Expanding pain treatment options

There are many ways to address chronic pain beyond opioids. Although there might not be a magic pill or an instant fix, many people find that a combination of activities and treatments work well to support their overall well-being and provide pain relief.

In this module, we help you explore new treatment ideas. We also help you consider whether any treatments you’ve tried before might be worth retrying.

It is important to remember that you are the expert on your pain, and you have a choice about the treatments you try. The goal of this module is to help you expand your options and find ways to add to your pain management toolkit.

Pictogram symbol of a person.

Laura, age 70, back pain

“For me, it was massage. It helped me mentally and physically, it was really focusing on me. I went weekly for 12 weeks and it was like my body didn’t have tension in it, it didn’t have as much pain, and I really think that helped tremendously, just having that time where I was pain free or had less pain. I’m never pain free, but I had less pain. It made a difference. And then like I said, the DBT skills, thinking of something to do. My therapist had me do a lot self-care, and having something to look forward to, going for a walk with a friend, get things set up on the calendar that you focus on. … Like I said , having a good therapist is critical. It really makes a big difference finding the right therapist, the right counselor.” ”

Check Your Understanding

Here are a few questions for you to try answering. You won’t be graded on your answers. These are just for you to see what you already know about this topic.

Learn/Refresh

In Module 2, we discussed how chronic pain is more complicated than scientists previously thought. So, perhaps it’s not surprising that treating chronic pain often involves multiple treatments and approaches. And it may take some trial and error to find what combination works best for you.

Here are a few things to think about as you develop your approach to managing pain:

  • You may find it helpful to try a treatment more than once, as a lot of things can affect how well a treatment works at any one point in time.

  • You may find that different combinations of treatments work differently at different times in your life.

  • To work best, most treatments for chronic pain need to be repeated regularly. They might also need to become part of your daily or weekly routine.

  • Your care team is there to provide advice. Always consult with your insurance provider for coverage information.

Now, let’s explore some ways to treat chronic pain that don’t involve taking opioids.

1

Re-training the brain:
Behavioral approaches like counseling to support “retraining the brain” and reframing your pain.

2

Supporting the body:
Physical treatments that support your body by improving your strength and flexibility.  

3

Supporting the whole person:
Complimentary and integrative health treatments and self-care strategies to support you as a whole person.

4

Non-opioid medications:
Prescription and over-the-counter medications that may work as well or better than opioids for treating your pain and that have fewer risks and side effects.

1) Re-wiring the Brain: Behavioral Approaches

Behavioral approaches are some of the most effective treatments for chronic pain.

Things you should know about behavioral approaches...

  • Talk therapy for chronic pain does not mean the pain is “in your head.” Rather, a trained mental health provider will work with you to identify how the pain is interfering with your life and work with you to develop tools and plans for addressing your unique needs.

  • Examples of behavioral approaches include counseling, talk therapy, cognitive behavioral therapy (CBT), and acceptance and commitment therapy (ACT).

  • Many patients find it validating to spend time with someone who understands their chronic pain experience and who can provide real-world, practical advice and support. People also gain practical skills like “pacing” and then put those into practice. Over time, these approaches work to help “re-wire” the brain and its relationship to pain.

  • You can influence your nervous system by practicing activities and thoughts that help cope with pain. Many of these activities can be learned from professionals in a care setting, or you can develop your practice at home on your own.

Linda, age 45, back pain from scoliosis

“I do regularly attend counseling. Sometimes we talk about chronic pain and sometimes we talk about the weather, it's whatever is affecting me today. But being in chronic pain does affect your emotional health and you have to have the right avenue to deal with that, to have the tools that you need to make it through life.”

Here are some examples of practical strategies you can try, either working with a professional or on your own…

  • Trained professionals can provide expert support through talk therapy. A few common  approaches to talk therapy include:

    • Counseling involves talking with a trained counselor about your experience of chronic pain and strategies to refine and improve pain management. You might meet with a counselor one-on-one or in a group.

    • Cognitive behavioral therapy (CBT) helps you identify and change the ways automatic responses (thoughts and behaviors) make coping with chronic pain more difficult. 

