Total knee arthroplasty (TKA) is frequently associated with significant postoperative pain, often managed with opioids despite well-documented risks of adverse effects and dependency. There is evidence for three non-pharmacological strategies; Cryotherapy demonstrates a consistent capacity to reduce pain, though its impact on opioid consumption appears modest and context dependent. Acupuncture shows potential benefits in intermediate and late recovery phases but offers limited and inconsistent evidence for reducing opioid use. Continuous passive motion, by contrast, confers minimal analgesic or opioid-sparing benefit while increasing costs and hospital stay. Barriers to adoption—including economic, logistical, and clinical challenges—further constrain their utility. Collectively, these findings highlight both the promise and limitations of current alternatives and underscore the importance of a multidisciplinary approach that combines pharmacological and non-pharmacological strategies to optimize pain control while addressing the broader challenges of opioid stewardship in TKA care.