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Can I get help proofreading my scoping literature review paper? It is supposed to follow the Joann Briggs framework? 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: 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 is a widespread public health issue that affects millions around the globe, including a significant portion of the United States (US). It is often treated with opioids, which have limited long-term efficacy and potential for misuse. “Estimates suggest that over one-quarter of the US adults suffer from chronic pain, making it a frequent reason for outpatient clinic visits and a major contributor to reduced quality of life through physical limitations, emotional distress, and social isolation” (Dydyk & Conermann, 2024). Chronic pain is typically defined as “pain lasting more than 3 months in noncancer conditions. It encompasses conditions such as neck and back, headaches, migraines, arthritis, and other musculoskeletal disorders” (Patel et al, 2021). According to 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 affects 7.1%, arm and hand pain affects 4.1%, and headaches affect 3.5%. Additionally, 3.6% of patients with chronic pain experience widespread pain.” Chronic pain can be challenging to diagnose and manage. Opioids have historically formed the cornerstone of chronic pain management. Yet, their long-term benefits are questionable, and their use is associated with significant risks, including dependency, overdose, and other adverse health outcomes. Consequences include opioid use disorder, overdose-related death, impaired daily function, mood disturbances, and decreased overall quality of life. According to the Centers for Disease Control and Prevention (CDC), nearly 108,000 people died from drug overdoses in 2022, with approximately 82,000 of these deaths involving opioids (CDC, n.d.). The opioid epidemic remains a significant public health crisis, with opioid-related fatalities continuing to rise over the past decade. “Responding to it has been difficult due to the rapidly changing nature and the severity of its associated outcomes” (Volkow & Blanco, 2020). Prescription opioids are an essential contributor to these deaths, although illicit drugs also play a considerable role. The CDC identifies three waves in the opioid overdose crisis: the first wave began in the 1990s with increased opioid prescribing and a subsequent rise in overdose deaths related to prescription opioids; the second wave, starting in 2010, was primarily driven by heroin; and the third wave beginning in 2013, has been linked to synthetic opioids, particularly illicitly manufacturd fentanyl (CDC, n.d.). Prescription opioids remain a central factor in overall opioid-related mortality. Beyond the risk of fatal overdose, regular opioid use can lead to tolerance, physical dependence, increased pain sensitivity, and a wide range of side effects, including constipation, nausea, sedation, confusion, depression, hormonal dysregulation, and reduced functional capacity (Dydyk & Conermann, 2023). All these factors can impact the 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 complications collectively have a profoundly negative impact on patients and their families, increasing the risk of dose escalation, mismanagement, and further morbidity. The graphics shown clearly demonstrate the side effects of opioid medications; these side effects are included in prescriptions used for treating chronic pain. Recent statistics underscore the scale and severity of opioid misuse. In 2023, nearly 8.6 million Americans aged 12 and older reported misusing prescription opioids, with most reporting use for physical pain relief and many obtaining medications from non-medical sources. Over 5 million Americans reported a prescription opioid use disorder, and from 1999 to 2022, prescription opioid overdoses accounted for approximately 294,000 deaths nationwide (CDC, 2023). Therefore, the pressing clinical goal is to provide adequate pain relief while minimizing these significant risks. 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 pain management strategies and lifestyle modifications as safer alternatives and adjuncts in chronic pain care. “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). These approaches include a wide array of non-opioid pharmacologic agents and lifestyle interventions such as exercise, dietary modification, and sleep hygiene. “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 adjunct for the management of chronic pain.” Many alternative and integrative therapies, including cognitive behavioral therapy, biofeedback, physical and occupational therapy, acupuncture, chiropractic care, and mindfulness practices, have longstanding roles in pain management (Urits et al., 2021; Shi & Wu, 2023). Non-pharmacological interventions offer the promise of reducing pain and enhancing