Cognitive-behavioral interventions are some of the most useful tools in helping to manage chronic pain and are consistently recommended in pain management guidelines. There are many different types of cognitive-behavioral interventions, such as cognitive restructuring, relaxation techniques, and mindfulness-based stress reduction, all of which replace maladaptive coping patterns (such as catastrophizing, fear avoidance, and overgeneralizing) with more constructive coping skills. How cognitive-behavioral techniques are incorporated into an individual patient's multimodal management strategy depends on local resources and patient preference; however, numerous studies show that primary care physicians can implement some cognitive-behavioral techniques effectively in the office setting.

The lidocaine patch is an effective topical agent for localized neuropathic pain; however, it would not be an effective option to treat widespread central pain, such as that in this patient with fibromyalgia.

NSAID therapy can be considered for intermittent flares of pain, but it is generally ineffective when used on a scheduled basis for central pain.

There is little evidence supporting the use of opioids in patients with chronic noncancer pain and ample evidence of potential harms of chronic opioid therapy in such patients. Furthermore, there is some weak evidence that opioids may in fact worsen central pain. Therefore, opioids should only be considered as a last resort in certain low-risk patients after all other modalities have failed.