10 Alternatives to Opioids for Pain Management

There are many alternatives to opiate-based medication for pain management available, and plenty of scientific data to support their effectiveness.

Opioids can be highly addictive, but healthcare providers are still writing enough prescriptions for painkillers each year for every American adult to have a bottle of pills. Are opioids the only answer for people who are suffering from acute or chronic pain? There are many alternatives to opiate-based medication for pain management available, and plenty of scientific data to support their effectiveness.

Choosing an alternative to opioids for pain could be the difference between pain relief and addiction, particularly for teens or young children who are at a higher risk of addiction due to their developing brains.

This post has been updated to reveal even more scientifically-proven, non-opioid alternatives for pain management.

10 Alternatives to Opioids for Pain Management

1. Acupuncture

Acupuncture uses needles to stimulate certain points on or under the skin. This method of treating pain, nausea, and many other conditions has been used in Eastern medicine for centuries.

How does acupuncture work?
The needles are thought to stimulate nerves, which then:

  • Send signals to the brain to release feel-good hormones such as beta-endorphins
  • Reduce pro-inflammatory markers that lead to inflammation and pain
  • Stimulate nerve growth factor that helps the nerve to regenerate

How effective is acupuncture?
According to Harvard Medical School, research from a team of international experts has provided evidence that acupuncture does provide real relief from common forms of pain. More than 29 studies revealed acupuncture to relieve pain by about 50%.

2. Guided Imagery

Guided imagery is a pain intervention that uses relaxation techniques and visualization of calming mental images to manage acute and chronic pain.

How does guided imagery work?
When you’re under stress, your body’s fight-or-flight mechanism kicks in. Cortisol and other stress hormones can ratchet up inflammation levels in your body. Mind body practices, like guided imagery, calm the nervous sympathetic system.

While in a state of deep relaxation, you visualize your body as you wish it would be. The process eases stress and lowers cortisol levels, bringing a decrease in pain perception and anxiety with it.

How effective is guided imagery?
Closing your eyes and imagining your pain away? It may sound like an ineffective method of pain management, but a comprehensive meta-analysis found evidence that this relaxation and visualization technique can be effective for the management of cancer-related pain, anxiety, nausea, and depression.

In a review of seven randomized controlled studies, guided imagery brought statistically significant improvements for all 287 individuals suffering from arthritis and other rheumatic diseases.

A woman looking at her phone.

3. Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a form of talk therapy that helps people identify and develop skills to manage negative thoughts and behaviors. For pain management, CBT helps patients change their awareness of pain and develop better coping skills - even if their pain doesn’t change.

Currently, CBT is the prevailing psychological treatment for individuals with chronic pain conditions such as low back pain, headaches, arthritis, orofacial pain, and fibromyalgia. CBT has also been applied to pain associated with cancer and its treatment, as well as anxiety and insomnia.

How does cognitive behavioral therapy work?
CBT focuses on the relationships between thoughts, behaviors, and emotions. Negative beliefs about pain can lead to maladaptive coping, exacerbation of pain, increased suffering, and greater disability.

CBT teaches patients effective coping strategies and helps replace negative thought patterns with less harmful thoughts, helping patients increase adaptive behaviors, identify and correct maladaptive thoughts and beliefs, and increase self-efficacy for pain management.

How effective is cognitive behavioral therapy?
Numerous meta-analysis and large, randomized controlled studies support CBT for chronic pain. One meta-analysis reviewed 22 studies and found that CBT has positive effects on pain intensity, pain-related interference, health-related quality of life, and depression.

One large, randomized controlled trial looked at the short- and long-term effects of CBT for chronic temporomandibular disorder (TMD), a condition that can cause severe pain and discomfort that can last for years in the face, jaw, neck, and shoulders. At a 12-month follow-up, CBT patients were 3x more likely to report no pain interference and twice as likely to report clinically meaning improvement compared to the control group.

4. Complementary and Alternative Therapies

Group therapy, music therapy, and pet therapy are among some of the most commonly used complementary and alternative therapies offered by hospice care providers to provide comfort and alleviate pain and anxiety for patients with cancer and other chronic conditions.

How does complementary and alternative therapy work?
In music therapy, certified music therapists use methods such as song writing, improvisation, lyric analysis, singing, instrument playing and relaxation techniques to treat the needs of patients.

Pet therapy, or animal-assisted therapy, uses animals that have been trained to be obedient, calm, and comforting to provide therapeutic benefits.

Group therapy often includes many other alternative pain management techniques, such as guided imagery, CBT, focused breathing, muscle relaxation and visualization, applied in a group session.

How effective is complementary and alternative therapy?
Numerous scientific studies are proving that complementary and alternative therapies can be effective methods for managing pain and stress.

A meta-analysis on the effects of music on pain published in the Journal of Music Therapy found that music interventions had statistically significant effects in decreasing pain, emotional distress from pain, anesthetic use, opioid intake, non-opioid intake, heart rate, blood pressure, and respiration rate.

A study conducted at an outpatient pain management facility concluded that therapy animals can provide a significant reduction in pain and emotional distress for chronic pain patients.

Group therapy sessions can provide all of the benefits of techniques such as CBT or guided imagery, but then adds another layer of benefits from the support and positive influence of peers. Group sessions can lesson the isolation of a chronic pain condition and expand a patient’s support network.

A study on the effects of a single group session for pain management in chronic pain patients found a significant decrease in overall pain scores following a session. Another large, randomized controlled study evaluated the effectiveness of a group CBT intervention in patients with low back pain. After 12 months, the CBT group patients reported significantly lower levels of pain and greater satisfaction with treatment compared to those who didn’t receive group CBT intervention.

