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 Managing Pain Without Opioids

Managing Pain Without Opioids

Opioids are strong medicines used to treat moderate to severe pain. For some people, especially those who have long-term (chronic) pain, opioids may not be the best choice for pain management due to:
  • Side effects like nausea, constipation, and sleepiness.
  • The risk of addiction (opioid use disorder). The longer you take opioids, the greater your risk of addiction.

Pain that lasts for more than 3 months is called chronic pain. Managing chronic pain usually requires more than one approach and is often provided by a team of health care providers working together (multidisciplinary approach). Pain management may be done at a pain management center or pain clinic.

Types of pain management without opioids

Managing pain without opioids can involve:
  • Non-opioid medicines.
  • Exercises to help relieve pain and improve strength and range of motion (physical therapy).
  • Therapy to help with everyday tasks and activities (occupational therapy).
  • Therapy to help you find ways to relieve pain by doing things you enjoy (recreational therapy).
  • Talk therapy (psychotherapy) and other mental health therapies.
  • Medical treatments such as injections or devices.
  • Making lifestyle changes.

Pain management options

Non-opioid medicines

Non-opioid medicines for pain may include medicines taken by mouth (oral medicines), such as:
  • Over-the-counter or prescription NSAIDs. These may be the first medicines used for pain. They work well for muscle and bone pain, and they reduce swelling.
  • Acetaminophen. This over-the-counter medicine may work well for milder pain but not swelling.
  • Antidepressants. These may be used to treat chronic pain. A certain type of antidepressant (tricyclics) is often used. These medicines are given in lower doses for pain than when used for depression.
  • Anticonvulsants. These are usually used to treat seizures but may also reduce nerve (neuropathic) pain.
  • Muscle relaxants. These relieve pain caused by sudden muscle tightening (spasms).

You may also use a type of pain medicine that is applied to the skin as a patch, cream, or gel (topical analgesic), such as a numbing medicine. These may cause fewer side effects than oral medicines.


Physical therapy involves doing exercises to gain strength and flexibility. A physical therapist may teach you exercises to move and stretch parts of your body that are weak, stiff, or painful. You can learn these exercises at physical therapy visits and practice them at home. Physical therapy may also involve:
  • Massage.
  • Heat wraps or applying heat or cold to affected areas.
  • Sending electrical signals through the skin to interrupt pain signals (transcutaneous electrical nerve stimulation, TENS).
  • Sending weak lasers through the skin to reduce pain and swelling (low-level laser therapy).
  • Using signals from your body to help you learn to regulate pain (biofeedback).

Occupational therapy helps you learn ways to function at home and work with less pain.

Recreational therapy may involve trying new activities or hobbies, such as drawing or a physical activity.

Types of mental health therapy for pain include:
  • Cognitive behavioral therapy (CBT) to help you learn coping skills for dealing with pain.
  • Acceptance and commitment therapy (ACT) to change the way you think and react to pain.
  • Relaxation therapies, including muscle relaxation exercises and focusing your mind on the present moment to lower stress (mindfulness-based stress reduction).
  • Pain management counseling. This may be individual, family, or group counseling.

Medical treatments

Medical treatments for pain management include:
  • Nerve block injections. These may include a pain blocker and anti-inflammatory medicines. You may have injections:
    • Near the spine to relieve chronic back or neck pain.
    • Into joints to relieve back or joint pain.
    • Into nerve areas that supply a painful area to relieve body pain.
    • Into muscles (trigger point injections) to relieve some painful muscle conditions.
  • A medical device placed near your spine to help block pain signals and relieve nerve pain or chronic back pain (spinal cord stimulation device).
  • Acupuncture.

Follow these instructions at home


  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • If you are taking pain medicine, ask your health care providers about possible side effects to watch out for.
  • Do not drive or use heavy machinery while taking prescription pain medicine.


  • Do not use drugs or alcohol to reduce pain. Limit alcohol intake to no more than 1 drink a day for nonpregnant women and 2 drinks a day for men. One drink equals 12 oz of beer, 5 oz of wine, or 1½ oz of hard liquor.
  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay healing. If you need help quitting, ask your health care provider.
  • Eat a healthy diet and maintain a healthy weight. Poor diet and excess weight may make pain worse.
    • Eat foods that are high in fiber. These include fresh fruits and vegetables, whole grains, and beans.
    • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
  • Exercise regularly. Exercise lowers stress and may help relieve pain.
    • Ask your health care provider what activities and exercises are safe for you.
    • If your health care provider approves, join an exercise class that combines movement and stress reduction. Examples include yoga and tai chi.
  • Get enough sleep. Lack of sleep may make pain worse.
  • Lower stress as much as possible. Practice stress reduction techniques as told by your therapist.

General instructions

  • Work with all your pain management providers to find the treatments that work best for you. You are an important member of your pain management team. There are many things you can do to reduce pain on your own.
  • Consider joining an online or in-person support group for people who have chronic pain.
  • Keep all follow-up visits as told by your health care providers. This is important.

Where to find more information

You can find more information about managing pain without opioids from:

Contact a health care provider if:

  • You have side effects from pain medicine.
  • Your pain gets worse or does not get better with treatments or home care.
  • You are struggling with anxiety or depression.


  • Many types of pain can be managed without opioids. Chronic pain may respond better to pain management without opioids.
  • Pain is best managed with a team of providers working together.
  • Pain management without opioids may include non-opioid medicines, medical treatments, physical therapy, mental health therapy, and lifestyle changes.
  • Tell your health care providers if your pain gets worse or is not being managed well enough.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.