p < 0.001). The use of NPMs did not affect patients’ desire for more pain treatment, except for a positive effect observed in the subgroup of total knee replacement patients [41]. There is limited evidence supporting nondrug treatments like heat, spinal manipulation, massage, acupuncture, and exercise for certain acute pain conditions [24].

Table 1.

Summary of physical pain management techniques

Techniques	Advantages	Disadvantages
Preoperative education	Minimizes postoperative anxiety and fear before surgery; reduces discomfort after surgery	Requires resources for patient education; may not be applicable and effective for all patients
Cryotherapy (cold therapy)	Reduces pain and inflammation; can be easily applied postoperatively	May not be suitable for all patients; effectiveness may vary, limiting blood flow and postponing the delivery of healing agents to the injured area, prolonged use may delay healing, tissue necrosis, or nerve impairment
Transcutaneous electrical nerve stimulation (TENS)	Provides pain relief; noninvasive, easy to use, and cost-effective	Effectiveness may vary among individuals; short-term relief; requires resources and training
Acupuncture	Can help manage pain; may have long-term benefits for some patients	Effectiveness varies; may not work for everyone; requires resources and training of healthcare providers
Massage	Promotes relaxation and pain relief; improves blood circulation and reduces muscle tension	Requires trained personnel; may not be suitable for all conditions; effects may be short-term
Heat therapy	Relieves muscle tension and pain; increases blood flow to the affected area	Risk of burns if not used properly; may not be suitable for certain conditions
Aromatherapy	Can help reduce anxiety and improve mood; provides a noninvasive relaxation method	Individual responses to scents vary; may not work for everyone; limited evidence on efficacy

Note: The specific benefits and drawbacks may differ based on the individual patient, their condition, and the healthcare provider’s expertise

Table 2.

Summary of psychological approaches

Techniques	Advantages	Disadvantages
Cognitive-behavioral therapy (CBT)	Addresses psychological factors contributing to pain perception; promotes coping strategies	Requires trained therapists; may not be effective for all individuals; long-term commitment needed
Mindfulness meditation	Promotes relaxation and stress reduction; enhances self-awareness and pain management skills	Requires practice and commitment; effectiveness may vary; not applicable for all patients
Hypnotherapy	Can help manage pain and anxiety; induces a state of deep relaxation and focus	Effectiveness may vary; not suitable for everyone; limited availability in healthcare settings
Biofeedback	Provides real-time feedback on physiological responses; empowers patients in pain management	Requires specialized equipment and training; may not be accessible to all patients
Music therapy	Can improve mood and distract from pain; enhances emotional well-being and relaxation	Individual music preferences; may not work for everyone; limited evidence on efficacy
Guided imagery	Helps create a mental image to promote relaxation and pain relief; it is noninvasive and cost-effective, and aids in stress reduction	Effectiveness may vary; requires imagination and focus; may not be suitable and applicable for all individuals
Yoga	Improves physical function and pain management; enhances well-being and relaxation	Requires practice and commitment; may not be suitable for all individuals; limited accessibility

Note: The specific benefits and drawbacks may differ based on the individual patient, their condition, and the healthcare provider’s expertise

The findings from this research suggest that non-pharmacological methods such as physical therapy and mental health interventions can complement the use of opioid pain medication following surgery. A meta-analysis showed that psychological preparation was associated with a reduction in postoperative negative effects (standardized mean difference [SMD] of −0.35) and reduced time of hospitalization (mean difference of −0.52 days). However, due to high heterogeneity, confidence in these findings is limited [42]. Additionally, nondrug interventions help prevent and manage postoperative delirium, such as helping patients reorient themselves, encouraging early movement, promoting a regular sleep schedule, ensuring proper hydration, and providing visual and hearing assistance [43]. Research shows that transcutaneous electrical nerve stimulation (TENS) may enhance movement and respiratory function, and reduce postoperative symptoms such as nausea, vomiting, chest infections, hypoxia, cardiac issues, pressure ulcers, deep vein thrombosis, loss of appetite, and wound infections, as well as feelings of depression and anxiety [44]. Additionally, these approaches are cost-effective with fewer side effects, aiding post-discharge care as well [45]. These approaches may offer a safer option or supplement to medication. However, due to the limited number of direct comparisons between different techniques, it is difficult to determine which methods are most effective for individual patients. Nevertheless, combining nondrug options like physical therapy, mental health strategies, and education for both patients and caregivers can significantly improve pain relief. However, while some nondrug approaches work on their own, others tend to be more effective when used alongside medications [46]. Multimodal analgesia, which combines these nondrug therapies with medication, including CBT, aligns more closely with the biopsychosocial model of pain, acknowledging the diverse factors contributing to pain perception and management [45, 47] (Fig. 1).

