Best Drug-Free Therapies for Chronic Pain

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When it comes to chronic pain, the intention of mindfulness training is to learn about and potentially shift your perceptions of and reactions to pain. Studies have shown an eight-week course in mindfulness can lower pain frequency, sensitivity, and even just the unpleasantness of pain itself. That doesn’t mean that pain is simply “all in your head”; actually, magnetic resonance imaging ( MRI ) scans have shown that practicing mindfulness changes how the brain responds to pain. It has proven to be useful for inflammatory bowel syndrome and inflammatory bowel diseases, lower back pain , psoriasis , fibromyalgia, and rheumatoid arthritis ( RA )–related symptoms.
Mindfulness-based stress reduction courses are most commonly offered in a group setting with an instructor, or some may explore practicing mindfulness independently via books or audio recordings. MBSR activities often include guided meditation and group discussions, writing exercises to facilitate self-reflection, and other practices such as loving kindness.
2. Qigong and Tai Chi
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These ancient Chinese practices involve slow, deliberate movements, and can be thought of as forms of moving meditation. Tai chi is more of a full-body approach that is part of a martial art form, whereas qigong is usually performed while standing or sitting with less active moments. The goal of these low-impact practices is to increase or access energy in the body, known as “chi” or “qi,” which in turn leads to heightened inner balance and well-being.
While the many benefits are backed by science and the practices are generally considered safe, it’s not completely understood how tai chi and qigong reduce chronic pain. Experts theorize that the deep relaxation the practices can facilitate may relieve muscle tension, boost feel-good endorphins , and calm the nervous system. Exercise in general helps loosen up stiff muscles and improve blood flow, which can also help with pain reduction. In clinical trials, the practices have been found to help chronic low back pain and pain associated with fibromyalgia, osteoarthritis, and rheumatoid arthritis.
Classes can be found at local rec centers, hospitals, YMCAs, and fitness clubs. There are also plenty of online videos you can follow along with from the comfort of your home, although many people enjoy the social aspects of group practice and the support of a guiding teacher. You’ll get the best results if you practice regularly.
3. Pain Reprocessing Therapy
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This newer treatment has only been extensively trialed in people with chronic back pain, but the results have been very positive: In a clinical trial published in September 2021 in JAMA Psychiatry , out of about 150 patients with mild or moderate back pain without a clear physical origin, two-thirds were pain-free or nearly pain-free after four weeks of pain reprocessing therapy (PRT) instruction — and 98 percent had at least some improvement.
The therapy is based on the idea that with specialized training, people can actually train their brains to switch off chronic pain. Patients are first taught about how the brain interacts with pain, the toxic pain-fear cycle, and the reversibility of pain. They learn to change their perception of pain, viewing it with curiosity and nonjudgment instead of fear or apprehension. PRT instructors will also help people address other emotional roadblocks that can raise perceived threat levels which exacerbate pain, like difficult relationships and pernicious self-criticism. The treatment is also helpful specifically for pain catastrophizing, or believing your pain is unbearable, intolerable, or will never end. These sorts of thoughts are just that — thoughts, not facts, and pain reprocessing can help you overcome them.
Sessions occur one-on-one with a therapist, twice weekly for four weeks. Providers need special training, but the sessions may be covered by insurance if they’re billed as psychotherapy or physical therapy. More research is ongoing to look at long-term effects and if it may benefit other pain conditions.
4. Acupuncture
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Acupuncture treatment comes from traditional Chinese medicine (TCM), a practice that has been around for thousands of years. An acupuncturist treats a client by using thin needles to puncture the skin at specific points on the body to activate or shift the flow of chi, or energy, that helps keep the body healthy and functioning appropriately. From a Western medicine perspective, the needles are primarily thought to stimulate the central nervous system in ways that either increase or decrease different chemicals in the body in order to help with healing.
When it comes to chronic pain relief, a look at multiple studies examining the effectiveness of acupuncture showed that the practice is effective, its results persist over time, and its benefits cannot be explained away by the placebo effect. The treatment is also generally considered safe. It can treat chronic back pain, joint pain, and even headaches and migraine. Studies suggest it may also improve symptoms of Crohn's disease and ulcerative colitis , psoriatic arthritis (PsA), rheumatoid arthritis, and even endometriosis .