    • Acceptance and commitment therapy (ACT) focuses on helping you learn to accept difficult emotions and thoughts rather than trying to change them.

  • Finding your own practices can also be very helpful.

    • Mindful thinking, deep breathing, and meditation are all ways to reduce stress that accompanies pain and help manage pain overall. Apps, local classes, books, and articles are great ways to explore these options.

    • Movement and gentle activity with “pacing” provides a way to retrain your brain. The goal of pacing is to help you find a balance between activity and rest, so you can do the things you love without overdoing it and setting yourself back. Over time, you become less likely to expect pain and more likely to expect good things.

2) Supporting the Body:
Physical treatments

Taking care of your body is key to managing pain. Many people use treatments like physical therapy or therapeutic exercise early in their pain journey. For people with chronic pain, these therapies can continue to be valuable parts of their treatment plan.

Things you should know about physical approaches:

  • Increasing your strength and flexibility can help you do everyday tasks and activities, even if your underlying pain does not go away.

  • Research suggests physical therapy is effective for acute (short-term) pain. For chronic pain, it is most helpful if you have specific goals you want to achieve — for example, if you want to improve your movement by strengthening your back muscles and increasing your flexibility.

  • Your diet and nutrition can also affect your pain by affecting how much inflammation is in your body and your sleep. Our bodies are always reacting to changes and sometimes food or stress can trigger our immune system to overreact, and this can result in increased pain.

Brian, age 33, sickle cell

“Less bread, less red meat, vegetable oils and things like that. Less sugar. Anything with white sugar and stuff like that. Try to do some type of light physical activity, 90 minutes per week. I started juicing as well, fruits and vegetables, it really helps. So dieting and spiritual help and CBD helped.”

Here are some examples of practical strategies you can try, including professional care and activities you can try on your own…

  • This can be especially helpful when starting out. An expert can provide guidance, help you set realistic goals, and give you feedback on how you are doing.

    • Physical therapy uses exercises, stretches, and movements to address the underlying cause of pain by improving strength and mobility.

    • Occupational therapy focuses on improving your ability to do your daily activities. This may involve making changes to your environment, helping you improve certain movements, and finding new tools and approaches to doing specific tasks.

    • Manipulative therapy involves a specialist moving or massaging one or more parts of your body to relieve pain and improve movement. Examples include osteopathic and chiropractic care, myofascial release, and structural medicine.

    • Advice from a dietician can help you support your body through better eating habits and nutrition which can relieve chronic inflammation.

    • Therapeutic exercise, like physical therapy done in water, can help you improve your strength and flexibility through gentle movements.

  • Self-care options that help you strengthen your body are plentiful. They also have the advantage of being fairly low cost and may fit better into your schedule than professional care.

    • Exercise can improve strength, balance, flexibility, and self-awareness. Exercise does not need to be vigorous and may include practices that involve slow, gentle movements.  Examples of more gentle exercise options include tai chi and water aerobics. You can also consider other activities that build your strength and overall fitness, such as fitness classes at your local community center, walking with friends, weight training, or any physical activity that you enjoy. Find what works for your goals and is available in your area…and remember not to overdo it, even a few minutes of exercise can help.

    • Nutrition information and advice is plentiful in books, websites, apps, and other sources. Look for information that is based on research. There are many diets that promote extreme changes that might not be helpful or practical for making sustainable changes. Overall, look for nutritional advice that helps you eat less sugar and more vegetables. Your doctor could be a source of information.

    • Heating pads, hot baths or showers, saunas, and other activities involving heat can help relax your muscles and other tissues, calm stress, and help reduce pain.

3) Supporting the whole person

There is growing recognition that a wide array of whole-person treatments provide relief for chronic pain. Whole-person treatments consider all aspects of a person’s well-being—body, mind, emotions, and social life.

Things you should know about whole person approaches: 

  • Acupuncture, massage, and yoga are common whole-person treatments. Acupuncture and massage are provided or overseen by licensed professionals. Yoga instruction is widely available in gyms, community centers, and other locations. Research shows that these treatments can provide relief from pain. Many people we spoke with reported finding value in adding these treatments to their pain-relief toolkit.