The findings of the review on non-pharmacological methods for managing postoperative pain are promising. The studies discussed here indicate that using complementary approaches can reduce pain levels and the need for opioid medication. Techniques such as physical therapy and psychological interventions were effective in managing postoperative pain and reducing opioid reliance (Tables 1, 2). This highlights the potential for integrating complementary methods into standard pain management protocols. This holistic approach offers the potential to enhance patient outcomes and aid recovery, underscoring the significance of a comprehensive strategy to improve patient well-being and reduce opioid-related risks. A study assessed the use of complementary and alternative medicine for managing postoperative pain. The review analyzed eight studies—five randomized and three non-randomized. All the studies focused on postoperative pain, and five of them showed a significant reduction (p < 0.05). Additionally, five studies looked at opioid consumption, and two of these found significant differences (p < 0.05). Due to heterogeneity, a meta-analysis was not feasible, and potential bias was identified in all of the studies [48]. Non-pharmacological interventions like education, therapy, and distraction techniques can be used before, during, and after surgery [49]. These methods are often cost-effective and easy to implement, and can reduce pain and anxiety, especially for anxious patients. They can also empower patients to manage their pain [49]. Additionally, patients can actively manage pain through safe and cost-effective drug-free methods such as deep breathing, massage, and music [50]. Music therapy is a safe, affordable intervention that has been shown to reduce pain, anxiety, and the need for pain medication in various surgical settings, such as orthopedic, cardiac, and gynecologic surgery [51]. Furthermore, a meta-analysis by Fu et al. revealed that perioperative music significantly reduced postoperative opioid requirement by 31% (95% CI −45% to −16%) and intraoperative propofol and midazolam requirements by 72% (95% CI −101% to −43%) and 107% (95% CI −170% to −44%), respectively. However, it did not significantly impact the length of hospital stay [52]. The study analyzed data from 14,767 patients who underwent surgery. While 44.4% of patients used non-pharmacological methods (NPMs) such as distraction and cold packs, these methods were not associated with significant pain relief compared to those who did not use NPMs. Patients who did not use NPMs experienced slightly more pain relief (71.2% vs. 68.6%). Additionally, the use of NPMs also did not influence the need for additional pain medication. However, in the specific case of total knee replacement patients, NPMs were associated with some pain relief [53]. A review found that various psychological approaches (relaxation, education, therapy) may reduce postsurgical pain and opioid use, but results varied across studies [54]. Similarly, a review of 18 studies found that non-pharmacological interventions like CBT, relaxation, exercise, massage, and music improved sleep quality, reduced pain, and alleviated anxiety in post-cardiac surgery patients compared to usual care [55]. Further research is needed to assess the comparative effectiveness of treatments for different acute pain conditions, and their impact on non-pain outcomes including long-term effects, postoperative complications, length of hospital stays, co-effectiveness, and chronic pain prevention.

Preoperative Education

Postoperative discomfort can be minimized and managed with a variety of preoperative, intraoperative, and postoperative techniques [47]. Pre-surgery anxiety and fear can be alleviated through pre-anesthesia education, leading to higher patient confidence and satisfaction and faster recovery. The preoperative education provided to patients should set forth clear, evidence-based expectations regarding the anticipated dietary intake, pain relief measures, physical rehabilitation regimen, and mobility targets during the postoperative recovery period [56]. Patients should be informed about post-surgical pain options. This education can reduce opioid use, anxiety, sedation needs, and hospital stays, especially for high-risk patients. Even for others, knowing their options helps them participate in care decisions [47]. Preoperative anxiety is common, affecting up to 61–80% of patients. However, pre-surgery information provided in various formats, like videos or slide shows, can significantly reduce anxiety in patients opting for regional anesthesia. This approach is easy to implement and can benefit a large number of patients [57]. Preoperative education for cardiac surgery patients was found to significantly reduce preoperative anxiety (p = 0.02) and length of intensive care unit (ICU) stay (p = 0.02), and led to moderate improvement in postoperative anxiety, depression, and patient satisfaction (p = 0.04), according to a meta-analysis of 22 trials involving 3167 participants [58].

Physical Therapy Techniques

Physical modalities like TENS, acupuncture, massage, cold therapy, heat therapy, and others are utilized in perioperative pain control. While generally safe, evidence of their efficacy as supplementary treatments in a multimodal approach varies widely [47] (Fig. 1). Non-pharmacological approaches for postoperative pain control can be utilized from preoperative to postoperative stages. These cost-effective and straightforward interventions include patient education, CBT, and distraction techniques like music and aromatherapy. They enhance patient independence and autonomy and are increasingly explored due to concerns regarding traditional pharmacological side effects [49].

