Pain relief without drugs

How can physical therapy help?

Share on PinterestPhysical therapy can help a patient regain movement or strength after an injury or illness.

As with any medical practice, a variety of therapies can be applied to treat a range of conditions.

Orthopedic physical therapy treats musculoskeletal injuries, involving the muscles, bones, ligaments, fascias, and tendons. It is suitable for medical conditions such as fractures, sprains, tendonitis, bursitis, chronic medical problems, and rehabilitation or recovery from orthopedic surgery. Patients may undergo treatment with joint mobilizations, manual therapy, strength training, mobility training, and other modalities.

Geriatric physical therapy can help older patients who develop conditions that affect their mobility and physical function, including arthritis, osteoporosis, Alzheimer’s disease, hip and joint replacement, balance disorders, and incontinence. This type of intervention aims to restore mobility, reduce pain and increase physical fitness levels.

Neurological physical therapy can help people with neurological disorders and conditions such as Alzheimer’s disease, brain injury, cerebral palsy, multiple sclerosis, Parkinson’s disease, spinal cord injury, and stroke. Treatment may aim to increase limb responsiveness, treat paralysis, and reverse increase muscles strength by reducing muscle atrophy.

Cardiovascular and pulmonary rehabilitation can benefit people affected by some cardiopulmonary conditions and surgical procedures. Treatment can increase physical endurance and stamina.

Pediatric physical therapy aims to diagnose, treat, and manage conditions that affect infants, children, and adolescents, including developmental delays, cerebral palsy, spina bifida, torticollis and other conditions that impact the musculoskeletal system.

Wound care therapy can help to ensure that a healing wound is receiving adequate oxygen and blood by way of improved circulation. Physical therapy may include the use of manual therapies, electric stimulation, compression therapy and wound care.

Vestibular therapy aims to treat balance problems that can result from inner ear conditions. Vestibular physical therapy involves a number of exercises and manual techniques that can help patients regain their normal balance and coordination.

Decongestive therapy can help to drain accumulated fluid in patients with lymphedema and other conditions that involve fluid accumulation.

Pelvic floor rehabilitation can help treat urinary or fecal incontinence, urinary urgency and pelvic pain in men and women as a result of injuries or surgery, or because of certain conditions.

Apart from physical manipulation, physical therapy treatment may involve:

  • Ultrasound, to promote blood flow and healing by heating the tendons, muscles, and tissues
  • Phonophoresis, which uses ultrasound to deliver certain medications such as topical steroids. This can decrease the presence of inflammation
  • Electrical stimulation, or E-stim, which uses topical electrodes on the skin to reduce pain and increase functional capabilities. One type of E-stim is transcutaneous electrical nerve stimulation (TENS). At times, anti-inflammatory medications are used with certain E-stim modalities and is referred to as iontophoresis
  • Heat, moist heat and cold therapy
  • Light therapy, in which special lights and lasers are used to treat certain medical conditions

The physical therapist will recommend the most appropriate treatment.

Try these 9 simple remedies to ease your pain.
Here is a quick list of some popular non-drug therapies for arthritis pain relief. They may be used alone, or in conjunction with each other.

  • Hot and cold treatments. Usually applied directly to the pain site; heat may be more useful for chronic pain, and cold packs provide relief from acute pain.
  • Positive attitude and thoughts. Consciously switching to positive thoughts can distract your brain from feeling pain.
  • Exercise. Keeping your joints and muscles moving helps improve your general fitness level and can decrease pain.
  • Relaxation techniques. You can train your muscles to relax and your thoughts to slow down by using these techniques, which include deep breathing, guided imagery and visualization, among others.
  • Massage. Done properly, the method can relax your muscles, help you let go of tension and provide some arthritis pain relief.
  • Electrical stimulation. Also called transcutaneous electrical nerve stimulation (TENS), the therapy is delivered through a small device that sends a painless electrical current to large nerve fibers, generating heat that relieves stiffness and pain as well as releasing endorphins, the body’s natural pain killers. Consult your health-care provider about this therapy.
  • Topical lotions. These are applied directly to the skin over the painful muscle or joint. They may contain salicylates or capsaicin, which decrease sensitivity to pain.
  • Acupuncture. Considered a complementary or nontraditional therapy, acupuncture is the practice of inserting fine needles into the body along special points called “meridians” to relieve pain.
  • Sense of humor. Many studies have demonstrated that humor can bolster the immune system and increase the ability to handle pain.

Related Resources:

  • Living With Arthritis
  • Reduce Neck Pain From Arthritis With Massage

The PPM Guide to Relieving Pain Without Medication

Chinese (or Eastern) Medicine

Chinese medicine is actually an umbrella term for several treatments, including acupuncture, Chinese herbs, and tai chi, explains Jamie Starkey, LAc, manager of the Eastern medicine program and lead acupuncturist at the Cleveland Clinic’s Center for Integrative and Lifestyle Medicine.“Of these, acupuncture is the go-to treatment for pain,” she says. “There is an overwhelming amount of clinical evidence looking at acupuncture for pain relief. It can be especially effective for pain in the low back, knees, neck, and shoulder.”

With acupuncture, she explains, “Whether you have acute or chronic pain, you are getting a pain-relieving effect from the release of endorphins from your brain, and there is also local anti-inflammatory effect.”

