Non-Drug Strategies for Pain Management


Chronic pain is one of the paramount issues in the older adult population. Effective pain management is a challenging practice in the healthcare field. We are completely familiar with painkillers and some of us have them in our cabinet all the time, but the long-term use of pain relievers may cause side effects. In response to increasing demand for improved pain treatment, researchers have focused on testing the efficacy of many non-pharmacological pain management techniques. In lieu of previous research, interventions favour the non-pharmacological treatment techniques for both chronic and acute pain flares. These techniques include physical and psychological interventions.

The Rise of Non-Pharmacological Therapy

Medical pain management is in crisis due to inadequate pain treatment, escalation of prescription opioids and overdose deaths. Therefore, medical practitioners are reconsidering using medications for pain management. These are the reasons why physicians and clinicians are shifting from reliance on opioids, ineffective procedures and surgeries toward evidence-based non-pharmacologic options. Non-pharmacological therapy is considered as a valuable and effective mode of treatment. It reduces the side effects of painkillers, reduces drug dependency and healthcare costs.

Pain is an unpleasant sensation and emotional experience that is caused by injury to body tissues. Traditionally, pain management involves the use of pharmacological agents, but intensive usage of analgesics can have detrimental effects due to its side effects, drug dependency and increased healthcare costs, and it puts a burden on the country’s economy. Non-pharmacological pain management means interventions that do not involve medications to treat the disease. Therefore, non-pharmacological therapies have received considerable attention that shows excellent potential in managing pain. It is a simple and cost-effective method compared with pharmacological methods. They show no adverse effects on the mother and fetus, they reduce the dose of analgesics, reduce drug dependency and healthcare costs. The most effective non-pharmacological treatment should be recommended by taking into consideration the patient’s age, medical history and the current degree of pain.

Types of Non-Pharmacological Approaches

Non-pharmacological therapies are categorized into:
I. Physical Interventions: Physical therapies typically are patient specific. Some measures can reduce pain intensity and improve the patient's quality of life, such as massage, positioning, heat and cold treatment, transcutaneous electrical nerve stimulation (TENS), acupuncture and progressive muscle relaxation (PMR).
i. Massage: Pain can hamper one’s ability to continue his daily activity. Massage is the practice of rubbing and kneading parts of the body with hands to relieve pain and decrease tension. A gentle or strong pressure at a specific part of the body increases blood circulation. Massage decreases inflammation and edema caused by pain. Moreover, it stimulates the release of endorphin and enhances mental well-being. Massage can reduce stress, promote muscle relaxation, lower blood pressure, improve circulation, help improve posture, and strengthen the immune system.
ii. Positioning: Positioning is a part of therapy that includes maintaining a proper body position to reduce stress and anxiety. It reduces the risk for developing injuries, prevents developing bed ulcers and most importantly, reduces pain. It can enhance blood circulation which in turn prevents ulcers.
iii. Heat and Cold Therapy: Heat and cold therapy help soothe joint pains and relax muscles. This is inexpensive and can be easily used at home. Cold therapy includes applying a cool substance to any part of the body which reduces inflammation by decreasing blood flow. On the other hand, heat therapy increases blood flow. Alternating heat and cold therapy work best to relieve pain. They are more effective compared to over-the-counter medications such as Paracetamol and Ibuprofen.
iv. Acupuncture: Acupuncture is considered one of the oldest healing arts in the world. This age-old practice has now gained immense popularity as a viable alternative treatment for pain management. This traditional Chinese medicine involves the insertion of needles at a specific region called “acupoints” of the body, which stimulates the nerve. It also stimulates the release of endorphins, the body’s natural pain-killing chemical and helps relieve the pain. It also induces the immune system to increase circulation, wound healing, pain modulation and pain analgesia.
v. Transcutaneous Electrical Nerve Stimulation (TENS): TENS is a process of electrical stimulation that uses low voltage electrical current to provide pain relief. TENS activate the natural pain relief mechanisms in our body by stimulating sensory nerves. Clinical evidence suggests that TENS is useful for treating acute and chronic back pain, arthritis, and neuropathic pain.
vi. Progressive Muscle Relaxation (PMR): PMR is a technique in which participants are asked to tighten and relax different muscle groups in a progressive manner that will provoke the release of tension. The therapeutic benefits of PMR are enormous. It alleviates the pain as well as relieves stress and anxiety.

II. Psychological Interventions: Continuous pain may lead to increase distress and the development of psychiatric illnesses. The therapies that are most commonly used are cognitive behavioural therapy, mindfulness-based stress reduction, acceptance and commitment therapy (ACT) and biofeedback.
i. Cognitive Behavioural Therapy: Cognitive behavioural therapy (CBT) helps to develop an important set of coping skills that improve psychological functioning and behavioural activation to avoid prolongation and exacerbation of flares of pain.
ii. Mindfulness-Based Stress Reduction: It is a meditation therapy, combined with yoga, designed for stress management. It employs mindfulness meditation that helps individuals cope with their clinical and non-clinical problems. This technique helps the patient to disconnect himself from the sensory elements of pain.
iii. Acceptance and Commitment Therapy (ACT): ACT is a part of psychotherapy that encourages people to accept difficulties instead of denying the fact. Once the acceptance comes, patients can modify their behaviour instead of focusing on immediate relief from their emotions and thoughts. It is extremely helpful in treating anxiety, obsessive-compulsive disorder (OCD) and other psychological disorders.
iv. Guided Imagery: It is a mind-body technique in which the focus shifts from the pain towards an image on the mind, guided by the instructor. This process calms the sympathetic nervous system, and it is an effective technique to reduce pain.
v. Biofeedback: It is increasing in popularity as a modality for pain management. It is a tool that can monitor and fine-tune the connection between mind and health. In this technique, the patient receives extra “extrinsic” information about the subtle physical changes. With this information, the patient can control involuntary actions such as heart rate, blood pressure, muscle tension, skin temperature. This is an effective therapy in treating chronic pain, migraine headache, tension headache.

Other non-pharmacological therapies include:
III Music Therapy: Music has a magical power to alter and soothe our moods. Music as a therapy has a significant impact on patients’ lives. Music therapy has a great potential in pain management which stimulates sensory nerves in our body and evokes a response in the patient. It may alleviate pain, anxiety and stress, promote relaxation, reduce opioid requirements and improve the quality of life. Music is offered as an adjunctive therapy in many cancer centers.
IV Laser Therapy: Laser therapy uses a high-powered therapeutic laser that triggers biochemical changes within cells. It increases circulations and reduces long-term pain.

Benefits of Non-Drug Therapies

Non-pharmacological approaches have plenty of benefits such as
i. They can reduce pain effectively.
ii. Drug-free pain management has lesser adverse effects compared to analgesics.
iii. Psychological therapy increases the ability of an individual to control feelings.
iv. It reduces anxiety and stress.
v. It enhances the functional capacity and activity level.
vi. It reduces healthcare costs.

Non-pharmacological interventions are promising additions and alternatives to existing pharmacological treatments of persistent pain. The importance of non-pharmacological strategies to pain management is evolving and some non-pharmacological along with pharmacological therapies contribute to the overall improvement of the quality of life. These therapeutic approaches are relatively inexpensive, with a high safety profile and low side effects. While pharmacological drugs are essentially being used for treating physical pain, non-pharmacological therapies aim to explore the deep association between psychological behaviour and pain and treat accordingly.