Cryotherapy (Cold Therapy)

Humans have long used cold therapies, known as cryotherapy, for health and recovery. These treatments reduce pain, improve well-being, and aid post-exercise recovery [59]. Physiologically, the importance of cryotherapy lies in its effectiveness in providing pain relief by slowing the speed of sensory nerve conduction [59]. Ice therapy after shoulder surgery helps with pain, but how much and for how long depends on anesthesia. With a specific block used during surgery, 24 h of very cold ice (5 °C) works best. Without the block, shorter bursts of very cold ice at 5 °C (16 h) followed by less ice (24 h) provide better relief at 10 °C [60]. Cryotherapy is a cost-effective and convenient approach used to reduce pain, swelling, and stiffness after knee surgery. It accelerates rehabilitation and helps patients get back to normal life faster [61]. Newer technologies that combine cold therapy with compression are emerging and may offer even better pain management results [61]. However, there are some drawbacks to consider. While traditional cold therapy aids in acute injury analgesia, prolonged use may delay healing. Hyperbaric gaseous cryotherapy offers improved analgesia and anti-inflammatory effects, but conflicting study results persist [62]. Additionally, studies suggest it might not always benefit bone healing. Studies suggest it cools tissues up to 3 cm deep, potentially reaching bone in thin patients [63]. The long-term cooling on bone is not well understood. It is important to note that pain relief from cryotherapy likely comes from numbing the skin, not muscles or bones [63]. Cryotherapy has the potential to decrease inflammation but could also hinder the healing process. Although it can alleviate pain and swelling, it has the possibility of limiting blood flow and delaying the delivery of healing agents to the injured area. Consequently, this may result in tissue necrosis or nerve impairment [62]. Research suggests potential benefits for elderly patients after hip fracture surgery [64]. Applying ice after surgery may help alleviate swelling and discomfort, but the efficacy of this approach following oral surgery is still unclear [65]. Further high-quality research is required to fully understand the effects of both cold therapy and hyperbaric gaseous cryotherapy [59].

Heat Therapy

Fortunately, low-level heat therapy offers a safe, drug-free, and effective option for managing both acute postoperative pain and chronic lower back pain. Studies have shown its benefits in reducing pain scores, promoting muscle recovery, and helping patients return to normal function [66–68]. Heat therapy works by relaxing muscles, improving circulation, and flushing out pain-causing chemicals [67]. A study illustrated that individuals who underwent warming immediately after hernia surgery reported notably reduced pain scores (p = 0.014) compared to those who did not receive warming [68]. Hilotherapy significantly minimizes swelling and pain, accelerating the recovery of mandibular movement, enhancing patient comfort, and simplifying care for medical staff [69]. Thirty patients had third molar surgery and were treated with either Hilotherm or conventional cooling. Hilotherm resulted in less swelling, reduced pain, fewer neurological issues, and higher patient satisfaction compared to conventional cooling [70]. However, in a randomized trial, the Hilotherapy mask significantly cooled facial skin after facelift surgery but caused a notable increase in patient-reported postoperative swelling [71].

Transcutaneous Electrical Nerve Stimulation

A study on electrical nerve stimulation and acupuncture-like TENS (ALTENS) for reducing postsurgical pain medication use found that their effectiveness depended on stimulation parameters. Across 21 trials with 1350 patients, both methods reduced analgesic consumption by 26.5% compared to placebo. However, trials confirming “strong, subnoxious” electrical stimulation at adequate frequencies showed a 35.5% reduction, while those lacking confirmation had only a 4.1% reduction. This variance showed statistical significance (p = 0.0002), highlighting the importance of appropriate stimulation parameters for optimal pain relief and reduced medication use [72]. Additionally, research shows that TENS may enhance movement and respiratory function, and reduce postoperative symptoms such as nausea, vomiting, chest infections, hypoxia, cardiac issues, pressure ulcers, deep vein thrombosis, loss of appetite, and wound infections, as well as feelings of depression and anxiety [44]. However, the evidence is not entirely consistent. For instance, a study investigating the use of TENS following inguinal hernia surgery in men revealed no substantial disparity in pain levels, respiratory function, or medication usage between the TENS and placebo groups, despite the patients’ perception of benefit [73]. Conversely, research involving the application of high-frequency TENS (100 Hz) for alleviating pain following inguinal hernia surgery showed a notable decrease in pain and medication usage compared to a placebo group during the initial 24 h after the surgery. Active TENS notably decreased postoperative pain intensity at 2, 4, 8, and 24 h post-inguinal herniorrhaphy versus placebo TENS (p < 0.05). Analgesic usage was significantly lower in the active TENS group (p = 0.001) [13]. Likewise, the application of TENS to acupuncture points for pain control following hip replacement surgery in elderly patients produced favorable outcomes, as individuals in the TENS group needed less pain medication during the initial two days after the surgery [74].

