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I am wondering if you can help proof read my scoping literature review introduction? Title: Exploring Non-Opioid Pain Management and Lifestyle Interventions for Chronic Pain: A Scoping Review Abstract: Background: Chronic pain is a significant health concern. While opioid-based treatments are common, the current risks of dependency and adverse outcomes are troubling. How does one assist patients suffering from chronic pain when “24.3% of adults had chronic pain, and 8.5% of adults had chronic pain that frequently limited life or work activities in the past month as noted in 2023” (Centers for Disease Control, 2024)? Given that opioids are frequently prescribed, and the risks and benefits of treatment are assessed, one must consider alternative treatments to enhance the quality of life, daily activities, and overall well-being of chronic pain patients. Objective: This review aims to explore the extent and nature of existing literature on non-opioid pain management and lifestyle modifications in adults with chronic pain to assist in increasing quality of life while assisting in the reduction of pain. Methods: A scoping review followed Joanna Briggs’s Scoping Review Methodology and PRISMA-SCR reporting standards. A literature search for peer-reviewed articles was conducted in five databases. Results: I still need to input this Conclusion: A total of 58 articles met the inclusion criteria. Interventions assisting with non-opioid pain management were placed in nine categories, including opioids, exercise/yoga/therapies, lifestyle changes, dietary/food, meditation/mindfulness, acupuncture, education, technology, and sleep. All the studies were published in the last five years. Introduction: Chronic pain affects millions globally and many in the United States (US) and is often treated with opioids, which have limited long-term efficacy and potential for misuse. “Chronic pain affects over one-quarter of the United States population and is a prevalent complaint seen in the outpatient medical clinics and can significantly impair an individual’s quality of life, leading to physical limitations, emotional distress, and social isolation” (Dydyk & Conermann, 2024). Chronic pain is defined as “pain lasting for more than 3 months in noncancer conditions such as neck and back, headaches, migraines, arthritis and other musculoskeletal conditions” (Patel et al, 2021). It was reported by Dydyk & Conermann (2024) “among patients with chronic pain, chronic regional pain affects 11.1%, chronic back pain accounts for 10.1%, leg and foot pain affect 7.1%, arm and hand pain affect 4.1%, and headaches affects 3.5%. Additionally, 3.6% of patients with chronic pain experience widespread pain.” Chronic pain can be challenging to diagnose and manage, as Dydyk & Conermann (2024) report, “Failure to diagnose and effectively manage chronic pain can contribute to opioid use disorders and increase morbidity and mortality rates among affected individuals.” Chronic pain management has traditionally relied on opioid-based treatments, which are associated with significant risks, including dependency and adverse health outcomes. Opioid use can have the potential to lead to deaths, use disorders, a decrease in daily living functions, mood disorders, poor pain management, and an overall decline in quality of life in individuals suffering from chronic pain. The Centers for Disease Control (CDC) reported, “Nearly 108,000 people died from drug overdose in 2022, and approximately 82,000 of those deaths involved opioids (about 7.6%).” Volkow & Blanco (2020) report, “The current opioid epidemic is one of the most severe public health crises in US history. Responding to it has been difficult due to the rapidly changing nature and the severity of its associated outcomes.” As is evident, over the past ten years, there has been a growing number of deaths in the US from opioid use. It must be noted that not all these deaths are related to prescription opioids for pain management; however, they are a contributor to the number of deaths. The CDC classifies the rise in opioid deaths in three waves: the first wave, which began with “the increase in prescribing of opioids in the 1990s. Overdose deaths involving prescription opioids, both natural and semi-synthetic opioids, and methadone increased starting around 1999” (CDC, n.d.). The second wave began in 2010, which has been related to heroin use, but does not apply to this study. The third wave began in 2103, which has been associated with the use of synthetic opioids and involved illegally made fentanyl and fentanyl analogs. As one can see in the diagram from the CDC, commonly prescribed opioids are in the middle when it comes to overall opioid deaths. Furthermore, the CDC reports, “On average, 224 people died each day from an opioid