Insurance companies vary regarding coverage for acupuncture, Ms. Starkey says. “If an insurance company covers acupuncture, they will cover every diagnosis or they will cover specific codes,” she explains. “Patients should first determine whether their insurance company covers the treatment. If it does, then they should identify which specific codes are covered.” Acupuncture often is covered for chronic pain, migraines, and post-operative nausea and vomiting. For more information,

Acupuncture used in conjunction with traditional herbs can also be effective for treating pain, Ms. Starkey notes. Finding a Chinese herbalist is essential however due to their extensive knowledge about plants and their side effects which is especially important for patients taking medication. To find a practitioner, consult the National Certification Commission for Acupuncture and Oriental Medicine.

Caveat: Since Chinese herbs are not approved by the FDA, patients should check with their physician or pharmacist before taking a new supplement or herb. Many herbs and supplements may not react well with traditional Western medications.

Chiropractic Care

Chiropractic care has now become mainstream, and no longer viewed as “alternative or fringe.” In fact, studies have shown that spinal manipulation (the use of force to adjust a person’s spine that is misaligned) for chronic low-back pain is at least as effective as conventional medical care for up to 18 months.

Spinal manipulation (one of several options that include exercise, massage, and physical therapy), can provide relief from low back pain, according to the National Center for Complementary and Integrative Health (NCCIH), part of the NIH. When provided by a trained, licensed practitioner, spinal manipulation is believed to be a safe treatment for low back pain, with the common side effects, such as discomfort in the treated area, minor and likely to disappear within a day or two.

This form of treatment focuses on the relationship between the body’s structure, usually the spine, and its function. While most people will visit a chiropractor for the management of low back or neck pain, it can be helpful for headaches and upper- and lower-extremity joint conditions. It has also been used to treat pain associated with fibromyalgia. Chiropractors may use spinal adjustments and treatments like electrical stimulation, relaxation techniques, rehabilitative and general exercise, and counseling on diet, weight loss, and lifestyle.2

Cold and Heat

Most people know to ice an acute injury, like a bump on the head. But cold and heat are “extremely effective therapies” against chronic pain, says Dr. Shrikhande. “Cold helps decrease inflammation and heat helps to relax muscles that are in spasm,” she explains. “One is not necessarily better than the other and many people can benefit from both.” She suggests starting with 10 minutes of ice, followed by 10 minutes of heat. Research published by in 20143 focused on 87 patients with low back pain, which found cold and heat could be effective in the treatment of acute low back pain.

Hypnosis

In hypnosis, a health professional teaches you to respond to suggestions for changes in your feelings, behaviors, and sensations. You learn to use your mind to manage pain as well as anxiety. You can even be trained in self-hypnosis as a way of dealing with pain. “Hypnosis can relax an individual so that the person is in a nice, calm space,” Dr. Znidarsic says. “From there they can tap into their feelings and work on some of the emotional feelings such as anger and frustration that accompany pain.”

Some practitioners of hypnosis, which is the induction of a very relaxed state, use it as an aid to psychotherapy. The theory behind this is that when in a hypnotized state, there are fewer barriers in the conscious mind for psychotherapeutic exploration. When an individual is hypnotized, for instance, the practitioner might suggest to the person that his or her arthritis pain can be turned down, much like the volume of a radio.

Meditation

“Meditation and simple breathing techniques are among the useful methods to help alleviate chronic pain,” says Kiran Patel, MD, director of Neurosurgical Pain at Lenox Hill Hospital in New York City.

“All types of meditation have been proven to be helpful against pain,” Dr. Znidarsic says. “Meditation gets the body to be relaxed and rested, so there is no longer the fight-or-flight response to pain.”

Meditation can be effective whether you practice it for 10, 20, or 30 minutes daily, she says. If you’re not sure how to get started, there are many cell phone apps that walk you through a guided meditation, including Head Space and Insight Timer.

Relaxation and Breathing Exercises

The goal in relaxation and breathing exercises is to produce the body’s natural relaxation response, which is characterized by slower breathing, lower blood pressure, and a feeling of increased well-being, according to the National Institutes of Health.2 Relaxation techniques can help a variety of health conditions and may help with chronic pain and headaches in children and adolescents, according to the NIH.

“We tend to breathe short breaths when we are in pain,” Dr. Znidarsic says. “Learning to breathe deeply can help alleviate the pain. It is important that you learn to relax your muscles and do deep breathing.”

Music Therapy

Could listening to tunes on your iPod help with pain? Some research shows that it may. Music can actually reduce opioid requirements and may lessen postoperative pain, research shows. 3

Investigators looked at the effect of music on acute, chronic, or cancer pain intensity as well as pain relief and analgesic requirements. Some studies found that study participants exposed to music had a 70% higher likelihood of having pain relief than unexposed participants. Other studies found that participants required less opioid medication two hours after surgery, as well as 24 hours post surgery.

Music therapists help people find whatever music holds meaning for them, and teach people how to fully listen to that music and how to engage their brain so that their perception of pain is overcome by many sources, on many levels. For pain management, music therapy could include not just listening to music but composing music, songwriting, playing instruments, and singing.4

“Music therapy can be useful when used in conjunction with a multimodal treatment plan,” says Dr. Patel. “It can help with muscle relaxation and when experiencing bouts of acute or chronic pain.” Additionally, music therapy can bring joy to a person suffering pain, adds Dr. Znidarsic. “Music therapy is a chance to be creative.”