A randomized trial found no significant reduction in patient-controlled analgesia (PCA) use with TENS compared to sham TENS after total knee arthroplasty, concluding that TENS has no utility for postoperative pain management in this surgery [75]. Patients undergoing cardiac surgery who received a parasternal block had better pain control and required less opioid medication than those using TENS or receiving no treatment. Although TENS provided some pain relief compared to no treatment, it was not as effective as the block [76]. Transcutaneous electric acupoint stimulation (TEAS) appears to be effective in managing postsurgical pain. Research indicates that it reduces pain scores and opioid requirements significantly compared to acupuncture or no treatment, particularly for abdominal surgeries. TEAS may also enhance recovery and reduce nausea, vomiting, and hospital stay after laparoscopic procedures [77]. However, the review indicates that TENS could be used alongside medication in perioperative situations to help relieve acute pain and decrease the need for pain medication during and after surgery [44]. The efficacy of prolonged TENS application to manage postoperative pain has been debated due to differences in pain severity and surgical procedures [78]. A meta-analysis of 472 patients revealed that TENS was effective in reducing pain and opioid usage after total knee arthroplasty. Patients who received TENS reported lower pain scores and consumed fewer opioids at 12, 24, and 48 h post-surgery than those who did not receive TENS [79]. In contrast, a randomized controlled trial (RCT) found that TENS did not reduce postoperative pain after inguinal herniorrhaphy, despite patients’ belief in its effectiveness [73]. The clinical efficacy of TENS for various types of pain is unclear due to inconsistent use, lack of knowledge, and methodological issues in studies. However, TENS may be considered as an additional treatment option alongside analgesic medication for managing acute postsurgical pain [80]. Given the mixed results of current studies, future research should critically examine the potential of TENS as an adjunct therapy for postoperative pain management. Rigorous RCTs are planned to evaluate the parameters of TENS therapy and the variations in physiotherapy techniques.

Acupuncture

Research in the 1970s and earlier studies from the 1800s suggested that acupuncture has the potential to elevate pain thresholds and trigger the release of internal mediators, indicating possible analgesic effects. A 1977 study found that acupuncture notably raised pain threshold by 27.1%, compared to just 6.9% in the control group, providing further evidence for its pain-relieving properties [77]. Research on the effectiveness of acupuncture for postsurgical pain is inconclusive, with some studies lacking strong evidence [47]. However, a review of over 39 studies suggests it can be beneficial, potentially decreasing pain and opioid use and improving patient satisfaction after surgery, making it a valuable addition to pain management strategies [81]. Studies on specific surgeries such as cesarean section indicate that acupuncture is effective and safe for pain relief, with reduced recovery time and no side effects [82]. Acupressure might be a leading non-pharmaceutical method for postsurgical pain, potentially reducing discomfort and improving mobility for up to a week [83].

Acupuncture techniques like electroacupuncture show promise for various surgeries, including abdominal, spine, and pelvic procedures, with the potential to decrease pain and nausea, leading to reduced reliance on opioids, although more research is needed to identify the most suitable technique for individual patients [77]. A review of 22 studies suggests that acupuncture tended to help with pain relief, with 15 studies showing less or later use of pain medications. However, five studies saw no pain difference between acupuncture and controls. Acupuncture might be safe for postsurgical pain, but larger studies are needed to confirm its overall effectiveness [84]. However, a review of 22 studies involving 1878 patients found some evidence that acupuncture sped up early recovery after colorectal surgery. Patients receiving acupuncture experienced faster passage of gas (MD −0.77 h, 95% CI −1.22 to −0.33 h), earlier bowel movements (mean deviation (MD): −1.41 h, 95% CI −2.20 to −0.63 h), and quicker defecation (MD −1.03 h, 95% CI −1.88 to −0.18 h). They also had less nausea/vomiting (RR 0.72, 95% CI 0.59–0.89), but acupuncture did not significantly reduce pain [85].

Massage Therapy

A systematic review including 33 RCTs found that massage therapy (MT) is effective in postoperative pain control, with a large effect size (SMD −1.32, 95% CI −2.01 to −0.63, p = 0.0002). The remarkable pain-relieving effect was observed in both immediate and 4–6-week follow-up assessments. Notably, the duration or dose of massage therapy (MT) did not impact its effectiveness, and MT appeared more beneficial for adults than other age groups. Additionally, MT had effective analgesic effects for cesarean section and cardiac surgeries compared to orthopedic procedures [86]. However, the review acknowledges some limitations, including potential publication bias, high heterogeneity among studies, and difficulty in implementing double-blinding. While supervised rehabilitation can reduce pain within a week, its impact on function is less clear. Similarly, the effectiveness of ultrasound and laser therapy in pain management remains inconclusive, although laser therapy might offer relief for other symptoms [83].

