1. 2025;28;11-23Optimizing Chronic Pain Treatment: A Summary of Infrequently Investigated Therapeutic Interventions for Modulating Pain
   Narrative Review
   Andrew J. Ordille, MD, Michael Sabia, MD, Kingsuk Ganguly, MD, and Jasjit Sehdev, MD.

BACKGROUND: Although chronic pain is generally treated with pharmacological and surgical interventions, many patients still fail to reach adequate pain relief through these methods. Patients and providers have looked to complementary and alternative strategies for managing chronic pain due to these methods’ feasibility and cost-effectiveness and patients’ preferences for them. Some promising interventions for chronic pain include resistance training, fasting therapy, sauna therapy, and cryotherapy.

OBJECTIVES: The purpose of this narrative review is to provide a scoping overview of the mechanisms, efficacy, and applications of infrequently studied interventions for chronic pain disorders.

STUDY DESIGN: A narrative review of peer-reviewed literature examining the analgesic effects of 1) resistance training, 2) fasting therapy, 3) sauna therapy, and 4) cryotherapy on chronic pain.

METHODS: In September 2023, the PubMed, Embase, and Google Scholar databases were reviewed to identify research on the effects of resistance training, fasting therapy, sauna therapy, and cryotherapy on chronic pain. Our selection included randomized control trials, cohort studies, cross-sectional trials, qualitative studies, and review articles.

RESULTS: The mechanisms by which resistance training, fasting therapy, sauna therapy, and cryotherapy contribute to analgesia occur either in isolation or synergistically. The details of these mechanisms have yet to be fully elucidated, but they likely include central processes, peripheral mechanisms, neurotransmitters, nervous system activation, and mood enhancement. These modalities have shown promising results for a variety of chronic pain disorders, such as arthropathies, rheumatoid and rheumatoid-related conditions, and musculoskeletal conditions.

LIMITATIONS: This narrative review is not systematic in nature but is instead focused on providing an overview of the effects of the interventions on chronic pain disorders. Some of the studies included in this review are limited by their sample sizes, study periods, and lack of control groups for adequate comparison. Furthermore, many of the chronic pain conditions mentioned in this review lack investigations sufficient to suggest specific recommendation statements.

CONCLUSIONS: The experimental evidence that confirms the pain-alleviating properties of these therapeutic modalities is scarce and warrants further investigation. However, a substantial amount of work supports the use of these modalities in the multimodal and multidisciplinary managements of chronic pain disorders. Future work should continue to elucidate the relationships between chronic pain disorders and resistance training, fasting therapy, sauna therapy, and cryotherapy so that guidelines can be developed.

KEY WORDS: Chronic pain, complementary therapies, resistance training, exercise, fasting therapy, diet, sauna therapy, heat therapy, cryotherapy, cold water immersion