Acupuncture sessions take place with the patient sitting or lying down on a table, often in a calming, dimly lit room. The placement of the needles will depend on the area of pain, and they shouldn’t hurt significantly. Most people actually find the treatment relaxing. While some people report worsening symptoms after they first begin acupuncture, TCM practitioners say this is often normal, and it’s usually followed by quick improvement. Insurance coverage may vary, but some clinics offer sliding scale fees.
5. Cognitive Behavioral Therapy
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Cognitive behavioral therapy, commonly known as CBT, is a cornerstone of contemporary talk therapy, but you may be surprised to know that it can help chronic pain as well. CBT teaches people to identify negative or unproductive thoughts and replace them with beneficial ones. Put another way, patients learn to manage discomfort by shifting their focus and perspective, thereby lessening the perceived intensity of pain, which left unchecked can create a negative feedback loop.
Research studies have shown CBT can improve symptoms of chronic back and joint pain, in addition to headaches. In a study of nearly 1,000 people on long-term opioid treatment for chronic pain, individuals who received CBT along with yoga and breathing exercises for three months found their pain reduced even one year later. They also noticed improvements in sleep and the ability to complete everyday tasks.
CBT is commonly done in one-on-one sessions that can take place in person or via telehealth. It’s important to find a provider that makes you feel comfortable, and the first session should be more like a consultation. If the match isn’t good, know that it’s okay to seek out a new therapist. Once you conclude your therapy, usually after 5 to 20 sessions, you’ll need to continue practicing the skills you learned to see their benefits. There are also apps that offer CBT lessons that have some research behind them.
6. Chiropractic Therapy
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People who swear by their chiropractor, swear by their chiropractor. This hands-on therapy involves manipulating the spine and sometimes other parts of the body, to improve range of motion and physical function, and to correct alignment. Practitioners believe fixing spinal alignment reduces pressure on the central nervous system, increasing the body’s ability to heal itself and therefore reducing chronic pain.
The technique has only been proven effective for musculoskeletal issues: low back pain, sciatica , headaches and migraine, and neck pain . The evidence is strongest for low back pain. It also may be beneficial for people with multiple sclerosis (MS) and those with hip and back pain from osteoarthritis. It’s not recommended for active ankylosing spondylitis (AS).
Sessions take place in a medical office setting, and multiple visits may be required. Fortunately, it’s covered by most insurance plans. A chiropractor will perform adjustments with a patient sitting or lying down on a table. Soreness or fatigue may be felt for a few days after a session, similar to what’s felt after a rigorous workout.
7. Biofeedback
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Biofeedback shares some foundations with mindfulness-based stress reduction. Using different gentle sensors attached to the body, the practice can help people become aware of their physical responses to stress or pain, like quickening their breathing or tensing certain muscles. A therapist can then share techniques that can prevent or reverse these reactions when they threaten to exacerbate pain, providing physical and emotional relief in the process.
The technique has proven effective in treating chronic pain for numerous conditions, from fibromyalgia and osteoarthritis to cancer , lupus , and TMJ. It also helps with headaches and migraine, as well as back, knee, and vulvar pain. Not only does it reduce pain intensity, but it can also help with symptoms of depression and anxiety .
The types of sensors used and the techniques taught can vary significantly depending on the kind of pain and its cause. The number of sessions recommended can also vary. The treatment isn’t always covered by insurance, but if one-on-one therapy isn’t financially feasible, there are consumer wearables and even phone apps that can teach you similar techniques to practice on your own.
8. Physical Therapy
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Physical therapy, often called “PT” for short, is a mainstream, active treatment that can help patients with chronic pain regain strength and mobility, with the goal of reducing pain in the process. A physical therapist could help you build up the muscles around your core, for example, to help with low back issues. They might also use additional techniques like massage or TENS therapy (transcutaneous electrical nerve stimulation) to potentially help disrupt pain signals, increase blood flow for healing, and encourage the production of endorphins.
Physical therapy is effective for treating chronic pain related to hip and knee osteoarthritis , fibromyalgia, sciatica, back issues, and even pelvic pain associated with gynecologic cancers. It can also help people who are scared to move feel more comfortable and safe with exercise again, which has numerous physical and emotional benefits.
While you may need a referral from your primary care provider, the majority of comprehensive insurance plans cover PT. Physical therapists require proper education and certification, and they work in a variety of settings, from hospitals and private clinics to outpatient rehab centers. At your first session, a therapist will ask about your history and may test your strength and range of motion. It’s important to wear clothes that allow you to move freely, since your PT may ask you to perform various exercises or stretches. You’ll likely need to practice some exercises outside of sessions for the most benefit.
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