A review of seven cardiac surgery studies found significant heterogeneity in massage therapy protocols, limiting generalizability. While four out of five studies demonstrated that massage significantly reduced anxiety and pain, several failed to show decreased analgesic requirements, undermining the validity of these findings. The review does not support the use of massage therapy because there is a lack of current evidence to support its effectiveness in improving physiological outcomes like the onset of atrial fibrillation after cardiac surgery [87]. Research involving 60 children (aged 6–18) who had heart surgery revealed that there was no notable distinction in pain or anxiety levels between the massage therapy and reading groups during the initial 24 h (T1) and 48 h (T2) following the surgery. At the time of discharge (T3), children who received massage therapy showed a significant decrease in state-trait anxiety scores compared to the control group (p = 0.0075). Furthermore, the group receiving massage therapy showed a notable decrease in total benzodiazepine exposure during the initial 3 days following the surgery (median 0.002 mg/kg vs. 0.03 mg/kg, p = 0.0253) and required fewer benzodiazepine pro re nata (PRN) doses (median 0.5 vs. 2, p = 0.00346). There were no variances in the overall opioid intake between the groups [88]. In a single-blind study involving 31 post-cardiac surgery patients, with 16 participants in the experimental group and 15 in the placebo group, researchers discovered that administering a 10-min foot massage twice a day within 30 min of receiving opioid pain medication resulted in significantly decreased levels of pain intensity and anxiety compared to the placebo control group (p < 0.05) [89].

The impact of massage therapy on acute pain in critically and acutely ill adults after thoracic surgery was investigated in a systematic review of 12 RCTs. The analysis revealed that patients who received massage in addition to standard pain relief medication reported significantly lower levels of pain on a scale of 0–10, compared to those who received attention control/sham massage (3 RCTs, N = 462, mean difference −0.80, 95% CI −1.25 to −0.35, p < 0.001, I² = 13%) and those who only received standard care (7 RCTs, N = 1087, mean difference −0.85, 95% CI −1.28 to −0.42, p < 0.001, I² = 70%) [39]. This review supports using massage therapy as an effective nondrug intervention to reduce acute post-thoracic surgery pain when combined with standard pain relief treatment [39]. An RCT involving 46 cardiac surgery patients revealed that despite the absence of statistically significant disparities between the treatment groups, the cohort receiving a 20-min hand massage demonstrated lower peak pain intensity (median 5.75, range 2–10) than the hand-holding (median 6.50, range 1–10) and standard care (median 6.25, range 0–10) cohorts [90]. Moreover, the hand massage group attained a pain intensity score of 0 more frequently over the 24-h assessment period (median 0, range 0–7) than the hand-holding (median 2, range 0–5) and standard care populations (median 2, range 0–4.5). Trends toward reduced pain interference with ambulation (p = 0.176) and sleep (p = 0.050) were also observed in the hand massage intervention group [90].

Psychological Approaches

Relaxation Techniques

Studies investigating non-pharmacological pain control techniques for postsurgical pain yield mixed results. A study involving 312 participants undergoing surgery for malignant bone and soft-tissue tumors found that those who received the Registered Nurses’ Association of Ontario (RNAO) pain control protocol of Jacobson’s relaxation technique (JRT) had notably lower pain scores at 6, 24, and 72 h following operation than the placebo group (p < 0.001) [91]. Specifically, at the 72-h mark post-operation, various pain assessment measures were significantly lower in the JRT group (p < 0.001 for all). Moreover, participants in the JRT group showed higher satisfaction scores for nursing care (p < 0.001) and surgical pain control (p < 0.001) than the control group. These findings highlight the efficacy of JRT in enhancing postoperative discomfort and nursing satisfaction [91]. However, a study comparing jaw relaxation to full-body relaxation for postsurgical pain and anxiety found only slight pain reduction in all groups, with no significant differences in anxiety or relaxation levels [92]. A review of research on psychological approaches to manage pain and mobility after surgery suggests that these interventions might not significantly improve pain or movement, although some evidence hints at potential benefits for emotional distress [93]. Similarly, an analysis of 105 studies involving 10,302 participants revealed limited evidence suggesting that psychological preparation techniques were linked to reduced postoperative pain (SMD −0.20, 95% CI −0.35 to −0.06), shorter hospital stays (mean difference −0.52 days, 95% CI −0.82 to −0.22), and decreased negative emotions (SMD −0.35, 95% CI −0.54 to −0.16) compared to control groups [42]. The evidence for improved behavioral recovery was of very low quality but indicated potential benefits, particularly with behavioral instruction. However, due to high variability and unclear risk of bias, the authors concluded that the current evidence is insufficient to make definitive conclusions, highlighting the need for further well-designed research in this area [42]. Nonetheless, in a study of hernia surgery patients, the use of relaxation with heat (RWH) notably lowered presurgical anxiety compared to simply providing procedural information, resulting in better emotional preparation for surgery [94]. Overall, while some non-pharmaceutical techniques like JRT show promise, more research is necessary to definitively demonstrate the effectiveness of psychological approaches for managing postsurgical pain and mobility.

