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The American Psychological Association (APA)’s new clinical practice guideline for the treatment of chronic musculoskeletal pain highlights the best current evidence on psychological and behavioral treatments for this widespread condition.

The philosophy behind the guideline is that “when you’re living with pain, it’s not one thing that’s going to help you. It’s [a] number of different treatments and therapies combined,” said Penney Cowan, a panel member who helped develop the guideline and a patient advocate with lived experience with chronic pain.

The panel based the guideline, which was approved in 2024 and published in June 2025, on three systematic reviews of up‑to‑date research, including:

A review of studies on nonpharmaceutical interventions by the Agency for Healthcare Research and Quality
Another review on self‑management interventions for widespread chronic pain
A third review on psychological interventions for chronic pain, excluding headache

Various organizations have published guidelines on chronic pain, but the new APA guideline focuses specifically on chronic musculoskeletal pain, the most common chronic pain condition.

In so doing, it hopes to provide clear guidance centered on a specific patient population.

Experts say that although we still lack evidence to scientifically confirm some interventions, pain management decisions should be agreed upon between physicians and patients because empirically, many of these interventions do work.

The first‑line recommendations for chronic musculoskeletal pain include:

cognitive behavioral therapy,
multicomponent self‑management interventions, and, for specific areas,
exercise and psychological therapies.

Chronic pain is widespread. Studies in Latin America show that chronic musculoskeletal pain is present in 16% to 42% of the adult population.

The Central American Survey of Working Conditions and Health found that this type of pain is highly prevalent in all Central American countries. It is the leading cause of morbidity and disability and the most commonly reported occupational disease.

More than 1 in 5 US adults experience pain most days or every day. What’s more, treatment is expensive: a National Academy of Medicine report estimated that chronic pain costs the US economy between $560 billion and $630 billion each year.

Experts say that chronic musculoskeletal pain:

Affects quality of life, decreases the ability to work, and generates significant costs for healthcare systems.
Can lead to depression, anxiety, and other mental health problems.
In some cases, can lead to permanent disability and loss of independence.

Patients are often offered surgical solutions that are not necessarily proven to be more effective than noninvasive treatments. The prescribing of opioid medications for chronic pain has also fueled the opioid epidemic, making the development of alternative, evidence‑based treatments even more essential, says the document.

To create the guideline, the APA panel performed an exhaustive review of the literature to identify which reviews to use.

It focused on two primary outcomes:

Physical functioning and performance, which includes activities of daily living, impairment, disability, pain‑related interference, changes in strength or stamina, and range of motion;
and mental health and emotional functioning, which includes anxiety, depression, anger, and pain coping.

Additionally, it looked at health‑related quality of life, pain intensity, patient self‑efficacy, patient global impression of change, employment status and disability benefits, and adverse events.

The guideline also focuses specifically on adults and nonpharmacological treatments, which play a key role in the treatment of musculoskeletal pain. Psychological treatments are among the most promising therapies for chronic pain: in earlier guideline development for the American College of Occupational and Environmental Medicine, the team discovered that, of the 15% of treatments supported by evidence, many were psychological.

Recommended treatments

The panel of experts organized its recommendations into first line and second line based on the strength of the evidence, the benefit/harm balance, patient values and preferences, and applicability. The guideline is not a practice standard and does not cover all possible effective treatments, only those that have been researched with high‑quality methodology focused on functional outcomes.

For people with chronic musculoskeletal pain, the guideline recommends cognitive behavioral therapy (CBT) instead of the usual treatment or other active interventions.

The panel also found robust evidence to recommend multicomponent self‑management interventions, including a wide range of interventions such as: patient education, physical components like stretching and movement, and psychological treatment centered on the patient’s feelings, cognitions, and behaviors in response to pain.

For chronic low back pain, the guideline panel recommended exercise to manage short‑term pain and psychological therapy to manage short‑, medium‑, and long‑term pain. Psychological therapy for low back pain can include progressive muscle relaxation and operant therapy, which uses positive reinforcement to help patients achieve healthy behavior goals like exercise.

Finally, for patients with knee pain from osteoarthritis, the panel found robust evidence for a personalized,

professionally designed exercise program, as avoiding exercise can make knee pain worse over time.

This story was produced using content from original studies or reports, as well as other medical research and health and public health sources cited in links throughout the article.