TENS

A wearable TENS device delivers a series of mild electrical pulses to the body that can alleviate pain caused by conditions like fibromyalgia and rheumatoid arthritis. The acronym, TENS, stands for Transcutaneous Electrical Nerve Stimulation. Research shows that TENS is effective against pain, says Dr. Shrikhande, pointing to recent research in Current Rheumatology Reports. “One meta-analysis was able to show the positive treatment effects of electrical stimulation for relief of chronic musculoskeletal pain, and randomized controlled trials consistently demonstrate the effectiveness of TENS for acute, emergent, and postoperative pain conditions,” wrote the authors in Current Rheumatology Reports. “However, the effectiveness of TENS on individual pain conditions, such as low back pain, is still controversial, likely because of poor study designs and small sample size. Thus, continued research of TENS mechanisms and stimulation parameters in adequately characterized patient populations is critical.”

TENS can be used for any type of pain, Dr. Shen says. “It is very low risk,” she says. “Some people will benefit from it so try it to see if it helps you.” You can buy and use a TENS unit at home, Shrikhande says. “How long you would use it depends on the condition you are treating,” she says. “I don’t recommend a specific one as there have been no clinical trials comparing them.”

Therapeutic Massage

Therapeutic massage (which should never actually hurt) can be effective in providing relief for individuals who suffer from chronic pain, some studies show. Massage therapists employ a holistic approach in which they focus on the entire body system, not just on the site of the pain the person is experiencing. Massage therapy, which may relieve muscle and other soft tissue pain, can help individuals become more aware of their bodies. By virtue of human touch, therapeutic massage impacts the individual in a positive way. While additional research is needed to determine the optimal uses of massage, it stands to have a positive impact on patients with acute as well as chronic pain.4

Ultrasound

While one study found that there is still “limited effectiveness” in the treatment of lower back pain with ultrasound, many pain experts feel it can be effective. “There are three primary benefits,” says Shrikhande. “The first is speeding up the healing process from the increase in blood flow in the treated area. The second is the decrease in pain from the reduction of swelling and edema and the third is the gentle massage of muscle tendons or ligaments in the treated area.”3 Ultrasound would be administered by a trained professional such as a physiatrist.

Yoga and Tai Chi

Among the forms of exercise that can be helpful for pain is yoga, a meditative movement practice that is believed not just to reduce stress and improve fitness, but to reduce low back pain. Yoga, among other techniques, teaches the individual that his or her breath is the “bridge” that links body and mind. When practicing certain poses called asanas, which focus on the proper way to inhale and exhale, a deep sense of relaxation throughout the body can result.3

It’s important to find the appropriate form of yoga, says Judi Bar, yoga program manager at Cleveland Clinic’s Wellness Institute. “It is best to find an experienced yoga teacher,” she says. “The instructor needs to be experienced in order to guide the student through gentle moves so he or she can get accustomed to moving again and finding out what they can tolerate. Ultimately, through gentle movement, breathing, and relaxation, the goal is for the student to find they can manage pain better.”

Tai chi, on the other hand, is more of a daily meditative exercise that incorporates some breathing into the movements, says Dr. Shen. “It also includes some stretching and it can be effective against pain,” she says.

Updated on: 04/29/19 View Sources

Sources:
Email or phone interview with the following doctors and experts—
1. Josie Znidarsic, OD with the Cleveland Clinic’s Wellness Institute (hypnosis)
2. Kiran Patel, MD Lenxo Hill Hospital, New York, NY (biofeedback)
3. Allyson Shrikhande, MD Lenox Hill Hospital New York NY (cold and heat therapies)
4. Hong Shen, MD Cleveland Clinic’s Wellness Institute (biofeedback)
5. Jamie Starkey, LAc Cleveland Clinic’s Center for Integrative and Lifestyle Medicine (Chinese medicine)
6. Judi Bar Cleveland Clinic’s Wellness Institute (yoga)

Continue Reading: Using Your Head to Control Your Pain

Want a drug-free way to help you manage pain? Cognitive behavioral therapy (CBT), which involves improved self-talk and a practical approach to problem solving, is best known for helping people with anxiety and insomnia. CBT may also help ease chronic pain.

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CBT is a short-term, goal-oriented form of talk therapy. The goal is to learn new ways of managing pain through relaxation techniques and coping strategies. What’s interesting about this drug-free approach is that it recognizes that pain can have different triggers in different people.

According to pain psychologist Jill Mushkat Conomy, PhD, “CBT recognizes that each person is unique and their pain and its consequences are unique to them.”

She uses CBT to help patients develop skills for managing the impact of pain on their life or to help them to learn to live with a new orthopaedic implant.

How does CBT work?

CBT starts at the root of many problems: a person’s thoughts.

For example, we can focus on dysfunctional thoughts — the things we tell ourselves — that may reflect all-or-nothing thinking, catastrophizing (in which we believe something is worse than it actually is), or other ideas that can lead us to choose self-defeating options.

“In the case of pain, a person may say to themselves: “‘I’ll never be any better,” with the subsequent thought, “why bother?” The subsequent behavior becomes: Do nothing,” Dr. Mushkat Conomy says.