Biofeedback

Research on psychological interventions for postsurgical pain such as music therapy, hypnosis, and CBT shows mixed results, lacking strong evidence for effectiveness after total knee replacement [95]. Biofeedback, on the other hand, emerges as a promising technique. Studies on biofeedback following total knee arthroplasty suggest its effectiveness in improving gait symmetry, decreasing discomfort, and increasing activity during rehabilitation [96]. Reviews also indicate good tolerance for biofeedback and neurofeedback, with minimal risks and rare side effects [40]. Researchers analyzed data from six RCTs comparing electromyography-biofeedback (EMG-BF) with other therapies. The results showed a significant improvement in knee range of motion (ROM) with EMG-BF (SMD −0.48, 95% CI −0.82 to −0.14, p = 0.006), suggesting it may be more effective than other methods in this aspect [97]. However, the study found no statistically significant difference for pain relief (SMD −0.33, 95% CI −0.67 to 0.02, p = 0.07) or physical function (mean difference 1.83 points, 95% CI −3.48 to 7.14, p = 0.50) between EMG-BF and other therapies [97].

While EMG-BF shows promise for improving ROM in knee surgery rehabilitation compared to other methods, it might not necessarily outperform standard rehabilitation for pain or overall function [97]. On the contrary, another review analyzed biofeedback for rehabilitation after total knee replacement. Out of 380 studies, 11 met the criteria (7 high-quality trials), including 416 patients, with a mean of 37.8 patients per research trial. Importantly, 9 out of 11 studies (81.8%) showed significant improvements in activity scores or pain for those receiving biofeedback. This translates to a high chance (over 80%) that biofeedback offers meaningful benefits in these areas [96]. However, the variety of biofeedback devices used (goniometers, force plates, etc.) limits comparisons between specific methods [96]. The systematic review concluded that EMG-BF is an efficient method for post-knee surgery rehabilitation, enhancing quadriceps strength and activation in contrast to home exercises, standard rehabilitation, and electrical stimulation. It also showed positive results in functional assessments, but evidence for knee ROM was inconclusive. EMG-BF seems to have a positive impact on pain management and the enhancement of quadriceps strength and functionality [98]. In a study of 40 who had anterior cruciate ligament (ACL), incorporating EMG-BF into the standard rehabilitation protocol resulted in a considerable increase in quadriceps strength after 4 weeks (p = 0.0001). Conversely, the control group did not exhibit any noteworthy changes in muscle strength during the same time frame (p = 0.368). The EMG-BF group also had significant improvements in knee function scores. The authors suggest that adding EMG-BF to standard rehabilitation can lead to better functional recovery in a shorter time for ACL reconstruction patients [99].

Mind–Body Connection in Postsurgical Pain Relief

A study by Lee et al. investigated the link between pre-surgery depression and pain after surgery. They analyzed 60 studies and found that people with preoperative depression were more likely to have worse pain within 72 h after surgery and in the later stages of recovery (over 6 months) [100]. They also asked for more pain medication early on but not necessarily throughout recovery. Interestingly, there was no clear connection between depression and pain levels in the intermediate period (3–6 months after surgery) [100]. This suggests a possible U-shaped curve, where depression impacts pain most intensely early and later in recovery, with a less clear connection in between. Finally, the alteration in pain scores over some time (pre-surgery to 1–2 years after) did not differ significantly between those with and without depression [100]. Some studies suggest a link between depression and postsurgical pain. However, when factors like age, gender, pre-surgery pain, anxiety, and negative thinking about pain (pain catastrophizing) are considered, depression does not always predict worse pain. This raises doubts about whether depression truly causes more pain, or is simply coincident with other factors that contribute to pain [101]. A study implemented a CBT-based intervention using an RCT design, revealing that CBT was more effective than usual care in alleviating anxiety from 7 to 14 days and depression at 3 months post-surgery. Anxiety, especially in females, was prevalent, and CBT showed greater efficacy in addressing psychological symptoms than pain. For people over 70, CBT seemed to help more with mental health than with pain [102].

Some studies found that people with depression reported more pain after surgery and used more opioids, but other studies did not find this association [100]. Importantly, research suggests that routine opioid use after surgery might be unnecessary. Additionally, studies comparing opioid and opioid-free anesthesia found similar pain relief but fewer side effects in the opioid-free group [103]. Instead of relying heavily on opioids, we should explore the body’s built-in pain relief mechanisms. Research suggests that high opioid use is linked to more pain and less satisfaction. People who manage depression and use positive coping strategies might be tapping into this natural pain relief system more effectively [104]. Addressing both physical and mental health through rehabilitation is crucial for patients to recover their ability to function and adjust emotionally [105]. Controlling pain after surgery is crucial to preventing patients from feeling overly stressed or uncomfortable, and minimizing any potential problems that might arise. The best approach to postsurgical pain management involves the use of a combination of medications and comfort techniques to achieve the most effective pain relief for each patient [106].