quality of life with fewer adverse effects compared to opioid therapy (Dydyk & Conermann, 2024). Nonetheless, the evidence base for these alternatives’ effectiveness, implementation, and comparative value remains fragmented and inconsistent across disciplines and practice settings. This scoping review aims to provide a comprehensive synthesis of the current research landscape regarding non-opioid pain management strategies and lifestyle interventions in chronic pain. Its objective is to synthesize existing literature, aiming 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? Background: Chronic pain is a widespread and debilitating health issue affecting a substantial proportion of the adult population globally. Beyond its physical toll, chronic pain has emotional, psychological, and social dimensions, disrupting multiple domains of daily life, including work, relationships, and personal goals (Dassieu et al., 2021). Historically, opioid medications have been a primary approach to managing chronic pain. While they may provide modest short-term relief, long-term use (>1 year) offers little sustained benefit and is linked with serious, dose-dependent harms, including tolerance, physical dependence, misuse, overdose, fractures, and endocrine disruption (AHRQ, 2020; Chou et al., 2021; CDC, 2022). In recent years, the escalating opioid epidemic has prompted critical examination of opioid prescribing practices and a call for safer, more sustainable alternatives. In response, interest in non-opioid interventions, such as physical therapy, acupuncture, mindfulness-based stress reduction, and other complementary therapies (e.g., yoga, massage), has grown (Chou et al., 2021). Concurrently, lifestyle modifications, including regular physical activity, healthy dietary habits, improved sleep hygiene, and stress management, are increasingly recognized as critical factors in both perpetuating and managing chronic pain, with growing evidence supporting personalized multimodal lifestyle interventions (Salazar-Méndez et al., 2024). However, evidence on the comparative effectiveness of combined non-opioid and lifestyle-based interventions is fragmented across disciplines. It remains unclear how these approaches compare to opioid-based management in reducing pain and improving quality of life within six months. Given the diversity and fragmentation of existing research, a scoping review is well-suited to systematically map the evidence on non-opioid pain management strategies combined with lifestyle modifications for adults with chronic pain, compared to opioid-based approaches. This review will identify knowledge gaps, inform clinical practice, and guide future research. Methods: Eligibility Criteria: The inclusion criteria were determined using the Population-Concept-Context (PCC) framework as recommended by the Joanna Briggs Institute Information Sources: The following databases were searched: PubMed, CINAHL, MEL, SportDiscus, and Google Scholar. Additional sources included grey literature and the reference lists of relevant articles. Search Strategy: A comprehensive search strategy was developed, combining relevant keywords and Boolean operators (e.g., AND, OR) to capture studies on chronic pain management. Search terms included “chronic pain,” “adults,” “non-opioid,” “lifestyle modification,” “pain management,” “diet,” “acupuncture,” “opioid use,” “lifestyle,” “sleep,” “meditation,” and “quality of life,” along with synonyms and controlled vocabulary (e.g., MeSH terms) where applicable. The timeframe for inclusion was January 2019 to May 2025, and only studies published in English were included. Eligible study types included randomized controlled trials, open-label controlled trials, cross-sectional observational studies, and qualitative studies (e.g., focus groups, surveys). The reviewer independently screened titles and abstracts to determine relevance to the inclusion criteria. Selection of Sources of Evidence: All identified citations were imported into a reference matrix, and duplicates were removed. The reviewer screened titles and abstracts independently based on pre-defined inclusion criteria. Full-text articles were retrieved for potentially relevant studies and further assessed for eligibility. Inclusion Criteria: Population: Studies involving adults (aged 18+) with a chronic pain diagnosis Interventions: Non-opioid strategies and lifestyle modifications Timeframe: Studies published between January 2019 and May 2025 and outcomes reported within a six-month timeframe Study types: randomized controlled trials, open-label controlled trials, cross-sectional observational studies, and qualitative studies (e.g., focus groups, surveys) Concept: Non-opioid pain management strategies combined with lifestyle modifications. Context: Any healthcare or community setting. Exclusion Criteria: – Studies involving pediatric populations Studies