We can then use CBT to break down that statement. A person can realize those thoughts are not true. Instead, they might realize: “I have had better days since this happened, and some days I have setbacks, but that does not mean I will never be better.”

Then, we may explore what made some days better than others, and apply those skills to make improvements.

“A big part of this centers on helping people regain control over their lives. Often what they tell themselves makes them feel that they have no control and the pain is in control,” Dr. Mushkat Conomy says.

How CBT could help with back pain

Here’s an example of how you might use CBT to deal with back pain. To help weigh the options, you could take a piece of paper and write:

Options Consequences
Take medication May help but can cause drowsiness. Feel less in control.
Exercise May help, but results not immediate. Feel more in control.
Improve sleep habits Have more energy, feel rested.

By writing down options, and anticipating possible consequences, it becomes easier to make better choices. This is a better alternative to providing self-statements that provoke feelings of hopelessness and helplessness.

“Look at what worked before, what didn’t, what could be done differently, and what is the worst that can happen if I try?,” says Dr. Mushkat Conomy.

“For women, issues of family stress, weight gain and sexuality can be front and center when it comes to the onset of pain,” she says. “When meeting with patients, I share a long list of biological, psychological and social issues to consider for us to get the conversation started.”

As she reviews these factors, she works with patients to develop skills for managing the challenges of living with pain. “CBT helps patients feel more in control of their pain,” she says.

Pain Management Without Drugs

Pain Management: Hot and Cold Therapy

Heat therapy boosts blood flow to areas of the body in pain due to inflammation, and allows muscles to relax. You can apply a heating pad or a heat wrap, or relax in a hot bath for pain management, which can soothe body and soul.

Cold therapy can also be useful in pain management. By slowing blood flow to a painful joint, swelling is reduced and nerves aren’t able to quickly send messages of pain. Applying ice, a cold wrap, or a cold pack can ease a flaring, painful joint.

Pain Management: Therapy for the Mind

Anxiety, stress, and depression can aggravate chronic pain, so it’s important not to ignore the emotional side of your pain. Cognitive-behavioral therapy, which can teach you how to manage thoughts and feelings and your body’s physical response, can effectively manage chronic pain. Biofeedback is another method that teaches you how to control your body’s reactions to pain, while hypnosis allows deep relaxation to help with pain management.

Pain Management: TENS Treatment

By electrically stimulating the area where the pain is localized, you can actually help alleviate it. Transcutaneous electrical nerve stimulation, or TENS, is the electrical stimulation technique most often used in pain management. A small device attached to the skin sends electrical impulses to the painful area, stimulates the nerves, and as a result, reduces pain.

The Right Solution for You

You don’t have to live with chronic pain or rely on a bottle of pills for the rest of your life. There are so many pain management options to choose from that by consulting with your doctor, you’re sure to find a method that works to control your pain.

Non-Drug Pain Management

What is pain?

Pain is a signal in your nervous system that something may be wrong. It is an unpleasant feeling, such as a prick, tingle, sting, burn, or ache. Pain may be sharp or dull. It may come and go, or it may be constant. You may feel pain in one area of your body, such as your , abdomen, chest, pelvis, or you may feel pain all over.

There are two types of pain:

  • Acute pain usually comes on suddenly, because of a disease, injury, or inflammation. It can often be diagnosed and treated. It usually goes away, though sometimes it can turn into chronic pain.
  • Chronic pain lasts for a long time, and can cause severe problems

What are pain relievers?

Pain relievers are medicines that reduce or relieve pain. There are many different pain medicines, and each one has advantages and risks. Some are over-the-counter (OTC) medicines. Others are stronger medicines, which are available by prescription. The most powerful prescription pain relievers are opioids. They are very effective, but people who take them are at risk of addiction and overdose.

Because of the side effects and risks of pain relievers, you may want to try non-drug treatments first. And if you do need to take medicines, also doing some non-drug treatments may allow you to take a lower dose.

What are some non-drug treatments for pain?

There are many non-drug treatments that can help with pain. It is important to check with your health care provider before trying any of them:

  • Acupuncture involves stimulating acupuncture points. These are specific points on your body. There are different acupuncture methods. The most common one involves inserting thin needles through the skin. Others include using pressure, electrical stimulation, and heat. Acupuncture is based on the belief that qi (vital energy) flows through the body along paths, called meridians. Practitioners believe that stimulating the acupuncture points can rebalance the qi. Research suggests that acupuncture can help manage certain pain conditions.
  • Biofeedback techniques use electronic devices to measure body functions such as breathing and heart rate. This teaches you to be more aware of your body functions so you can learn to control them. For example, a biofeedback device may show you measurements of your muscle tension. By watching how these measurements change, you can become more aware of when your muscles are tense and learn to relax them. Biofeedback may help to control pain, including chronic headaches and back pain.
  • Electrical stimulation involves using a device to send a gentle electric current to your nerves or muscles. This can help treat pain by interrupting or blocking the pain signals. Types include
    • Transcutaneous electrical stimulation (TENS)
    • Implanted electric nerve stimulation
    • Deep brain or spinal cord stimulation
  • Massage therapy is a treatment in which the soft tissues of the body are kneaded, rubbed, tapped, and stroked. Among other benefits, it may help people relax, and relieve stress and pain.
  • Meditation is a mind-body practice in which you focus your attention on something, such as an object, word, phrase, or breathing. This helps you to minimize distracting or stressful thoughts or feelings.
  • Physical therapy uses techniques such as heat, cold, exercise, massage, and manipulation. It can help to control pain, as well as condition muscles and restore strength.
  • Psychotherapy (talk therapy) uses methods such as discussion, listening, and counseling to treat mental and behavioral disorders. It can also help people who have pain, especially chronic pain, by
    • Teaching them coping skills, to be able to better deal with the stress that pain can cause
    • Addressing negative thoughts and emotions that can make pain worse
    • Providing them with support
  • Relaxation therapy can help reduce muscle tension and stress, lower blood pressure, and control pain. It may involve tensing and relaxing muscles throughout the body. It may be used with guided imagery (focusing the mind on positive images) and meditation.
  • Surgery can sometimes be necessary to treat severe pain, especially when it is caused by back problems or serious musculoskeletal injuries. There are always risks to getting surgery, and it does not always work to treat pain. So it is important to go through all of the risks and benefits with your health care provider.