Imagery Therapy

Several studies explored relaxation techniques with guided imagery (GI) for managing pain after surgery. The findings suggest that GI could be a useful tool alongside pain medication, even though most studies used it with other therapies [107, 108]. A review by Carpenter et al. suggests that guided imagery is a beneficial, noninvasive, and cost-effective approach for managing pain and anxiety in postoperative orthopedic patients, making it a viable holistic option for pain management in this population [108]. Another review also looked at mirror therapy, motor imagery, and virtual reality for phantom limb pain. While all showed some promise in reducing pain, the studies were not of high quality, and stronger methods are needed to confirm their effectiveness [109]. Another part of the review evaluated the different stages of graded motor imagery (GMI) used for phantom limb pain. However, current research mainly focuses on mirror therapy [110]. An RCT involving 60 children aged 6–12 years undergoing minor surgery found that the use of relaxation-guided imagery in the experimental group (n = 30) before general anesthesia induction led to significantly lower levels of preoperative anxiety (p < 0.001) and postoperative pain (p < 0.001) compared to the control group (n = 30) receiving standard care [111]. Interestingly, playing calming music or guided imagery recordings during minor surgery under local anesthesia did not seem to help patients relax or feel less pain. However, surgeons appeared to feel less anxious when these recordings were playing [112].

Music

An investigation involving 117 individuals found that allowing patients to listen to their chosen music before the surgical procedure resulted in reduced anxiety levels, improved patient satisfaction, and regulated hemodynamic factors. However, anxiety reduction from music did not correlate with decreased pain levels [113]. Twelve research studies including 1299 participants investigated different psychological methods for managing pain after knee replacement surgery. Although they utilized music therapy, hypnosis, and CBT, the diverse interventions and lack of safety data resulted in inconclusive findings [95]. On the other hand, a synthesis of nine RCTs underscored the potency of music in diminishing pain after surgery. The SMD for music medicine was −0.41, and the SMD for music therapy was −0.31, indicating that both modalities demonstrate substantial efficacy. Patient-selected music yielded superior results (p = 0.02), while music therapy additionally mitigated postoperative anxiety (SMD = 0.44, p = 0.005). Although effects on physiological parameters, opioid consumption, and hospital stay are modest, music emerges as a promising non-pharmacological intervention for postsurgical pain management [114]. Additionally, a review of 73 RCTs with sample sizes ranging from 20 to 458 participants found that music had significant effects in reducing postoperative anxiety (SMD −0.68), discomfort (SMD −0.77), and analgesia need (SMD −0.37). Additionally, it improved patient satisfaction (SMD 1.09) [115]. However, the data did not reveal a notable effect of music on the length of hospitalization. Ancillary subgroup assessments and meta-regression modeling did not discern any substantial influence of music selection or timing of implementation on the reported results. Intriguingly, the review also indicated that music remained beneficial even when patients were under general anesthesia during the postoperative interval [115]. Research indicates that music therapy may have a substantial impact on reducing postsurgical pain levels [48]. Furthermore, a review and meta-analysis demonstrated that patients who participated in musical interventions had notable decreases in anxiety and pain, in contrast to those who did not undergo this treatment (p < 0.05) [116]. This is consistent with suggestions for drug-free pain control, such as utilizing music therapy to enhance mood following a surgical procedure. Nevertheless, the effectiveness of music therapy in alleviating pain may stem from its ability to divert attention from the pain rather than directly reducing it.

Yoga

While further research is needed to compare yoga to other interventions and explore shorter, more affordable options [117], early yoga intervention after breast cancer surgery significantly improved well-being and daily function compared to waiting. Yoga may also help manage postsurgical symptoms and motivate patients to stay active [118]. Even isolated practices like yogic breathing can yield benefits, with studies showing a significant reduction in anxiety among dental surgery patients [119]. Yoga is generally safe, though individuals in poor health may experience physical and mental stress as adverse effects. However, studies indicate no significant difference in adverse events between yoga practitioners and those who engage in other forms of exercise [117]. A review of 11 systematic reviews of the impact of yoga on post-traumatic stress disorder (PTSD) in adults, including eight meta-analyses, found that seven reviews showed small to moderate reductions in PTSD symptoms, one found no significant effect, and all non-meta-analysis reviews reported beneficial effects of yoga on PTSD symptoms [120]. A systematic review and meta-analysis found that yoga significantly improved self-reported PTSD and depression symptoms, but not clinician-reported PTSD [121]. A literature search found limited studies on post-mastectomy pain syndrome (PMPS) treatment. Mindfulness and yoga show potential benefits, but more research is needed to confirm their effectiveness in treatment [122]. An RCT involving 40 breast cancer patients demonstrated that the practice of yoga led to a significant increase in the expression of miR-133B, a lower incidence of post-mastectomy pain syndrome (10% vs. 30%), and improved quality of life [123]. Additionally, a meta-analysis found that yoga had significant positive effects on anxiety, pain, and biomarkers in patients who underwent coronary artery bypass graft (CABG) surgery, based on the analysis of 17 studies. The evidence supporting the benefits of yoga in postoperative recovery was of moderate quality [124].

