There are a variety of non-medicine-based treatment options to manage pain, for example, physiotherapy or exercise, manual therapy, TENS, acupuncture, cognitive behavioural therapy (CBT) and mindfulness. Before starting any treatment, a visit to your doctor is recommended so that treatment options can be discussed and to ensure that they are suitable for you.
|Questions to consider before starting a treatment|
Once you have decided on a treatment you may like to discuss with the therapist what benefits you may experience, possible time frames and when a review will take place to discuss any progress.
You do not have to continue treatment if you do not think it is helping you or if you do not feel comfortable with the therapist. You can discontinue at any time.
Types of non-medication treatments for pain
There are many different types of non-medication treatments available. We discuss the pros and cons of some of the more common ones:
- Physiotherapy or exercise
- Manual therapy
- Transcutaneous electrical nerve stimulation (TENS)
- Rongoā Māori
- Cognitive behavioural therapy (CBT)
Physiotherapy or exercise under the supervision and guidance of a physiotherapist can be used to manage ongoing, persistent or chronic pain. Before starting any treatment, the physiotherapist will do an assessment which will include a thorough medical history to decide what would be the best treatment for you.
- Your physiotherapist may advise you to do general exercises such as walking, swimming, dancing or cycling, or specific exercises to increase the strength and movement of particular muscles or joints.
- The exercises are individualised to your specific condition; they are designed to keep you active and to build on what you can already do.
- Pain often results in inactivity which can cause stiff joints, weak muscles, increased weight, poor fitness and getting breathless more easily, as well as low mood.
- This, in turn, can result in more inactivity and increased pain.
- Your physiotherapist may also use other methods of treatment such as massage, TENs, and sometimes acupressure/acupuncture.
- Each therapist will work in a slightly different way depending on their training and experience.
There are 3 main types of manual therapy – massage, manipulation and mobilisation. These are usually performed by physiotherapists, chiropractors, osteopaths and some acupuncturists.
- Massage may involve gentle as well as deep-tissue hands-on treatment to ease tension in your muscles and distract you from your pain. The effects of massage may only be short-term but this may help you to get over a difficult period. You can give yourself a massage or you can see a qualified therapist. You can even ask a family member or good friend to give you a gentle massage.
- Manipulation is a more forceful movement of a joint, possibly beyond what it would normally do. It can help to increase your range of movement and reduce pain.
- Mobilisation is a gentle movement where your joint is moved as much as possible within your existing range of motion. Tai Chi is an example of an exercise that promotes joint mobility by stretching in a slow, focused manner.
- You can use your hands, or a foam roller, massage balls or other massage aids, such as a tennis ball or a golf ball to massage the soles of your feet.
- If you are using a ball for your feet, simply put it on the floor, place your bare foot on top of it and gently roll the ball along the length of your foot. If you’re unsteady on your feet, sit down while you do this.
- If you’re massaging elsewhere on your body, before starting, ease some of your muscle tension with a warm shower or by applying a heat pack (warm not hot) to the painful area.
- Use smooth, firm strokes. You’ll feel the difference between strokes that are relieving your muscle tension, and those that are adding to it. Adjust the pressure, from hard to gentle, based on the degree of your pain.
- Using an oil or lotion can help your hands move smoothly over your skin; however, it’s not essential – it’s a personal choice.
- Try to massage yourself regularly to prevent muscle pain and tension building up.
Transcutaneous electrical nerve stimulation (TENS)
In this technique, a hand-held device called a TENS machine is used to pass a small electric current through your skin to your nerves. It can reduce your pain by interfering with pain signals and blocking them from reaching your brain, or by stimulating production of your body's natural pain relieving chemicals (called endorphins). It can also reduce the sensation of muscle tension and spasm.
The effects of TENS may be short-term; evidence for long-term benefit is weak. TENS is not suitable for everyone. People with a pacemaker should not use it.
Acupuncture is referred to as traditional Chinese medicine in which fine needles are inserted into parts of your body called meridians and sit just under the skin. The position and number of needles vary according to your condition and symptoms. The needles may stimulate your nerves to block pain signals and relax your muscles. Treatment can be from a few minutes, up to about 30 minutes.
Acupuncture may not be suitable if you have a fear of needles, allergies to metals, or have an infection or poor skin integrity in the area to be treated. Acupressure is another treatment that may be offered. This does not involve the use of needles, instead, pressure by the therapists hands is applied to points on your body to release tension and increase circulation in the body.
Your consultation may also involve some massage, pulsing of the needles and heat therapy. You will have an initial assessment with the therapist where your health history will be discussed and an explanation of treatments discussed and a plan developed to best meet your needs.
Rongoa Maori is traditional Maori medicine or healing.Rongoa Maori is seen in two main forms — Rongoa rakau and Te Oo Mai Reia.
Rongoa rakau (plant remedies) are plant or tree based medicinal remedies.
Te Oo Mai Reia (spiritual healing) utilises different physical techiniques along side spiritual. Te Oo Mei Reia can be seen as Maori healing through prayer, cleansing work, bodywork - known as mirimiri = message and komiri = deep message. Please note: the name of this type of healing and the variations may change from iwi to iwi but the principles remain the . Read more about Rongoa Maori.
Cognitive behavioural therapy (CBT)
CBT is a type of counselling that can help you manage your pain by changing the way you think about your pain. It can reduce anxiety and distress that is associated with long-term pain. It focuses on teaching you techniques and skills to help you cope better with chronic pain, such as such as relaxation, distraction, planning and routine, and problem-solving. All of these techniques are used in order to replace the negative thoughts common to chronic pain with more positive and calming thought processes.
Mindfulness reduces stress, tension and anxiety. It can help you to avoid focusing too much on your pain as well as directing your thoughts in a way that is helpful to managing your pain. Read more about mindfulness.
Understanding and managing pain: information for patients The British Pain Society
Managing your pain Arthritis.org
What is acupuncture? Acupuncture NZ
About physiotherapy Physiotherapy.org.nz