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Pain Relief Without Drugs — What Are Your Options?

Rob Trager, D.C.

There are plenty of conservative, natural, and holistic treatment options for those with pain. Advancements in the fields of manual therapy (hands-on treatment), nutrition, exercise, and other therapies have created a much larger toolbox for practitioners treating pain. Some therapies require seeing a provider such as a chiropractor or physical therapist, while other therapies can be performed at home. 

The first step to reducing pain is identifying its cause. Providers at our integrated medical-chiropractic-physical therapy clinic will perform a thorough examination and may also utilize lab tests and/or diagnostic imaging. Once these steps are complete, it is easier to find therapies that will help reduce pain. Please consult with your own provider before using any of the therapies listed in this article; this article does not constitute medical advice.

Manual Therapies

Manual therapies reduce pain by affecting the nervous system. Mechanical stimulation using hands-on methods or tools can reduce spasm, increase range of motion, and reduce inflammation. Manual therapies may work by stimulating tiny sensory receptors called mechanoreceptors and proprioceptors. Sensations from these receptors in turn block nociceptive signaling (pain signals) in the spinal cord and brain.

There are three main categories of manual therapy: joint-based, soft-tissue based, and nerve-based. Joint manual therapies include manipulation or “adjustments” of the spine and extremities. Soft-tissue therapies include therapies such as cupping, scraping — also called gua-sha or instrument-assisted soft tissue manipulation (IASTM) — myofascial release, and dry needling. Special types of stretching called neural mobilization or nerve flossing as well as kinesiology taping target the nervous system more directly. A trained clinician should provide these therapies, although you may ask your provider if there are any therapies such as foam-rolling or cupping that you can perform at home safely.

Instrument Assisted Soft Tissue ManipulationFigure 1: Instrument-Assisted Soft Tissue Manipulation (IASTM), from Kim et al, 2017: Therapeutic Effectiveness of Instrument-Assisted Soft Tissue Mobilization for Soft Tissue Injury: Mechanisms and Practical Application - Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/)

Spinal manipulation is a broad category of treatments and is often used by chiropractors and physical therapists for those with back and neck pain. Techniques range from joint mobilization and traction to thrust-type techniques that may produce a popping sound. Numerous studies have found spinal manipulation to be effective for those with low back pain, sciatica related to disc herniation, and neck pain. Some studies have found joint-based manual therapies to be effective for tension headaches and migraines.

Chiropractic Procedure Spinal Manipulation
Figure 2: Spinal Manipulation Image copyright Robert Trager, DC.

Soft-tissue based manual therapies increase circulation of the treated area. One study using thermography imaging showed that IASTM raised the blood flow and skin temperature of the treated area for 90 minutes. The increase in circulation brings in oxygen and other healing factors while removing inflammatory substances.

Exercise Therapy

Exercise has numerous benefits, not only for pain but for overall health. Exercise can reduce pain neurologically by stimulating the body’s own pain-blocking abilities, a process called descending inhibition. It can help stabilize joints such as the spine, and reduce pain related to spinal instability. Specific exercises can help athletes overcome injuries and return to play.

Half Kneeling Pallof PressFigure 3: Half-Kneeling Pallof Press — Spinal Stability Exercise. Image copyright Robert Trager, DC.

Providers such as physical therapists and/or chiropractors may use a personalized exercise program as early as reasonably possible after an injury. Patients typically start at a lighter level then increase the intensity and dose depending on their progress and condition. The goal is to return each person to as much functionality as possible and empower them to continue with exercise in some form on their own.


Diet and nutrition influence the likelihood of developing diabetes, obesity, and cardiovascular disease, which are all associated with pain. General principles of an anti-pain, anti-inflammatory diet include low amounts of refined carbohydrates such as sugar and flour, low trans-fats, a high amount of vegetables and fruits, and sufficient protein. The ideal amount, ratio, and type of food varies for each person, their goals, and activity level. Ask your provider for guidance and help finding the right diet for you.

Dehydration increases our brain’s response to painful sensations. Research has shown that dehydration is common, especially in adolescents. When we become dehydrated, we run the risk of depleting water in our intervertebral discs (normally 66–86% water) and cartilage of our joints. Monitoring the color of urine is an accurate method of evaluating hydration status, with optimal being a pale straw yellow.