Challenges in Implementing Non-pharmacological Pain Management Approaches

These drug-free methods are cost-effective and have minimal side effects, but implementing them safely and effectively can be challenging in some healthcare settings [38] (Tables 1, 2). Blinding both participants and researchers in non-pharmacological pain trials is challenging due to the difficulty in designing a convincing placebo intervention [125]. Healthcare providers play a key role in nondrug pain management for surgery patients by providing emotional support, assisting with daily activities, and creating a comfortable environment [126]. However, factors like age, education, experience, and hospital culture can influence the utilization of these approaches [126]. Despite benefits, a study found that nurses acknowledged some limitations in their knowledge of nondrug pain management techniques. While they recognized advantages like lower cost (21%), fewer side effects (17%), patient self-management after discharge (17%), and relaxation benefits (14.9%), the findings suggest that nurses might need more training to implement these techniques effectively [45]. Studies have identified a lack of training, poor resources, and limited support from managers and doctors as common barriers to the use of nondrug pain relief [38]. Healthcare providers identified a lack of time (25.5%) as the greatest hurdle in using nondrug pain management. Additionally, patient resistance (17%) and their beliefs about pain (17%) were also seen as significant barriers [45]. A cross-sectional study of 154 nurses at national referral and private hospitals assessed the use of non-pharmacological pain management methods and perceived barriers. Nurses most commonly used emotional support (45.5%), helping with daily activities (67.5%), and creating a comfortable environment (61%), while cognitive-behavioral (5.9%) and physical methods (5.8%) were rarely used. At the bivariate level, nurses’ age (p = 0.013), education (p = 0.012), work experience (p = 0.001), and workplace (p = 0.001) were significantly associated with non-pharmacological method use. However, multivariate analysis showed that hospital setting was the sole determinant, with statistical significance (p < 0.001). Key perceived barriers included heavy workloads (87.7%), lack of time (84.4%), limited resources (82.5%), absence of pain management guidelines (77.3%), uncooperative patient behavior (57.1%), language differences (64.4%), and nurses’ lack of knowledge (50%) and experience (40.3%). The study concluded that the variability in the use of non-pharmacological methods was due to the healthcare providers’ different knowledge and experience, suggesting that training and exposure for all providers could enhance the utilization of these techniques for postoperative pain management [126]. Bayoumi et al. examined how providers utilize non-pharmacological pain management techniques in surgical wards. The age ranged between 20 and 49 years, with a mean ± SD of 28.98 ± 7.30 years. More than three-quarters of the providers were female (80.9%). The nurses’ level of nursing certificate was mostly from technical institutes (44.72%) or baccalaureate (38.06%) levels. The years of experience ranged from novice to expert, with a mean ± SD of 9.36 ± 7.50 years [45].

Conclusion

This study highlights the significant potential of non-pharmacological interventions in the management of postoperative pain, emphasizing their role in reducing opioid reliance and enhancing recovery outcomes. The evidence suggests that approaches such as preoperative education, physical therapy, and mind–body techniques can effectively decrease pain intensity and improve patient satisfaction following surgery. These interventions not only address the physical aspects of pain but also incorporate psychological and social dimensions, aligning with the biopsychosocial model of pain management. However, the implementation of these strategies faces several challenges, including resource constraints, variability in healthcare provider training, and the need for a supportive hospital culture.

Despite recognizing the benefits of non-pharmacological methods, healthcare professionals often report limitations in their knowledge and skills regarding these techniques, which can hinder their effective application in clinical practice. To optimize postoperative pain management, it is essential to integrate these nondrug approaches into multimodal analgesia regimens, ensuring that they complement traditional pharmacological treatments. Future research should focus on establishing robust evidence for the efficacy of individual non-pharmacological interventions, exploring their long-term benefits, investigating the variations in physiotherapy techniques, and developing comprehensive training programs for healthcare providers. By addressing these challenges and promoting a collaborative approach to pain management, we can significantly improve patient outcomes and enhance the postoperative recovery process. While our current study briefly explores TENS therapy, we aim to delve deeper into its application and efficacy in various postoperative contexts in future research.

Author Contributions

Emery Niyonkuru conceptualized the study design and drafted the initial manuscript. Xu Zhang and Peng Ma reviewed the manuscript. Muhammad Asad Iqbal contributed to the review and technical writing. All authors participated in writing and revising the initial draft. Emery and Peng collaboratively revised subsequent versions. All authors reviewed and approved the final manuscript. We are grateful to the study participants.

Funding

The Rapid Service Fee was funded by Zhenjiang City’s Science and Technology Planning Social Development Project: SH2022083.

Data Availability

Since this review study is based on existing published data, data availability is not a relevant consideration.

Declarations

Conflict of Interest

Emery Niyonkuru, Muhammad Asad Iqbal, Xu Zhang, and Peng Ma have nothing to disclose.

Ethical Approval

This study did not involve original research with human participants or animals; therefore, ethical approval was not required.