The over-prescription of opioid painkillers such as Hydrocodone and OxyContin is one of the main causes of the current addiction epidemic in this country. According to the Centers for Disease Control (CDC), nearly 50 percent of all opioid-related overdose deaths in the US involve a prescription painkiller and almost two million people in this country abuse or are dependent on prescription opioids.

Unfortunately, people have legitimate pain issues that can lead to a substance use disorder. As many as 25 percent of people who receive prescription painkillers in a physician’s office or hospital are struggling with addiction. The CDC has recently released guidelines aimed at reducing the misuse of opioid pain medications. Here are ten ways that various experts recommend managing pain without the use of opioids.

1. Biofeedback. Biofeedback is a treatment or exercise that allows a patient to learn to consciously control his or her heart rate and response to stimuli on a screen. It is useful for pain management because it can teach patients to bring their own pain levels under control.

2. Chiropractic Care. Chiropractic care is now an accepted form of treatment for chronic low back pain, neck pain, and headaches. A chiropractor manipulates the spine to help the body function properly and may also order physical therapy and massage treatment.

3. Eastern Medicine. Also referred to as Chinese medicine, this is a term that encompasses both herbal treatments as well as acupressure and acupuncture. Acupuncture, in particular, has been used for the relief of pain in the shoulder, low back, neck, and knees.

4. Hypnosis. When patients undergo hypnosis, they receive suggestions that help them respond differently to sensations and feelings in their body. A patient can learn to use relaxation and other techniques to reduce anxiety, which can also result in lower levels of pain.

5. Cold and Heat. Cold and heat are accepted as effective therapies against chronic pain in various parts of the body. Cold helps reduce inflammation and heat can alleviate spasms in muscles.

6. Meditation. One method of reducing pain is incorporating various relaxation exercises into everyday life. This includes learning to breathe to lower blood pressure and practicing meditation techniques. Meditation can help reduce the “fight-or-flight” response to pain, and there are even smartphone apps that act as simple guides.

7. Massage. Massage therapy is another effective way to provide relief from chronic pain. Most massage therapists will provide massage to the affected area as well as the whole body with the goal to relieve muscle pain as well as improve circulation.

8. Medication. Just because you are avoiding opioid painkillers, that does not mean that you cannot take any medications for chronic pain. Among the medicines that the CDC recommends for pain relief are:

  • Analgesics such as Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and acetaminophen
  • Antidepressants
  • Topical agents

9. TENS. A Transcutaneous Electrical Nerve Stimulation (TENS) produces electrical stimulation in the affected area, which has been shown to reduce pain related to musculoskeletal conditions.

10. Yoga and Tai Chi. Exercise can be an excellent way to build up the muscles around damaged tissue and vertebrae. Among the best forms of exercise are those that use slow and smooth movements such as yoga and Tai Chi. These are both guided programs that also focus on breathing and relaxation techniques.

Learn About Addiction Recovery Options for Opioid Use Disorder

For some chronic pain suffers, addiction to opioid pain medication is already a reality. Living with an opioid use disorder can be frightening and disheartening, but there is a way out as well as effective non-opioid treatment for your pain issues. Contact The Recovery Village now to learn more about how our comprehensive addiction recovery program can help you break free from opioid addiction and find a new way to live.

Pain Relief Without Drugs or Surgery

Pain relief doesn’t always come in a bottle of pills. Pain can take many forms and relief is not a one-size fits all process. This Special Health Report, Pain Relief Without Drugs or Surgery, explores beyond the boundaries of standard medical treatments (drugs and surgery) and describes the many other approaches that are available for pain relief.

Pain is debilitating, interfering with the ability to sleep, work, and enjoy life. It can aggravate other health conditions and lead to depression and anxiety symptoms. Relieving it often requires a trial-and-error approach that embraces the whole person, not just the source, which cannot always be identified clearly. Many people find it useful to choose from a menu of different pain treatments and remedies, combining them in a regimen that fits their lifestyles.

