**6. Non-pharmacological pain control**

Non-pharmacological approach to pain management starts with working on psychological components of the pain. Devine et al. analyzed 191 studies and confirmed significance of psychological and educational care of surgical patients and its role in managing acute postoperative pain. It included providing patients with proper information about procedures and the expected level of pain, instructing them on proper coughing and breathing techniques, and providing emotional support [39].

Transition from acute to chronic pain conditions also involves several psychological factors such as depressive state, somatization, or significant distress [40].

Many kinds of questionnaires and tests were developed to be applied in chronic pain, discussion of which is beyond the scope of this chapter. Generally, psychological management of chronic pain patients should be carried out with the help of certified psychologist or psychiatrist.

Considering the burden of musculoskeletal pain in CKD patients, therapies to reduce muscle tension and myofascial release should be applied, such as bed rest, bracing, traction, manipulation and mobilization, exercise, and heat/cold applications. Acupuncture was proven to be effective in lower back pain and knee pain; therefore, along with mindfulness, meditation and relaxation techniques prove to be safe and applicable to CKD patients too [41].