focused on acute, surgical, or cancer-related pain Studies examining opioid-only interventions Meta-analyses, meta-syntheses, or systematic reviews Data Charting Process: A standardized data spreadsheet was developed and used to extract data relevant to the research question. Information charted included study characteristics, sample size, intervention details, outcome measures, and major findings. The reviewer conducted the charting process and revised it as necessary to ensure consistency and completeness. Data Items: The following data items were extracted from each source: -Author(s) and year -Purpose statement -Study type, design, and methodology -Sample size and type -Level of evidence -Measurements -Type of intervention(s) (non-opioid strategy and/or lifestyle modification) -Comparator (if applicable) -Measured outcomes (e.g., pain reduction, quality of life) -Major findings and implications -Point of article -Search engine (e.g., CINHAL, PubMed, MEL, SportDiscu, Google Scholar Data Charting: – Author/year – Study design – Population – Intervention details – Comparator (if any) – Outcomes (pain, QoL) – Follow-up duration DO THIS Critical Appraisal of Individual Sources of Evidence: Critical appraisal was not performed for this scoping review, which was consistent with the objectives of scoping reviews to map the existing evidence rather than evaluate the quality or risk of bias of individual studies. Synthesis of Results: Data were synthesized descriptively using narrative summaries and tabular presentations. Findings were grouped by type of intervention (e.g., dietary, physical activity, sleep interventions) and outcome domain (e.g., pain intensity, quality of life). The synthesis focused on identifying key concepts, research gaps, and implications for practice. Fifty-eight studies published between 2019 and 2025 were reviewed. Of the 58 studies, 31 met criteria, and 27 were excluded for not meeting criteria. The 31 studies included encompassed randomized controlled trials (put in N), open-labeled and pilot studies (put in N), mixed-methods and qualitative evaluations (put in N), and cross-sectional observational investigations (put in N). These were conducted across diverse chronic pain populations, including low back pain, neck pain, musculoskeletal, migraine, and neuropathic pain. Interventions fell into four main categories: exercise/physical therapy (including Pilates, yoga, physiotherapy, cervical stabilization), lifestyle modifications (dietary changes, ketogenic or low-calorie diets, lifestyle coaching), mind-body/meditation (mindfulness, yoga-based MBLM), and other holistic modalities (acupuncture, weighted blankets, eHealth apps, sleep programs). Studies were also reviewed discussing opioid use and how it can be related to a decrease in quality of life, opioid use disorder, and uncontrolled pain. Overall, the exercise-based interventions (Pilates, yoga, physiotherapy) consistently demonstrated short-term improvements in pain and quality of life—for example, Pilates improved HRQOL in chronic low back pain after 8 weeks; yoga, exercise, and physical therapy all reduced pain and stress, with no single approach proving superior. Lifestyle programs that combined guidelines-based physiotherapy, dietary adjustments, and health coaching yielded clinically meaningful reductions in disability, pain, weight, and enhanced quality of life at 26 weeks. Nutritional/Dietary interventions, such as ketogenic or whole-food diets, were linked to pain reduction and better sleep, while pilot intermittent fasting regimens showed feasibility and initial pain relief potential. Mindfulness and meditation delivered significant benefits in pain self-efficacy and quality of life, reduced inflammatory markers, and effectively treated chronic migraines. Acupuncture studies showed improvement in pain and disability, particularly in elderly participants. Additional modalities—including weighted blankets, eHealth applications, and smartphone-supported posture programs—revealed statistically significant gains in pain reduction, anxiety, sleep, and functional outcomes. Qualitative and mixed-methods findings highlighted the importance of group-based support, personalized education, and self-management skills, with several participants reporting sustainable lifestyle improvements beyond the intervention period. Across studies, the common thread was that non-opioid interventions combined with lifestyle-based strategies were associated with enhanced pain relief, improved function, and better quality of life, typically observed within 6 to 24 weeks. However, gaps remain in long-term follow-up, direct comparisons with standard opioid-based therapies, and integration of multimodal strategies in diverse clinical settings. Intervention Categories: Interventions clustered into five primary categories Opioid-use behavior and quality of life Exercise and Physical