For many people, over the counter painkillers and anti-inflammatories can help to take the edge off their chronic pain. Doctors often prescribe a range of stronger medications for pain patients. However, pain medication doesn’t work for everybody, and many medications can have some unpleasant side effects and risks attached!
This treatment protocol on chronic pain management explains that opioids in particular reduce in effectiveness over time, can become addictive, and that they, “have adverse effects that many patients cannot tolerate”.
There are many reasons patients may want to manage their pain without medication, and thankfully there are plenty of very effective options to choose from. You might be surprised to know that chronic pain can be reduced and even completely overcome without the use of medication!
Pain Neuroscience Education (PNE)
Learning about pain science enables you to understand what is happening within your body when something hurts. They say that knowledge is power and that really is the case. By understanding how your body creates pain, you come to understand that chronic pain can be overcome.
With the knowledge that chronic pain doesn’t equal damage, and that you can train your brain away from pain, you can move from feelings of hopelessness to empowerment.
Psychological therapies can have a big positive impact on reducing, and in some cases even eliminating, chronic pain symptoms. Once you understand the science behind pain as we previously discussed, you can understand how these therapies can make such a big difference! There are a variety of options to choose from so that you can find the type of therapy which suits you and your situation.
These therapies can be accessed through your doctor or specialist who may refer you to specific therapy sessions. You may also be referred to a pain clinic which may incorporate one or more of these methods. You can access sessions privately, find them online, or through a pain relief app like ours.
- Cognitive Behavioural Therapy (CBT)
CBT is a therapy which works on the basis that our thoughts and our bodies are connected. When we perceive pain in a negative way, for example feeling that there’s nothing we can do about it, our pain actually worsens. Our behaviour changes in accordance with our thoughts. So, if we think in a maladaptive (unhelpful) way, then maladaptive behaviours follow which literally perpetuate our chronic pain.
CBT can help you to recognise those patterns and therefore change them, enabling you to replace those maladaptive thoughts with adaptive (helpful) thoughts and behaviours. These adaptive behaviours help you to manage your pain and reduce it!
- Acceptance and Commitment Therapy (ACT)
While from the same school of thought as CBT, rather than trying to change negative thoughts, ACT focuses on accepting those thoughts. By accepting your thoughts as they run through your head, you can come to understand that they are just thoughts; they don’t need to equate to actions.
ACT can help you to accept your chronic pain and the negative thoughts you may have about it, so that you find them less distressing. The therapy then teaches commitment to changing behaviours and acting in a positive way, so you can increase your functioning and reduce your chronic pain.
- Graded Exposure Therapy
Graded exposure therapy works by gradually introducing you to situations which are painful or which you fear. This gradual approach not only teaches you that you do not need to fear specific activities, but also retrains your brain by teaching it that these situations do not require pain messages to be sent out.
- Graded Motor Imagery (GMI)
GMI uses visualised movements to harness the power of the brain’s neuroplasticity and retrain the brain away from pain. Neuroplasticity simply means that your brain is changeable and learns from your experiences and environment. Your brain can learn to continue producing chronic pain, but it can also relearn not to produce chronic pain!
Mindfulness is about learning to be present in the moment, not worrying about the future or the past. It’s a powerful tool in reducing stress which in turn reduces pain levels. Through relaxation, mindfulness can allow you to gain better control over your emotions and cope with your pain more effectively.
Mindfulness can be guided, often through mindfulness meditations, guided visualization or breathing exercises. Mindfulness can also be incorporated into your everyday life in tasks such as going shopping or washing the dishes!
Biofeedback is a process of the patient taking control over their biological processes, such as controlling stress levels. This type of therapy typically involves heart rate monitors for example, to make the patient aware of how their heart rate rises when they are stressed.
Once this awareness is gained, the medical professional teaches the patient how to calm their heart rate through relaxation. This article from the National Institutes of Health explains that biofeedback, “teaches you to be more aware of your body functions so you can learn to control them.” Stress and pain are deeply interlinked, and once you learn how to reduce stress responses in the body, so you can reduce your pain levels.
Biofeedback can also be used to identify and control other biological processes, including muscle tension which can contribute to chronic pain. As patient’s learn to recognise when their muscles are tense and how to relax them, their pain can be reduced.
Psychotherapy is a talking therapy which focuses on the patient talking about their feelings and experiences. The therapist is there to listen and gently guide you with the aim of you reaching conclusions and realisations on your own. This in turn leads to you figuring out how to resolve problems or tackle issues in your life.
