by Dr Deborah lee, Dr Fox Online Pharmacy
Living with chronic pain is miserable. Many of us are relying on painkillers and other medication to help our symptoms. But unfortunately, popping pills is not always the answer. Your body becomes tolerant to the effects of pain killers as time passes. You can also become physically dependent on them. If there are other ways of managing pain that don’t involve medication, this has to be a preferable option.
Here is a list of treatment alternatives to help with chronic pain that don’t involve prescribed medication.
Heat and cold treatment
Appling heat or cold to a painful area can relieve muscular pain. A hot pad is thought to work because it increases blood flow and oxygen supply to the damaged area and accelerates the removal of inflammatory mediators. Heat also dampens down overactive peripheral nerves, which when they are in an excitable state, can cause muscle cramps and stiffness.
Cold therapy reduces inflammation, swelling and pain. The cold causes peripheral blood vessels to constrict, diverting more blood towards the heart and lungs, ensuring it is well-oxygenated. When the cold is removed, well oxygenated blood flows more readily to the damaged area, and lactic acid and other waste products are then removed. Repeated episodes of cold-water therapy are thought to have long-term positive effects on the blood circulation.
Hot therapy can be administered by applying a heated pad to the painful area, or by sitting in a hot bath or sauna. Cold therapy can be undertaken by applying an ice pack, or a cold pad to the area, or getting into a cold or ice bath. With both therapies, wrap a towel around the pad before putting it into direct contact with the skin to avoid burning. 5-10 minutes of treatment at a time is recommended, and no more than 20 minutes per session.
Physiotherapy
The physiotherapist will assess each problem on an individual basis and how it is affecting you. They can suggest an exercise program tailored towards the injured area. Physios use a variety of techniques to improve mobility and flexibility, muscle strength and balance. As the health of the muscle or joint improves, pain becomes less severe.
Massage
Massage helps relieve pain because the direct action of pressure onto the muscles, reduces muscular tension and allows blood to flow more freely. This lowers inflammation and the person feels able to move the joint or muscle again.
In a 2008 randomised controlled trial, deep massage reduced muscular pain by 25%-50%. In a 2010 study, 30 minutes of massage on one or more occasions, significantly reduced pain in a group of medical and surgical inpatients.
Massage is recommended by the National Institute of Clinical Excellence (NICE) for those with low back pain, in conjunction with psychological therapies such as CBT.
Yoga
Research suggests that yoga can lower chronic pain. A 2022 review and meta-analysis of 27 randomised controlled trials compared yoga with passive movement to treat low back pain. The authors found that yoga significantly reduced pain intensity, pain-related disability, and mental ill-health as well as improving physical function. These benefits continued long-term, apart from the mental health benefits.
This is not surprising. After all, yoga is a mind-body exercise which lowers anxiety, slows the heart rate and improves the oxygen uptake in muscles. The breathing techniques in yoga stimulate the parasympathetic nervous system – the body’s involuntary pathway which is linked to feelings of pleasure and relaxation. Yoga is a good treatment for stress management. Anything that lowers stress is likely to reduce pain.
Acupuncture
Research into acupuncture for pain has produced conflicting results, However, a 2019 review of the medical literature, concluded there was enough evidence to support the fact that acupuncture gives modest relief from chronic lower back pain, tension headache, migraine and musculoskeletal pain.
TENS
Transcutaneous electrical nerve stimulation (TENS) is a pain treatment modality that has been used with success for post-operative pain, low back pain, diabetic peripheral neuropathy, osteoarthritis, fibromyalgia and neuropathic pain.
A TENS machine is a battery-operated unit connected to the skin via electrodes. The mechanism of action is complex but it stimulates the nerves involved in both the central and the peripheral nerve response. It is not suitable for anyone pregnant, who has epilepsy or who has a pacemaker.
CBT
Cognitive behavioural therapy (CBT) is a psychological treatment which aims to improve a patient’s knowledge and understanding of their condition and helps them to develop coping strategies. It has been used successfully to treat pain.
In a 2022 systematic review and meta-analysis of CBT and other treatment methods for chronic low back pain, CBT was found to produce the greatest effect in reducing pain, fear-avoidance and improving self-efficiency.
CBT helps change how a person perceives their illness/symptoms. It helps them see it from a less negative perspective. Many people fear using a joint or muscle which is painful but in fact, using it is often exactly what they should be doing. The body dislikes long periods of inactivity and was made to be used. However, some people may need to hear this from a therapist to believe it!
Also, pain causes stress, and stress causes pain. CBT involves relaxation techniques which break this cycle. You can self -refer for CBT on the NHS – to find out more click here.
Biofeedback
Biofeedback is a psychological technique where you undergo relaxation therapy, breathing exercises and/or mindfulness and meditation, while connected to a computer. This means readings such as your body temperature, heart rate, breathing rate and blood pressure can be fed back to you. In this way, you become more aware of the autonomic nervous system, your body’s involuntary pathway, so you can learn what to do to slow your breathing and your heart rate and lower your blood pressure. Biofeedback has been successfully used to treat chronic low back pain, fibromyalgia and headaches.
Exercise
Research shows that physical exercise is an excellent way to help reduce pain. Your body was made to be used and long periods of inactivity cause stiffness, muscle weakness and contribute to obesity, putting further stress on your joints.
Exercise improves cardiovascular function, muscular strength, proprioception and balance. It can be carried out alone or in groups or teams. Exercising with others is good as it improves connectivity and is a great way to combat loneliness. Good examples pf suitable exercise for patients with pain include Pilates, Yoga, Tai Chi, swimming and hydrotherapy.
Ultrasound
Therapeutic ultrasound uses sound waves that interact with body tissues. It can improve blood flow, encourage healing, stimulates collagen production and improves elasticity in the area.
In a 2021 systematic review and meta-analysis of ultrasound treatment for chronic low back pain, the authors reviewed 6 randomised controlled trials involving 699 patients. 5 out of the 6 studies concluded that ultrasound significantly reduced pain.
Although generally safe, therapeutic ultrasound is not safe in pregnancy, in anyone with pacemaker or other types of implanted devices, or who has a localised cancer in the treatment area.
Final thoughts
If you suffer from chronic pain, you might like to try any of the above, in addition or instead of, your current medication. Check with your GP first if you have any concerns. Finding alternatives to prescribed medication is a good thing. For example, your GP may be able to prescribe exercise for you, or sometimes hydrotherapy. You can also self-refer to CBT.
- If you are in pain, what other treatment options might help you?
- What could you do today to start to feel better?
For more information
- NHS – 10 ways to reduce pain
Harvard Health Publishing – 8 non-invasive pain relief techniques that really work