Therapy Lifestyle Modifications (Diet, Weight, Coaching) Mind-Body Approaches (Mindfulness, Meditation, Yoga) Other Holistic or Non-Pharmacologic Modalities Opioid-use Behavior and Quality of Life: Four studies examined how opioid use can affect quality of life. There were no interventions reviewed in this section. This established the groundwork and support for the PICO question. The goal of this article review was to determine how opioid use can negatively impact quality of life. Studies accepted included: Earnest et al. (2022): poorer physical health was linked to higher risk opioid use and lower overall quality of life. Most frequently endorsed motives for opioid use were pain relief and pleasure. Godinez et al. (2024): greater ADL disability among older adults was associated with 1.6-3.6 times higher odds of opioid consumption. Anderson et al. (2024): both patients and providers viewed opioids as a “last resort” for functional improvement; conversations around deprescribing were challenging. Wei et al. (2022): older adults with injury after opioid initiation had a 1.4-fold increased risk of opioid-related adverse events (ORAEs). Exercise and Physical Therapy: Four studies examined movement-based therapies, such as Pilates, yoga, cervical stabilization, and physiotherapy. These interventions typically ranged from 6 to 12 weeks and consistently reported short-term improvements in pain, functional ability, and quality of life. A randomized controlled trial (RCT) of Pilates for chronic low back pain reported significant improvements in health-related quality of life (HRQOL) and function at 8 weeks. Another study comparing yoga, exercise, and physical therapy for chronic pain found all three equally effective, suggesting flexibility in clinical choice. Cervical stabilization exercises for neck pain demonstrated sustained benefits in pain and disability after 12 weeks. Studies included: Yang et al. (2020): an 8-week Pilates program improved health-related quality of life (HRQoL) earlier than usual care, though both reduced pain. Oz & Ulger (2024): yoga, home exercise, and physical therapy all decreased pain, improved function, and reduced stress, with no clear “best” intervention. Park et al. (2024): cervical stabilization with eye exercises significantly improved neck pain, disability, and quality of life over manual therapy alone. Lindahl et al. (2022): regular physiotherapy combined with patient education improved independence, social engagement, and HRQoL. Lifestyle Modifications: A total of five studies addressed diet, weight management, or structured lifestyle coaching. Programs combining low-calorie or ketogenic diets, guideline-based physiotherapy, and behavioral coaching achieved clinically significant reductions in weight, pain, and disability at 26 weeks. Participants following whole-food diets or anti-inflammatory plans reported enhanced sleep, mood, and daily function. An intermittent fasting pilot study in adults with chronic pain demonstrated early feasibility and potential for pain reduction, though larger trials are needed. Lifestyle medicine group visits with plant-based eating and stress management education led to qualitative improvements in pain coping and empowerment. Studies included: Mudd et al. (2025): a healthy lifestyle program (HeLP) combined with physiotherapy led to clinically meaningful improvements in disability, weight, and quality of life at 26 weeks. Hestmann et al. (2023): participants in self-management lectures and physical activity groups reported sustained positive lifestyle changes and better pain self-management. Field et al. (2022): both ketogenic and minimally processed food diets reduced pain and improved quality of life; ketogenic diet showed additional benefits. Safari et al. (2020): short-term low-calorie diet reduced sciatic pain and disability compared to diet plus NSAIDs. Carlisle et al. (2023): dietary supplements (hemp, calamari oil, broccoli) resulted in a 52% reduction in pain and decreased oxidative stress. Mind-Body Therapies: Mindfulness-based and yoga-meditation interventions were explored in six studies. Mindfulness training was associated with increased pain self-efficacy, lower perceived stress, and improved quality of life. A yoga-based intervention for migraine sufferers significantly reduced headache intensity, frequency, and inflammatory markers (e.g., IL-6, TNF-α) over 12 weeks. Meditation delivered in group or digital formats was generally well tolerated and accepted, with moderate improvements in emotional well-being. Studies included: Mindfulness/yoga: Matko et al. (2023), Diaz et al. (2022), and Grazzi et al. (2023) all showed improved pain self-efficacy, emotional well-being, sleep quality, and reduced inflammatory markers. Holistic and Digital Approaches: Five studies explored diverse non-pharmacologic strategies: Acupuncture trials in elderly adults with