  • Addressing the whole person goes beyond professional treatments. It also includes how you take care of yourself. How you respond to stress and pain are connected, so reducing stress also can reduce pain. Mindfulness, deep breathing, and meditation are common practices for reducing stress and managing pain.

  • Spirituality and religion can also play important roles for some people. Consider spiritually meaningful activities that enhance your well-being as a part of your tool-kit.

Here are some examples of practical strategies you can try, including professional care and activities you can try on your own…

  • Trained professionals can provide tailored, personal care.

    • Acupuncture is based on traditional medical practices from Asia. It focuses on balancing and regulating the whole body by inserting thin needles into specific points. Acupressure and cupping are other treatments sometimes used by acupuncture practitioners.

    • Massage involves rubbing and kneading skin, muscles, tendons, and ligaments to improve pain, relieve stress, and promote health and well-being.

    • Yoga is a type of exercise that has a whole-person focus, aiming to connect the body, breath, and mind.

  • There is a lot of benefit in finding and pursuing hobbies and activities that are enjoyable or meaningful to you.

    Social connections and activities that bring you joy are important.  Engaging in a meaningful conversation or social activity can help turn down the volume on pain temporarily while keeping us connected to the people that mean the most to us.

    • Hobbies can help provide balance and enjoyment. It is important to pace yourself and not overdo it. It may also be possible to adjust the way you do hobbies to make them physically easier.

    • Distractions such as video games and virtual reality can be enjoyable activities that can help you focus less on your pain. Engaging your mind and getting lost in a game or story can help distract from pain flare ups and improve relaxation.

    • Spirituality can be a source of comfort, social connection, and strength for many people.

    • Some things that you do as therapy can also count as self-care, as they may feel good and bring enjoyment into your life. This could include therapeutic exercise or talking with a supportive counselor or therapist.

4) Non-opioid medications

There are many non-opioid pain medications that aim to alleviate pain. There are several different classes of medications used depending on the type and pain severity. Some are sold over-the-counter (OTC) and others are prescribed.

Over-the-counter (OTC) medications

can be purchased at a pharmacy or online. These are powerful medications and should be used only as directed. Here are some examples…

    • Typically used to relieve inflammation and associated pain, may have side effects like stomach upset.

    • Examples and brand names include: Acetaminophen (Tylenol), ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin

    • Patches, creams or gels that are applied to the skin.

    • Used to relieve joint or arthritis pain.

    • Examples and brand names include: Biofreeze, Aspercreme, SalonPas patches

Prescription non-opioid medications

are prescribed by your doctor on a short or long-term basis depending on the individual. These are powerful medications and should be used only as directed. Here are some examples…

    • Used for pain and nerve conditions.

    • Examples and brand names include: Gabapentin (Neurontin), Pregabanlin (Lyrica), Amitriptyline (Elavil), Duloxetine (Cymbalta)

    • Help relieve muscle spasms and pain associated with muscle injuries.

    • Examples and brand names include: Cyclobenzaprine (Flexeril), Meraxalone (Skelaxin).

Reflect

These exercises can help you think about the kinds of treatments, and combinations of treatments, that you might want in your personal pain management toolkit.

Exercise 1. Exploring treatments.

Click here to download the exercise worksheet

Exercise 2. Setting functional goals (rather than pain reduction goals).

Click here to download the exercise worksheet

Exercise 3. Learning about treatments from friends/family.

Click here to download the exercise worksheet.

Consider these possible next steps:

Looking at your notes from the exercises, think about what treatments you might like to try or try again.

  1. Select one (or more) activity to try on your own, like a self-care activity. Make a specific plan to try it out. (For example, you might make a plan to go on 2 to 3 short walks per week for a month, or you might try mindfulness for a few minutes each day for a few weeks.) Check and adjust.

  2. Select one treatment to ask your provider about. Consider what questions you have for your provider and what additional information you might want to gather first? Make a plan and reach out.

  3. Review the resource list and decide what you'd like to explore further. If you'd like to, make a “reading list” for yourself.

Close up view of hands typing on a computer keyboard and notebook next to it.

Resources

Websites with toolkits, videos, information