Psychotherapy can aid you in reducing stress, engaging in more adaptive behaviours to tackle your pain and dealing with any comorbid mental illnesses which often come along with chronic pain.
Passive physical therapies (meaning those within which the therapist does the majority of the work to manipulate and move your body) can be accessed through your doctor as a referral to a physical therapist. Physical therapists will often be part of pain management clinics, and you can also access them privately.
Active physical therapies (those which are guided but you do most of the work) can also be accessed online. You can find videos, courses and exercises to be carried out at home. Our pain relief app (download links below) can also guide you through physical therapy sessions.
Physical therapy can involve a range of the following treatments and often incorporates psychological treatments to produce the best results for patients.
- Strengthening and flexibility exercises: Exercises which strengthen your muscles, reduce stiffness and increase flexibility can be helpful in reducing pain and increasing functioning.
- Therapeutic exercise: Many therapists use graded, low impact exercise to, “increase strength, aerobic capacity, balance, and flexibility; improve posture; and enhance general well-being.”
- Massage: Therapeutic massage can help to loosen tight muscles, reducing pain and increasing mobility.
- Hydrotherapy: Exercises are carried out within heated pools. The heat eases pain while the water takes the weight off your joints to make movement easier.
- Laser therapy: Lasers generate specific wavelengths of light which can promote healing within the body.
- Ultrasound: An ultrasound machine produces targeted sound waves which can promote improved blood circulation, tackling inflammation and reducing swelling and stiffness.
- Dry needling: Thin needles are used to target specific muscles to ease pain and relieve tension within the muscle.
- Kinesiology taping: A flexible tape is applied to specific areas of the body to support joints during movement. Kinesiology taping is also thought to reduce inflammation and interrupt pain messages to ease pain.
Alternative and complementary treatments
By alternative, we simply mean that these treatments may not be backed by as much medical science as other treatments as explained in this study. This can sometimes mean that they can be harder to access through your doctor. You may need to access them privately.
During acupuncture, fine needles are inserted into specific points in the body. The treatment works by inducing the body’s natural pain-relieving chemicals. Acupuncture is typically carried out in a calming environment, while you are lying down. It can help to reduce stress levels and promote relaxation.
A chiropractor will manually move your body in specific ways to try and reduce stiffness and improve flexibility. Typically, a lot of their focus will be on the back and spine.
Osteopaths utilize physical manipulation, as well as massage and stretching specific areas of your body to increase your range of motion. Osteopathy also aims to increase blood supply and promote healing within the body.
- Art therapy
Art therapy can be done in groups or in individual person to person sessions. It can also be done in your own home. Creative expression through art is thought to relax pain patients, promoting lower stress levels and providing an outlet for a lot of the difficult emotions that come from living with chronic pain. The idea of art therapy is being used as part of other therapies more and more. This study concluded that, “there could be a broad field for the use of art therapy in pain management programs.”
- Music therapy
Listening to music can be relaxing and provide a distraction from pain symptoms. Music therapy focuses on using music which really resonates personally with the patient, providing a creative and fun opportunity. Music therapy may involve singing, writing music, listening to music and playing instruments.
This study found that, “In patients, whose perception of disease and treatment expectation is determinated by the idea that their pain results from physical causes alone, compliance in music therapy is usually better than direct psychotherapeutic approaches.”
An occupational therapist may come to your home or workplace and talk through your daily routine. Their aim is to help you increase your level of functioning and enable you to live a fuller life. They’ll help you identify tasks that you struggle with and aid you in performing them in a safer way which is less likely to evoke a flare. They may provide adjustments to your environment or provide mobility aids to help you increase your level of functioning. They can offer guidance on how to reduce your pain and improve your quality of life.
Hypnosis is typically done by a therapist in their office in a relaxing atmosphere. Before your session starts the therapist will talk to you about what your goals are from hypnotherapy so that they can plan what they will address during sessions going forward.
The therapist will usually ask you to close or relax your eyes and either lie or sit back in a comfortable position. They will guide you through becoming completely relaxed, also known as a hypotonic state. When you’re in this state you are less inhibited, more likely to deal with problems openly. You are also more open to suggestion, so hypnotherapy can be used to alter behaviours.
The hypnotherapist will address what you have discussed previously in a calm, quiet voice. They may ask you to visualize certain situations, or to talk about specific things. At no point during hypnotherapy are you out of control of your own body and mind. You can stop at any time.
Hypnotherapy can help you change negative behaviours and replace them with positive ones which are going to help you proactively manage your pain. Hypnosis can help you to be in a more positive and accepting mindset about your pain. Hypnosis can also reduce stress levels and aid in relaxation, which in turn contributes to reducing pain. This article found that, “hypnosis interventions consistently produce significant decreases in pain associated with a variety of chronic-pain problems.”
