Mechanisms and Clinical Evidence of TCM Non-Pharmacological Therapies for Chronic Pain

Abstract

Chronic pain remains a major clinical challenge, with pharmacological treatments often limited by modest efficacy and safety concerns. Non-pharmacological therapies rooted in Traditional Chinese Medicine, including acupuncture, tuina, moxibustion, and mind-body interventions have gained increasing research attention as potentially independent therapeutic strategies. This review synthesizes current evidence on the multidimensional mechanisms through which these TCM-based modalities may exert analgesic effects, while critically appraising the clinical evidence base from randomized controlled trials, observational studies, and systematic reviews. Rather than treating these interventions as a homogeneous category, we distinguish between modalities and examine their contributions to pain modulation at peripheral, spinal, and supraspinal levels, with attention to neuroimmune interactions and central sensitization reversal. outcome measurement, and control conditions complicates straightforward interpretation of aggregated evidence and underscores the need for rigorously designed trials with standardized reporting. Important methodological challenges persist, particularly regarding blinding feasibility in manual interventions and distinguishing modality-specific from contextual effects. Future integration of multi-omics and neuroimaging approaches may elucidate biological substrates, though translational relevance to clinical practice remains to be established. This review provides a balanced reference for researchers and clinicians while identifying knowledge gaps for future investigation.