5. Aromatherapy

For most people, the idea of smelling something to make you feel better may sound a bit silly, at best. But aromatherapy has been used for pain management since the time of the ancient Egyptians. Peppermint oil, lavender oil, chamomile oil, and African marigold oil have been used for pain management ever since.

How does aromatherapy work?
According to Psychology Today, aromatherapy positively stimulates the limbic system of the brain to ease chronic pain and anxiety.

How effective is aromatherapy?
Cardiovascular surgeon, Mehmet Oz, MD, studied aromatherapy to expedite recovery time and reduce anxiety in his heart patients. “Aromatherapy is effective because it works directly on the amygdala, the brain’s emotional center,” says Dr. Oz. He recommends lavender, chamomile, or eucalyptus oil, or even the scent of green apples to reduce migraines and joint pain.

According to the University of Maryland Medical Center, aromatherapy has been shown to be effective to relieve anxiety, stress, depression, and in several clinical trials, aromatherapy has been used in laboring women to reduce the need for pain medications during labor. Rose, lavender, and frankincense were most effective in these trials.

6. Massage Therapy

Many people seek out massage therapy for a number of reasons, including a drug-free alternative to pain management. Massage comes in two forms, relaxation and rehabilitative massage that can help rehabilitate injuries and reduce pain.

How does massage therapy work?
The stretching and kneading of soft tissues in the body, and pressure applied to various points on the body, relaxes muscles. But massage does more than just relax muscles; new research has shown that massage activates certain genes to directly reduce inflammation.

How effective is massage therapy?
The effectiveness of massage therapy for pain has been supported by various studies. It has been found most effective for non-specific lower back pain, both acute and chronic, but studies have also found massage to be effective for shoulder pain, headache pain, fibromyalgia, mixed chronic pain, and neck pain.

One specific type of massage known as Osteopathic Manual Treatment (OMT), has been found to be particularly effective for lower-back pain. OMT is administered by an osteopathic physician, rather than a massage professional. In a review of clinical studies, OMT was shown to provide significant reductions in lower back pain with results lasting up to three months.

7. Hypnotherapy

Hypnotherapy is an alternative practice where a licensed hypnotherapist guides your mind to a highly focused mental state.

How does hypnotherapy work?
Hypnosis used for the treatment of chronic pain typically involves a hypnotic induction followed by suggestions for comfort and relaxation. Patients are often taught a cue that they can then use on their own to quickly enter a state of comfort.

How effective hypnotherapy?
A review of 13 controlled studies revealed that hypnosis is significantly effective for chronic pain conditions, including low-back pain, arthritis, cancer, and disability-related pain. In some cases, hypnotherapy reduced chronic pain for up to three months. In one controlled study, fibromyalgia patients who received hypnotherapy showed significant improvements in pain reduction, as well as fatigue and sleep patterns.

8. Chiropractic

Chiropractic care uses spinal manipulation to treat neuromusculoskeletal complaints such as back pain, neck pain, migraine headaches, fibromyalgia, and joint pain.

How does chiropractic medicine work?
Chiropractors perform spinal manipulation, or adjustments, to manually restore joint mobility and heal injured tissues through controlled force. A chiropractor may also use postural and exercise education, ultrasound therapy, laser therapy, and ergonomic training as well.

How effective is chiropractic medicine?
The American Chiropractic Association provides excerpts and summaries from recent studies that support chiropractic care as an effective treatment for chronic and acute pain, headaches, and neck pain. The studies that are often quoted as supporting chiropractic care as an effective treatment, however, are often cited as having serious flaws in their reporting, execution, and design. This doesn’t stop approximately 30 million people from receiving chiropractic treatment each year.

9. Herbs

Natural pain treatments include herbal medicines—plants that are used to treat health problems including pain management. The seeds, berries, roots, bark, leaves, and flowers of plants have been used as medicine long before recorded history. Many modern day pharmacological medicines are based on herbal remedies.

How do herbal pain treatments work?
Many herbs have potent properties and multiple ingredients that have a beneficial effect on the body. Some herbs and plants have been shown to decrease inflammation and have the same pain relieving effects as NSAIDs.

How effective are herbal pain treatments?
Different herbs have different effects on the body. According to Everyday Health, the following herbal remedies can provide all-natural relief:

  • Capsaicin: Derived from chili peppers, capsaicin has been known to reduce the pain sensation in the central nervous system.
  • Ginger: The phytochemicals in ginger have been known to reduce inflammation.
  • Turmeric: The active ingredient in turmeric, curcumin, has been known to reduce inflammation and pain.

10. Medical Marijuana

Medical marijuana is a controversial, non-opioid alternative for pain. More and more states are passing laws allowing medical marijuana use for conditions such as pain, headaches, nausea, seizures, and Crohn’s disease.

How does medical marijuana work?
Marijuana contains hundreds of chemical compounds, but THC is the cannabinoid in marijuana that has been most widely researched. THC binds to receptors in the brain to produce effects such as reducing pain or anxiety. THC also provides the sensation of being “high,” which makes this a controversial treatment option.

How effective is medical marijuana?
More than 60 peer-reviewed studies were examined by ProCon.org, seven of which focused on marijuana effectiveness for pain relief. Six of the seven double-blind studies associated cannabis use with lowered chronic pain, and neuropathic pain.

According to a report by US Health News, medical marijuana appears to be a mostly safe treatment for chronic pain, without an increased risk of side effects. A study found that medical marijuana had a better safety profile when compared to opioids for long-term chronic pain.

There is no question that using opioid painkillers can lead to addiction, and put your entire family at risk for prescription drug misuse, as well as accidental overdose and medicine poisoning. There are many alternative treatments to pain relief, some more controversial than others, that may be a lower risk for your family and your health. Before you fill a prescription for an opioid painkiller, make sure you know all of the risks and alternative treatments available to you.


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