When we have days when our pain is low and we feel able to function, we are often inclined to ‘make the most’ of these days. We try to fit everything in that we haven’t been able to do while we were flaring. This can result in us making ourselves flare again and making our symptoms worse! This is known as the boom and bust cycle.
To combat this, we can pace activity to bring optimum results. This means that we gradually increase our levels of activity so that our body can build up a tolerance. We also actively plan rests, even if we feel that we don’t need them, in order to minimise the risk of flares.
Using heat and cold
Heat pads, hot water bottles or rice packs which you heat in the microwave can provide some relief from pain. The heat tends to ease pain and encourage muscles to relax. Cold packs and ice packs (not directly onto your skin) can help to ease inflammation and bring some relief from pain. You can alternate between the two which sometimes helps to bring more relief from symptoms.
TENS (transcutaneous electrical nerve stimulation) uses a machine with small pads which you attach to your skin at specific points where you experience pain. Low electrical signals are sent out via these pads which work by interrupting pain signals to bring relief from chronic pain.
You can buy a TENS machine yourself, or you may be offered one through your doctor. Often during pain clinics or through physical therapy TENS is utilized, and you will be given the machine to take home once you know how to use it.
Pain management clinics
Your doctor or specialist may refer you to a pain management clinic or programme. These tend to be outpatient programmes which you will attend regularly for several weeks. Within the clinic you will see a variety of the specialists we have previously mentioned, and a lot of the treatments we’ve talked about are available.
The aim of a pain management clinic is to give you the tools to manage your pain effectively at home, to increase your level of functioning and your quality of life.
There are a wide range of mobility devices available, from wheelchairs and mobility scooters to walking sticks, shower chairs and other adaptations around the house. An occupational therapist or physical therapist will be able to advise you in more detail on what aids may be useful for your specific situation.
The key to using mobility aids is to ensure that you are using them to increase your level of functioning. It’s important to keep being as active as you can to tackle your chronic pain. If a mobility device can help you with adaptive behaviours and enable you to live a fuller life, then they are a highly positive thing.
It’s important that we implement healthy coping behaviours to tackle and reduce our chronic pain. There are many ways that you can self-manage your pain; a few of the main ones are listed below.
- Relaxation and stress relief
We know that stress contributes to chronic pain, so it’s important to keep stress levels as low as possible. Talking through your problems with someone you trust can be helpful, rather than keeping things bottled up.
Practicing mindfulness in your day to day life can help you to stay relaxed and in control of your emotions. Identifying aspects of your life, aside from your chronic pain that contribute to stress levels and doing your best to deal with them head on can help you to reduce the levels of stress in your life.
- Eating well
A healthy, balanced diet has so many benefits for general health as well as for tackling chronic pain. With the right nutrients you can ensure your body has the energy it needs to function and to fight fatigue. With a healthy diet you provide your body with the right tools to tackle inflammation and increase your immune system.
- Regular exercise
Doing low impact exercise on a regular basis actively reduces chronic pain and contributes to good general health. Exercise is proven to reduce inflammation, to tackle deconditioning, to improve general fitness and so much more. It’s also amazing for your mental health!
- A good sleep routine
Sleep can be a hard task to master when you live with chronic pain but doing your best to have a good regular sleep routine is really setting yourself up for success. Being active during the day can really help to make your body tired enough to sleep, and of course reducing your pain symptoms tackles painsomnia (a colloquial term for insomnia caused by pain)
- Seeking support
Reaching out for help is hard but so important. Whether it’s help to carry out practical tasks or emotional support from someone that you love, reaching out for help can make a big difference.
Chronic pain can be managed effectively without medication; it can even be reduced and overcome! There’s no shame in taking medication if it helps you to manage your symptoms, but knowing there are other options out there can help you to make an informed choice about what is best for you.
- National Institutes of Health, U.S. Department of Health and Human Services, (2018), “Non-Drug Pain Management”
- Center for Substance Abuse Treatment.: Treatment Improvement Protocol (TIP) Series, No. 54. (2012), “Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders.”
- International Journal of Clinical and Experimental Hypnosis, Volume 55, Issue 3, Gary Elkins, Mark P. Jensen, David R. Patterson, (2007), “Hypnotherapy for the Management of Chronic Pain”
- Müller-Busch HC, (1991), “Art therapy in chronic pain.”
Please note: This article is made available for educational purposes only, not to provide personal medical advice.