In addition to the standard pain medications, and surgical repairs of specific problems, patients and their clinicians also have access to a wide range of nondrug therapies for pain. Acupuncture, biofeedback, topical treatments, assistive devices, tai chi and yoga are just a few of the many options available. Not everyone is able or willing to take pain medication every day, and not everyone can or should have surgery for painful conditions. The good news is that mainstream medicine is embracing a wider variety of treatments than ever before. And it’s important to recognize when it’s time to see a physician for an evaluation of pain. If a new pain develops and persists beyond a few days, check with your doctor. And see a doctor immediately if you have chest pain or anything else that could be serious. Severe pain should always be a signal that medical consultation is needed.

Pain Relief Without Drugs or Surgery​ compiles the latest information on a variety of nondrug pain-relieving therapies and their applications to a number of common types of pain. It also provides specific treatments for 10 common pain conditions including low back pain, knee pain, shingles, heel pain, fibromyalgia, and others.

Pain Relief Without Drugs or Surgery was prepared in collaboration with the editors of Harvard Health Publishing and Melissa L. Colbert, MD, Instructor in Physical Medicine and Rehabilitation, Harvard Medical School, Interim Medical Director, Spaulding Rehabilitation Outpatient Center (2019).

Negative emotions like fear, sadness, and anger are a basic part of life and sometimes we struggle with how to deal with them effectively. It can be tempting to act on what you’re feeling right away, but that often doesn’t fix the situation that caused the emotions. In fact, it may lead to more problems to deal with down the road.

Some of the harmful ways that people deal with negative emotions:

Denial

Denial is when a person refuses to accept that anything is wrong or that help may be needed. When people deny that they are having problematic feelings, those feelings can bottle-up to a point that a person ends up “exploding” or acting out in a harmful way.

Withdrawal

Withdrawal is when a person doesn’t want to be around, or participate in activities with other people. This is different than wanting to be alone from time to time, and can be a warning sign of depression. Some people may withdraw because being around others takes too much energy, or they feel overwhelmed. Others may withdraw because they don’t think other people like them or want them to be around. In some cases, people who have behaviors that they are ashamed of may withdraw so other people don’t find out about what they are doing. But withdrawal brings its own problems: extreme loneliness, misunderstanding, anger, and distorted thinking. We need to interact with other people to keep us balanced.

Bullying

Bullying is when a person uses force, threats, or ridicule to show power over others. People typically take part in bullying behavior because they don’t feel good about themselves and making someone else feel bad makes them feel better about themselves or feel less alone. It is harmful to both the bully and the person being bullied and does not address underlying issues.

Self-harm

Self-harm can take many forms including: cutting, starving one’s self, binging and purging, or participating in dangerous behavior. Many people self-harm because they feel like it gives them control over emotional pain. While self-harming may bring temporary relief, these behaviors can become addictive and can lead people to be more out of control and in greater pain than ever.

Substance use

Substance use is the use of alcohol and other drugs to make a person feel better or numb about painful situations. Alcohol and drug use can damage the brain, making it need higher amounts of substances to get the same effect. This can make difficult feelings even worse and in some cases, leads to suicidal thoughts or addiction. If you are concerned about your own or someone else’s use of drugs or alcohol, talk to a responsible adult right away to get help.

The good news is that with practice, everyone can do a better job of dealing with their negative emotions in healthy ways. One way to deal with uncomfortable or unpleasant emotions is to remember the word PATH. PATH stands for:

Pause Acknowlege Think Help

This step is important because instead of acting on feelings right away, you stop yourself and think things through. Count to 100 or say the alphabet backwards.

Step 2: Acknowledge what you’re feeling.

For example, are you mad at someone, or are you sad because your feelings were hurt by what they did? Whatever it is that you are feeling, it is ok to feel that way.

Step 3: Think.

Now that you have taken a few moments to figure out what exactly it is that you are feeling, think about how you can make yourself feel better.

Step 4: Help.

Take an action to help yourself based upon what you came up with in the “Think” step.

If you are having trouble thinking of ways to help yourself, try one (or a few) from this list:

Mood Boosters

  • Read the story of someone you admire
  • Watch a funny YouTube video
  • Play with an animal
  • Watch a movie you loved when you were younger
  • Reorganize your room
  • Make a list of places you want to travel

Address Your Basic Needs

  • Eat a healthy snack.
  • Drink a glass of water.
  • Take a shower or bath.
  • Take a nap.

Process Feelings

  • Draw how you’re feeling.
  • Make a gratitude list.
  • Punch a pillow.
  • Scream.
  • Let yourself cry.
  • Rip paper into small pieces.
  • Vent. Venting is not the same as asking for help, it’s taking an opportunity to share your feelings out loud. We do this naturally when we talk with someone we can trust about whatever is upsetting us. You can also vent by writing a letter to the person who upset you. Keep the letter a couple of days and then tear it up. Stick to pen and paper—using social media when you are highly emotional can be tempting, but you might say something you regret.

Problem Solving

  • Make a list of solutions to problems – it can help to brainstorm with a friend of family member.
  • Make a list of your strengths. There are plenty of things about you that are awesome, no matter how down you are feeling at the moment.
  • If a person has upset you, talk with them directly. Fill in the blanks to this sentence – “I feel ______ when (this happens) because ______. Next time, could you please ________.” Example: “I feel left out when there is no room at the lunch table, because then I don’t have friends to talk to. Next time can you please save me a seat?”

Volunteering/Acts of Kindness

  • Do something nice for someone you know.
  • Help a stranger.
  • Volunteer your time.

