Multiple studies using cognitive behavioral therapy, which includes stress management, show clinically meaningful improvements in conditions including chronic migraine and tension headaches, fibromyalgia, arthritis pain, low back pain, pelvic pain, bruxism, menopausal hot flashes, insomnia, and irritable bowel syndrome. The mechanism has to do with balancing the autonomic nervous system, by decreasing the sympathetic portion and increasing the parasympathetic branch of the system.  Changes in thoughts, emotions and behaviors can lead to actual changes in the brain, similar to those seen when medications are used.