Vitamins and Minerals

Our status of vitamins and minerals affects our tendency to develop pain. If you are in pain, ask your provider if you should have any lab tests to determine if these factors are involved. Two useful lab tests for pain-related disorders include vitamin D and magnesium. Ask a provider for guidance before beginning any nutraceutical therapy for pain.

Research has shown that magnesium levels relate to our level of pain. About half of the U.S. population may be deficient in magnesium. Magnesium helps keep the calcium in our neurons balanced, and is required for hundreds of enzymatic reactions, including virtually all reactions involving ATP, the energy currency of our cells. Research has shown that magnesium is useful for headaches and migraines.

The recommended lab tests for magnesium includes both a serum and RBC magnesium. The form to supplement with is chelated magnesium rather than magnesium oxide. The level of magnesium in the body can be raised by eating dark green vegetables, dark chocolate, nuts and seeds, mineral water, or by using magnesium lotions and/or taking Epsom salt baths.

Vitamin D affects pain in many ways. Studies have found that 52–77% of the U.S. population is deficient in vitamin D. Vitamin D influences over 2,000 genes in our DNA. It also affects how our neurons work; when we are deficient in vitamin D, we become hypersensitive to pain. The health of many structures in our body depends on optimal vitamin D status, including the production of neurotransmitters and function of discs in our spine.


Laser therapy, an acronym for Light Amplification by Stimulated Emission of Radiation, is a method of applying infrared light to the body. Research has shown laser therapy to benefit those with musculoskeletal and neurological pain. Laser stimulates production of cellular energy or ATP in the mitochondria of our cells. It also is absorbed by the water within our cells, which helps support the intra-cellular metabolism. These mechanisms benefit our neurons, muscles, and other body areas involved in common pain syndromes.

Pulsed electromagnetic field (PEMF) therapy is a technique of exposing the body to a pulsed magnetic field. This modality enhances many cellular processes by helping ions move across the cell membrane. It also stimulates blood flow, possibly by helping blood vessels dilate (open). Research has shown PEMF to benefit many pain-related conditions, including osteoarthritis and disc herniations.

Whole-body cryotherapy is a method of briefly exposing the body to subzero temperatures — and with our equipment, that’s as low as -220°F. This modality has been shown to reduce pain, muscular fatigue, and aid in recovery in athletes. Studies have shown that whole-body cryotherapy reduces markers of inflammation such as C-reactive protein and prostaglandins, which are often seen in arthritis.

Sleep Quality

Poor sleep quality worsens pain. Research has shown that melatonin is effective for improving sleep quality. Deficiency in magnesium and vitamin D can also contribute to poor sleep quality. Ask your healthcare provider before beginning any therapies to improve sleep quality.


There are numerous supplements available to those in pain. Quercetin and turmeric are two natural and inexpensive products with a strong level of evidence for their efficacy. Ask your provider which supplements may benefit your specific condition and are safe to take.

Other Therapies

Infrared light therapy may be performed at home with an infrared sauna or infrared heat lamps. These therapies have similar mechanisms to laser discussed above, but are typically weaker and may take longer to achieve a therapeutic result on any specific area.

Graded motor imagery is a technique of reducing pain by using imagery in three phases: (1) Left-right discrimination, (2) Thinking about moving without moving, and (3) Mirror therapy. Research has shown it to benefit those with musculoskeletal pain and complex regional pain syndrome. There is an app available for download called Recognise that includes left-right flashcards which help reduce chronic pain.

Mind-body therapies such as biofeedback and relaxation can be helpful for those in pain. These are typically performed in a clinical setting, but there are smartphone apps that can be helpful as well.

Binaural beats are a way to alleviate pain by simply listening to tones on headphones (you must use headphones for this to work). The brain perceives binaural beats when there is one frequency in one ear and another different frequency in the other ear. Research has shown that this therapy reduces pain levels, possibly by affecting brainwaves. There are numerous free binaural beats available on YouTube.

Essential oils applied to the skin may help reduce pain. Examples include those from mint or lavender plants. Be sure to ask your provider for guidance when considering this therapy.

Virtual reality video games may help those with pain and helps shift one’s focus away from pain.

This article isn’t meant to be an exhaustive list of pain relief treatment options. However, hopefully it provided some insight into steps that can be taken to help manage pain and achieve greater overall wellness. For more information on pain management, therapy options, and our integrated services, please reach out to Legacy Medical today.