Hobbies/Stress Relievers

  • Learn something new – there are tutorials for all kinds of hobbies online.
  • Create – try a craft project, color, paint, or draw. Invite a friend to join you for added fun.
  • Write – you could write a story, a poem, or an entry in a journal.
  • Get active – dancing, running, or playing a sport are some good ways to get moving.
  • Play a video game.
  • Get a plant and start a garden.

Relaxation Exercises

  • Practice belly breathing –put one hand on your stomach and start to inhale slowly. As you breathe in, imagine a balloon in your stomach filling up and continue to inhale until the balloon is very full. Put your other hand on your heart, feel your heartbeat, and hold your breath for 5 seconds. Now let your breath out slowly for 10 seconds – feel your belly flatten like a deflating balloon. Repeat this process 4 or 5 times and you should notice your heart beat slow down and your muscles relax.
  • Try progressive muscle relaxation –clench your toes for a count of 5, then relax them for a count of 5, then move to your calves, then your thighs, then your abs, then your arms, then your neck.
  • Play with Play-Doh.
  • Go for a walk – feel the ground under your feet and the air on your skin. Focus on your senses.
  • Find a guided meditation on YouTube.
  • Do yoga – you can find videos on demand using your tv or online.
  • Read a book.
  • Listen to music, a podcast, or an audiobook.
  • Unplug – turn off your phone, tablet, and/or computer for an hour or so.

Ask for Help

  • Text a friend.
  • Ask someone to just sit with you.
  • Call a family member.
  • Talk to an adult you trust.
  • Call a friend you haven’t talked to recently.
  • If you are in crisis, call 1-800-273-TALK or text “MHA” to 741741.

If nothing seems to work…

If you still feel sad, worried, or scared after trying to help yourself, you might be showing the early warning signs of anxiety or depression.

A screening is an anonymous, free, and private way to learn about your mental health and if you are showing warning signs of a mental illness. Visit mhascreening.org to take a screen?it only takes a few minutes, and after you are ÿnished you will be given information about the next steps you should take based on the results.

A screening is not a diagnosis, but it can be a helpful tool for starting a conversation with your doctor or a loved one about your mental health.

Adapted from Red Flags: Harmful Coping Responses and Coping Responses.

Veterans benefit from pain treatment without drugs

A new study finds a lower risk of adverse post-treatment outcomes among returning military service personnel with chronic pain who received nondrug therapy.

Share on PinterestNew research shows that some nondrug therapies, including exercise therapy, can help relieve pain in veterans.

Many people returning from military deployment experience physical and mental health issues.

These can include chronic pain, post-treatment alcohol use disorder, drug addiction, depression, thoughts of suicide, self-harm, or a combination.

Now, a new study in the Journal of General Internal Medicine concludes that receiving treatment that is not drug-based can reduce the likelihood of such outcomes in veterans with chronic pain.

According to the findings, United States Army service members who received nondrug therapy had a “significantly lower” risk of:

  • alcohol or drug use disorders
  • accidental poisoning with opioids, related narcotics, barbiturates, or sedatives
  • thoughts of suicide
  • self-inflicted injuries, including suicide attempts

The Department of Veterans Affairs (VA), the National Institute on Drug Abuse, and the National Center for Complementary and Integrative Health funded the new research.

Study methods

Statistician and suicide researcher Esther Meerwijk, Ph.D., of the VA Palo Alto Health Care System, in California, led the new study.

Meerwijk and colleagues analyzed military health records of 142,539 active Army personnel who had reported chronic pain after deployment to Iraq or Afghanistan in 2008–2014.

The scientists included data from up to the end of 2015 in their analysis. The median age of the personnel was 26, and their average tour of duty lasted just over 1 year.

Health issues involving the joints, back and neck, muscles, or bone were the most frequently reported causes of chronic pain.

According to the study, 29–44% of the active duty service members reported chronic pain to the Military Health System (MHS), with that number rising to 48–60% among those who went on to receive treatment from the Veterans Health Administration (VHA).

The researchers tracked the length of each individual’s care, the drug or nondrug therapies that they had received from the MHS, and the number of days, if any, during which they had taken opioids.

The analysis included the following nonpharmaceutical therapies (NPTs) offered by the MHS: “acupuncture dry needling, biofeedback, chiropractic care, massage, exercise therapy, cold laser therapy, osteopathic spinal manipulation, transcutaneous electrical nerve stimulation and other electrical manipulation, ultrasonography, superficial heat treatment, traction, and lumbar supports.”

Among the NPT group, 92.2% had received exercise therapy. Other nondrug therapies were less common, as described below:

Fewer than 10% of the individuals in the NPT group had received one of the other nondrug therapies.

Assessing outcomes

The researchers evaluated adverse outcomes by analyzing the individuals’ medical records after they had left service and transitioned to VHA care.

Since the study’s scope was relatively short-term, the authors acknowledge that “The potential long-term protective effect of NPT against adverse outcomes has not been examined.”

Still, the team’s analysis saw a reduction in adverse outcomes among those who had received NPT. The most significant effect was a 35% decline in the risk of accidental poisoning from opioids, related narcotics, barbiturates, or sedatives.