overdose in 2022.” If we calculate using 224 deaths daily and a U.S. population of 340 million, it would take 1,517,857 days or 4,000 years to eliminate the population based on current statistics. While that may seem like a long time, it’s important to remember that the Earth is about 4.5 billion years old. This time frame is small, highlighting the severity of the problem. Special note: This number is misleading as both the population and opioid use fluctuate. Other side effects and risks associated with opioid use include tolerance, physical dependence, increased sensitivity to pain, constipation, nausea, vomiting, dryness, sedation, dizziness, confusion, depression, low testosterone levels, decreased sex drive, reduced energy, and diminished strength. “Feared complications of opioid therapy include addiction, overdose resulting in respiratory compromise, and occasionally, death” (Dydyk & Conerman, 2023). All these factors can impact functioning and overall quality of life. A build-up of tolerance may lead to an increase in chronic pain, potentially requiring higher doses of opioids, which can lead to a use disorder. These issues can have catastrophic effects on the patient, caregiver, and family. The graphics below clearly demonstrate the side effects of opioid medications; these side effects are included in prescriptions used for treating chronic pain. The CDC notes the following: In 2023, nearly 8.6 million Americans 12 years and older reported misusing prescription opioids in the past year. Of those who reported misuse of prescription pain relievers in 2023, more than two-thirds reported misusing them to relieve physical pain, and more than a quarter obtained their pain reliever from a friend or relative. In 2023, over 5 million Americans 12 years and older reported a prescription use disorder in the past year. From 1999 to 2022, approximately 294,000 people died from overdoses involving prescription opioids. As one can see, while attempting to treat chronic pain with opioids, there is a risk of an adverse effect. Ultimately, the goal of both providers and patients is a good quality of life, the ability to function, and to have little to no pain present. In response, there is growing interest in non-opioid strategies and lifestyle modifications. Alternatives that combine non-opioid pharmacologic strategies and lifestyle changes (e.g., exercise, nutrition, sleep hygiene) are gaining attention. “Non-pharmacological alternative therapies for pain have been around for a long time, some for hundreds of years. They have been used throughout history to treat many issues” (Urits et al, 2021). Urits et al (2021) also noted, “Currently, alternative medicine is most frequently used to treat musculoskeletal pain, and between 59 and 90% of patients utilizing alternative therapies for chronic pain claimed they were helpful and can serve as an effective adjunctive for the management of chronic pain.” In a review study by Shi & Wu (2023) they found “non-pharmacological therapies (NINPT) for chronic pain “offer options for managing chronic pain safely and effectively without damaging tissues or causing significant side effects.” They explored a variety of therapies to assist with pain management and reported “NINPT represents a promising domain encompassing diverse interventions that modulate pain through peripheral, spinal, and supraspinal mechanisms” (Shi & Wu, 2023). Dydyk & Conermann (2024) noted, “the array of nonpharmacological therapies for chronic pain is extensive. These options include heat and cold therapy, cognitive behavior therapy, relaxation therapy, biofeedback, group counseling, ultrasound stimulation, acupuncture, aerobic exercise, chiropractic, physical therapy, osteopathic manipulative medicine, occupational therapy, and transcutaneous electrical nerve stimulation.” Other interventions include diet changes, changes in sleep cycle, the use of applications, mindfulness, and education on self-management. However, the evidence of these alternatives’ scope, effectiveness, and implementation remains scattered across disciplines. This scoping review will provide a broad overview of current research on non-opioid pain management with lifestyle interventions. Synthesizing existing literature aims to identify key strategies, standard outcome measures, and gaps in knowledge to inform future research and clinical practice. The aim is to map the existing literature on these interventions and assess their reported impact on pain reduction and quality of life within six months. PICO Question: In adults suffering from chronic pain, do non-opioid pain management strategies combined with lifestyle modifications lead to reduced pain levels and improved quality of life within six months compared to traditional opioid-based pain management?

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