chronic pain and insomnia demonstrated marked reductions in pain and disability. Use of weighted blankets was linked to reduced anxiety, better sleep, and lower pain scores, especially in fibromyalgia populations.An eHealth pain education app, a smartphone-supported posture program, and personalized sleep hygiene interventions also reported statistically significant improvements in function, adherence, and satisfaction. Studies included: Acupuncture: Minakawa et al. (2021) and Rybicka et al. (2024) reported clinically significant reductions in pain intensity and improved quality of life. Education: Morales-Fernandez et al. (2020) and Shaygan et al. (2022) demonstrated that nurse-led programs and multimedia training decreased pain and depression, and improved quality of life. Smartphone/e‑health tools: Abadiyan et al. (2021), Licciardone et al. (2022), and Suso-Ribera et al. (2020) found improved pain, posture, depression, and anxiety in patients using app-based interventions. Sleep interventions: Lopez-Monzoni et al. (2025) and Baumgartner et al. (2022) demonstrated that sleep/circadian programs and weighted blankets significantly reduced pain, anxiety, and improved sleep-related quality of life. Qualitative and Mixed-Methods Insights Five studies used mixed-methods or qualitative approaches to explore patient perspectives. Common themes included Group support, coaching, and shared experiences, which increased engagement. Participants valued non-pharmacologic pain education and self-management skills. Many described sustained improvements in lifestyle habits beyond the intervention period, especially in diet, exercise, and sleep routines. Other common findings across the studies reviewed included the following: Pain reduction: 19 of 22 studies reported significant decreases in pain intensity (e.g., VAS, NRS, WOMAC). Quality of life: 17 interventions demonstrated improvements in HRQoL (EQ-5D, SF‑36, WHOQOL‑BREF). Function/disability: 14 out of 22 studies showed enhanced physical functioning or reduced disability scores (ODI, RMDI, NDI). Psychological health: Many studies also noted improvements in mood, stress, or anxiety (BDI, STAI, cortisol, inflammatory markers). Adherence/self-efficacy: Lifestyle and mind‑body interventions showed stronger participant adherence and increased self-management skills. Evidence Gaps: Evidence gaps were noted within the article review processes. Some of those gaps include comparing in efficacy, long-term outcomes, diverse populations, and implementation and cost effectiveness. These evidence gaps were expected as this is a relatively new issue that has been reviewed, investigated, and researched. A breakdown of those comparative gaps is as follows: Comparative efficacy: Few head-to-head comparisons of opioid vs non-opioid strategies. Only two opioid-use studies included thematic interviews but lacked direct comparisons between non-opioid and opioid-based therapies. Long-term outcomes: Just 5 interventions (e.g., Mudd et al., Grazi et al.) included follow-up ≥ 6 months. Diverse populations: Few studies targeted individuals from low-income, rural, or ethnically diverse backgrounds; older adults were included primarily in opioid behavior studies. Implementation/cost-effectiveness: Rarely addressed. Only a few studies (smart apps and lifestyle programs) addressed feasibility, scalability, or cost. These findings affirm the PICOT focus that non-opioid pain management strategies combined with lifestyle modifications can meaningfully reduce pain and improve quality of life within six months and signal the need for future comparative effectiveness trials and implementation studies. Data were synthesized descriptively using narrative summaries and tabular presentations. Findings were grouped by type of intervention (e.g., dietary, physical activity, sleep interventions) and outcome domain (e.g., pain intensity, quality of life). The synthesis focused on identifying key concepts, research gaps, and implications for practice. Results: Selection of Sources of Evidence: A total of 57 records were initially identified through database searches. After title and abstract screenin and removal of duplicates, 23 full-text articles were reviwed resulting in 22 studies being included in this scoping review. ENTER PRISMA Characteristics of Sources of Evidence: The included articles span multiple intervention categories: Opioid behavior and motivation studies – 6 studies Physical activity and exercise interventions – 6 studies Lifestyle-focused programs – 2 studies Dietary interventions – 3 studies Mind-body/meditation approaches – 3 studies Acupuncture techniques – 2 studies Educational and self‑management training – 2 studies Smartphone/e‑health tools – 3 studies Sleep and circadian interventions – 2 studies Results of Individual Sources of Evidence Five main themes emerged: Opioid-use behavior and quality of life Earnest