context: In the past decade, there has been a growing acceptance of the benefits of mind-body therapies, acupuncture, and some nutritional supplements for treating pain. Other alternative treatments such as massage, chiropractic therapies, therapeutic touch, certain herbal therapies, and dietary approaches have the potential to alleviate chronic pain in some people. However, the evidence supporting these therapies is less concrete. Mind-body therapies are treatments that are meant to help the mind's ability to affect the functions and physical symptoms of the body. Mind-body therapies use various approaches, including relaxation techniques, meditation, guided imagery, biofeedback, and hypnosis. Relaxation techniques can help alleviate discomfort related to chronic pain. Visualization, also known as guided visualization, may be another worthwhile pain-controlling technique. Try the following exercise: Close your eyes and try to call up a visual image of the pain, giving it shape, color, size, motion. Now try slowly altering this image, replacing it with a more harmonious, pleasing -- and smaller -- image. Another approach is to keep a diary of your pain episodes and the causative and corrective factors surrounding them. Review your diary regularly to explore avenues of possible change. Strive to view pain as part of life, not all of it. Electromyographic ( EMG) biofeedback may alert you to the ways in which muscle tension is contributing to your pain and help you learn to control it. Hypnotherapy and self-hypnosis may help you block or transform pain through refocusing techniques. One self-hypnosis strategy, known as glove anesthesia, involves putting yourself in a trance, placing a hand over the painful area, imagining that the hand is relaxed, heavy, and numb, and envisioning these sensations as replacing other, painful feelings in the affected area. Relaxation techniques such as meditation or yoga have been shown to reduce stress-related pain when they are practiced regularly. The gentle stretching of yoga is particularly good for strengthening muscles without putting additional strain on the body. Acupuncture is thought to decrease chronic pain by increasing the release of endorphins, chemicals that block pain. Many acu-points are near nerves. When stimulated, these nerves cause a dull ache or feeling of fullness in the muscle. The stimulated muscle sends a message to the central nervous system (the brain and spinal cord), causing the release of endorphins that block the message of pain from being delivered to the brain. Acupuncture may be useful as an accompanying treatment for many pain-related conditions, including headache, low back pain, menstrual cramps, carpal tunnel syndrome, tennis elbow, fibromyalgia, osteoarthritis (especially of the knee), and myofascial pain. Acupuncture also may be an acceptable alternative to or may be included as part of a comprehensive pain management program. Chiropractic treatment is the most common nonsurgical treatment for back pain. Improvements of people undergoing chiropractic manipulations were noted in some trials. However, the treatment's effectiveness in treating chronic back and neck pain has not been supported by compelling evidence from the majority of clinical trials. Further studies are currently assessing the effectiveness of chiropractic care for pain management. Massage is being increasingly used by people suffering from pain, mostly to manage chronic back and neck problems. Massage can reduce stress and relieve tension by enhancing blood flow. This treatment also can reduce the presence of substances that may generate and sustain pain. Available data suggest that massage therapy holds considerable promise for managing back pain. However, it is not possible to draw final conclusions regarding the effectiveness of massage to treat pain because of the shortcomings of available studies. Therapeutic touch and reiki healing are thought to help activate the self-healing processes of an individual and thereby reduce pain. Although these so-called "energy-based" techniques do not require actual physical contact, they do involve close physical proximity between practitioner and patient. Several reviews of the research have shown that while several studies reported beneficial effects with no significant adverse side effects, those studies are still too limited to allow definitive conclusions to be drawn. Further studies are needed before solid recommendations for their use can be made. There is solid evidence indicating that chondroitin sulfate may help relieve pain due to knee osteoarthritis. This compound has been found to decrease pain and increase mobility of the knee and is generally well tolerated and safe. Other dietary supplements, such as fish oils, also show some evidence of benefit, although more research is needed. It has been difficult to draw conclusions about the effectiveness of some herbal remedies. Others, such as white willow bark, devil's claw, ginger, and turmeric have some evidence to support their use to treat pain. If you decide to use herbs to better manage your pain, it is of critical importance to share this information with your doctor. Some herbs may interact with drugs you are receiving for pain or other conditions and may harm your health. Some people believe that changing dietary fat intake and/or eating plant foods that contain anti-inflammatory agents can help ease pain by limiting inflammation. A mostly raw vegetarian diet was found helpful for some people with fibromyalgia, but this study was not methodologically strong. One study of women with premenstrual symptoms suggested that a low-fat vegetarian diet was associated with decreased pain intensity and duration. Weight loss achieved by a combination of dietary changes and increased physical activity has been shown to be helpful for some people suffering from osteoarthritis. Still, further research is needed to determine the effectiveness of dietary modifications as a pain treatment.