In addition, the researchers observed that the NPT group:

  • were 17% less likely to sustain self-inflicted injuries, including those involved in suicide attempts
  • were 12% less likely to experience thoughts of suicide
  • were 8% less likely to experience alcohol or drug use disorders

“It made sense that if nondrug treatments are good at managing pain, their effect would go beyond only pain relief,” says Meerwijk.

“However, I was surprised that the results of our analyses held, despite our attempts to prove them wrong. Often enough in research, significant results disappear once you start controlling for variables that can possibly affect the outcome of the study.”

Though the authors note that their analysis establishes correlation rather than causation, Meerwijk suggests a possible mechanism at work:

“We may be seeing a genuine effect of nondrug therapies that occurs regardless of whether soldiers use opioids or not.”

Esther Meerwijk, Ph.D.

“If nondrug treatments make chronic pain more bearable, people may be more likely to have positive experiences in life. That makes them less likely to have thoughts of suicide or to turn to drugs,” Meerwijk proposes.

Noting the VA’s interest in her study and its results, Meerwijk is hopeful that the benefits of nondrug therapies for chronic pain will prompt military medical authorities to turn to nonopioid solutions more regularly.

Alternative Treatments That Work on Pain

Research shows these therapies can ease discomfort. For more information visit the website of the National Center for Complementary and Alternative Medicine.
TYPEWHAT THEY HELPHOW THEY WORKEXAMPLES
Movement-Based Therapies:
Physical exercises and practicesMusculoskeletal pain, joint pain, and lower-back painBy strengthening muscles supporting joints, improving alignment, and releasing endorphins• Physical therapy: Specialized movements to strengthen weak
areas of the body, often through resistance training
• Yoga: An Indian practice of meditative stretching and posing
• Pilates: A resistance regimen that strengthens core muscles
• Tai chi: A slow, flowing Chinese practice that improves balance
• Feldenkrais: A therapy that builds efficiency of movement
Nutritional and Herbal Remedies:
Food choices and dietary supplements (ask your doc before using supplements)All chronic pain but especially abdominal discomfort, headaches, and inflammatory conditions such as rheumatoid arthritisBy boosting the body’s natural immunity, reducing pain-causing inflammation, soothing pain, and decreasing insomnia• Anti-inflammatory diet: A Mediterranean eating pattern high in whole grains, fresh fruits, leafy vegetables, fish, and olive oil
• Omega-3 fatty acids: Nutrients abundant in fish oil and flaxseed that reduce inflammation in the body
• Ginger: A root that inhibits pain-causing molecules
• Turmeric: A spice that reduces inflammation
• MSM: Methylsulfonylmethane, a naturally occurring nutrient that helps build bone and cartilage
Mind-Body Medicine:
Using the powers of the mind to produce changes in the bodyAll types of chronic painBy reducing stressful (and, hence, pain-inducing) emotions such as panic and fear, and by refocusing attention on subjects other than pain• Meditation: Focusing the mind on something specific (such as breathing or repeating a word or phrase) to quiet it
• Guided imagery: Visualizing a particular outcome or scenario with the goal of mentally changing one’s physical reality
• Biofeedback: With a special machine, becoming alert to body processes, such as muscle tightening, to learn to control them
• Relaxation: Releasing tension in the body through exercises such as controlled breathing
Energy Healing:
Manipulating the electrical energy—called chi in Chinese medicine—emitted by the body’s nervous systemPain that lingers after an injury heals, as well as pain complicated by trauma, anxiety, or depressionBy relaxing the body and the mind, distracting the nervous system, producing natural painkillers, activating natural pleasure centers, and manipulating chi• Acupuncture: The insertion of hair-thin needles into points along the body’s meridians, or energetic pathways, to stimulate the flow of energy throughout the body; proven helpful for post-surgical pain and dental pain, among other types
• Acupressure: Finger pressure applied to points along the meridians, to balance and increase the flow of energy
• Chigong: Very slow, gentle physical movements, similar to tai chi, that cleanse the body and circulate chi
• Reiki: Moving a practitioner’s hands over the energy fields of the client’s body to increase energy flow and restore balance
Physical Manipulation:
Hands-on massage or movement of painful areasMusculoskeletal pain, especially lower-back and neck pain; pain from muscle underuse or overuse; and pain from adhesions or scarsBy restoring mobility, improving circulation, decreasing blood pressure, and relieving stress• Massage: The manipulation of tissue to relax clumps of knotted muscle fiber, increase circulation, and release patterns of chronic tension
• Chiropractic: Physically moving vertebrae or other joints into proper alignment, to relieve stress
• Osteopathy: Realigning vertebrae, ribs, and other joints, as with chiropractic; osteopaths have training equivalent to that of medical doctors
Lifestyle Changes:
Developing healthy habits at home and workAll types of chronic painBy strengthening the immune system and enhancing well-being, and by reframing one’s relationship to (and, thus, experience of) chronic pain• Sleep hygiene: Creating an optimal sleep environment to get deep, restorative rest; strategies include establishing a regular sleep-and-wake schedule and minimizing light and noise.

• Positive work environment: Having a comfortable workspace and control over one’s activities to reduce stress and contribute to the sense of mastery over pain.

• Healthy relationships: Nurturing honest and supportive friendships and family ties to ease anxiety that exacerbate pain.

• Exercise: Regular activity to build strength and lower stress

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