et al. (2022): Poorer physical health was linked to higher risk opioid use and lower overall quality of life. Godinez et al. (2024): Greater ADL disability associated with increased odds of opioid consumption. Anderson et al. (2024): Opioids viewed as a “last resort”; deprescribing discussions challenging. Wei et al. (2022): Opioid initiation led to higher risks of adverse events. Exercise and physical activity interventions Yang et al. (2020): Pilates improved HRQoL more rapidly than usual care. Oz & Ulger (2024): Yoga, home exercise, and physical therapy all reduced pain and stress. Park et al. (2024): Cervical stabilization improved neck pain and function over manual therapy. Lindahl et al. (2022): Physiotherapy plus education boosted independence and HRQoL. Non-pharmacological lifestyle interventions Mudd et al. (2025): Healthy lifestyle program + physiotherapy improved disability, weight, and QoL. Hestmann et al. (2023): Self-management programs promoted long-term lifestyle change and pain control. Dietary interventions Field et al. (2022): Ketogenic and minimally processed food diets reduced pain, with additional benefits in ketogenic group. Safari et al. (2020): Low-calorie diet reduced sciatic pain more than NSAIDs. Carlisle et al. (2023): Hemp, calamari oil, and broccoli supplements halved pain severity. Mind-body, acupuncture, education, tech, and sleep Mindfulness/yoga: Improved pain self-efficacy, emotional health, sleep, and inflammation (Matko, Diaz, Grazzi). Acupuncture: Reduced pain intensity and improved QoL (Minakawa, Rybicka). Education: Nurse-led and multimedia education decreased pain and depression, improved QoL (Morales-Fernandez, Shaygan). Smartphone/e-health tools: Improved pain, posture, depression, anxiety (Abadiyan, Licciardone, Suso-Ribera). Sleep: Circadian programs and weighted blankets improved sleep quality and reduced pain (Lopez-Monzoni, Baumgartner). Common Findings Across Studies Pain reduction: 19 of 22 studies reported significant decreases in pain. Quality of life: 17 studies showed HRQoL improvement. Function/disability: 14 studies improved physical function or reduced disability. Psychological health: Multiple studies improved mood, stress, or anxiety. Adherence/self-efficacy: Higher with lifestyle and mind-body approaches. Evidence Gaps Comparative efficacy: Few head-to-head comparisons of opioid vs non-opioid strategies. Long-term outcomes: Limited to 5 studies with ≥6 months follow-up. Diverse populations: Underrepresentation of low-income, rural, or ethnically diverse groups. Implementation/cost-effectiveness: Rarely addressed. (Paper instructions) not part of the assignment Begins with paragraph on search findings, including type and strength of studies. All sections begin with clear topic sentence and are well organized and developed. Written in student’s own words with more commentary and/or analysis than quotes or paraphrasing. Results section includes the analysis of literature in which the student thoroughly synthesizes the concepts found during the search and systematically leads the concepts toward the conclusion and implication. Uses quotes and paraphrased material purposefully: To illustrate or explain an opinion or idea; to assert a fact; to provide authority for an assertion made; to provide a focal point; to show many opinions Uses quotes only when vital to preservation of ideas; otherwise, paraphrasing is the standard Literature analysis is clearly tied to the overall PICOT question and project focus. Summary Framework: The comparator in the study was opioid. Summary of Findings: The reviewed studies consistently demonstrate that non-opioid pain management strategies, when paired with lifestyle modifications such as exercise, dietary changes, acupuncture, education, and alterations in sleep, significantly reduce chronic pain levels over six months. Several randomized controlled trials reported enhancements in patients’ quality of life scores compared to opioid-based treatments. It is noted that some studies have limitations regarding sample size and duration, indicating a need for more extensive long-term research. Discussion – Evidence suggests a growing body of literature supports combining non-opioid and lifestyle-based interventions for chronic pain. – Physical therapy and CBT are among the most frequently studied and beneficial combinations. – Gaps include limited studies on certain populations (e.g., minorities, rural communities) and limited short-term outcome reporting (<6 months). - Implications for practice and future comparative trials. 5. Limitations - Did not assess methodological quality - Possible publication bias - English-only articles may exclude relevant data 6. Conclusion This scoping review indicates promising outcomes from integrating non-opioid and lifestyle strategies for chronic pain management

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