For purposes of this discussion I have chosen to define physical treatment as any process involving movement or external stimulation of the body that may be able to reduce pain. This covers everything from acupuncture to physiotherapy to soaking in a hot spring at a spa.

Generally speaking physical treatments can be classified as active or passive. Examples of the latter include massage, manipulation and therapeutic touch. These categories can further be broken down to sub-categories such as Shiatsu or Swedish massage. Some forms of passive treatment are ancient, such as acupuncture, while laser therapy and ultrasound rely on modern technology.

Many or most forms of passive treatment have not been tested rigorously to determine their effects on pain. Evidence from controlled studies has shown that different (traditional, auricular and electro) forms of acupuncture and certain kinds of manipulation may be helpful with certain kinds of pain. Much more research is required to establish firmly what treatments can help what problems and whether effects are short or long term.

It may be intuitively obvious that active body movement is beneficial for health but evidence for the benefit of active physical treatments is in much the same position as that for passive treatments when it comes to pain management. Resistance training, stretching, aerobic exercise, Yoga, Tai Chi and a host of other practices may all help pain by modifying mechanical factors contributing to it. There are some studies showing that physical interventions may lead to partial pain reduction such as in the case of aerobic training for fibromyalgia.

Perhaps the best evidence for physical treatment in general comes from studies of multi-disciplinary treatment programs. Such programs all include some form of physical intervention (usually active) and have established their superiority over single treatment programs in the management of chronic pain. A deeper understanding of the neural processes involved in pain and their relationship with such things as exercise or massage may eventually let us target some pain with specific physical therapies.