• Profile

6 therapies for managing pain without opioids

MDlinx Jan 17, 2024

Evaluating your patient’s pain accurately and providing the most appropriate and effective treatment can be among the greatest challenges for healthcare professionals today. 

The opioid epidemic has left many providers reluctant to prescribe addictive pain meds. Therefore, adding more tools to your pain management arsenal gives you opportunities to further tailor your treatment recommendations and promote a better quality of life for those under your care.


Alternative therapies


Complementary therapies and alternative medicine have remained popular for pain management, particularly those with a low-risk profile.

While various practices may improve related symptoms like anxiety, depression, or insomnia, these three therapies demonstrate effective applications for pain specifically, as discussed in a review of integrative medicine approaches for pain in Journal of Cancer.

Deng G. Integrative medicine therapies for pain management in cancer patients. Cancer J. 2019;25(5):343–348.



This ancient Chinese practice involves inserting thin needles into specific points on the body and applying stimulation manually or using heat or electricity. Neuroscience research suggests acupuncture boosts the production of neurotransmitters and endorphins that affect pain perception.

Studies have shown acupuncture to be effective in managing various types of pain, and it’s increasingly being covered by insurance companies accordingly. In one systematic review of 17 studies, acupuncture effectively treated chronic and acute pain of the lower back when compared with “sham” acupuncture in control groups.


During hypnosis, patients enter a hyper-focused state that’s free from distractions. Once in this meditative state, they focus on manipulating their perceptions about a particular problem or sensation.

A systematic review of 21 studies found hypnosis to be an effective method of pain relief for dying patients and for those with cancer. Another review focusing on breast cancer identified 10 randomized controlled trials showing the positive effects of hypnosis on pain associated with breast biopsies, surgery, radiotherapy, and metastatic disease.

Music therapy

Music therapy is conducted in a patient-provider setting where the therapist plays recorded or live music, or the patient actively makes music by singing or playing instruments.

While it may seem like a benign form of treatment, a massive meta-analysis including 97 trials found music therapy effective for reducing pain and its associated emotional distress, as well as for reducing the use of anesthetics and opioids, in the general population.


Medication options


Whether prescription or over-the-counter, non-opioid pain medicines come with their own list of potential side effects and contraindications. Here’s a quick overview of medications most closely tied to effective pain management.

NSAIDs and acetaminophen

NSAIDs, like ibuprofen and naproxen, are widely used for pain management. They work by inhibiting enzymes that produce prostaglandins, substances responsible for inflammation and pain. NSAIDs are particularly effective for conditions involving inflammation, such as arthritis or musculoskeletal injuries.

Acetaminophen, commonly known as Tylenol, is a widely available over-the-counter pain reliever. It works by reducing the production of prostaglandins in the brain. While it's generally safe when used as directed, excessive consumption can lead to liver damage, making it essential to follow dosage guidelines.

Both NSAIDs and acetaminophen may not be appropriate in certain cases. The review article on integrative pain management in cancer states that patients undergoing chemotherapy are not candidates for use of these drugs given associated risks for liver and kidney toxicities. In addition, these fever-reducing medications can make it difficult for clinicians to spot the warning signs of infection, per the Journal of Cancer review.

Serotonin–norepinephrine reuptake inhibitors (SNRIs)

Certain antidepressant medications are often considered for the treatment of chronic pain. They work by altering neurotransmitter levels in the brain, which can affect pain perception. Despite some evidence for the efficacy of antidepressants for the treatment of pain, clinicians should use caution and understand the limitations of these drugs in pain management. Most studies on antidepressants for pain management are inconclusive or fail to show significant improvements.


However, in an overview of 26 reviews, the strongest evidence moderately supported the use of SNRIs for back pain, postoperative pain, fibromyalgia, and neuropathic pain.

Ferreira GE, Abdel-Shaheed C, Underwood M, et al. Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews. BMJ. 2023;380:e072415. February 1, 2023.

Specifically, favorable studies pointed to duloxetine at a median dose of 60 mg (range of 20 mg to 120 mg).



Medications like gabapentin and pregabalin, originally developed to treat epilepsy, have proven helpful in some populations in managing neuropathic pain that’s resistant to other therapies. Studies suggest that pregabalin is superior to gabapentin in reducing neuropathic cancer pain and the need for morphine.

Scarborough BM, Smith CB. Optimal pain management for patients with cancer in the modern era: Pain management for patients with cancer. CA: A Cancer Journal for Clinicians. 2018;68(3):182–196.

Nonetheless, insurance companies may require attempts with gabapentin before approving coverage for pregabalin.


What this means for you

Clinicians should stay open-minded about new and old methods for pain management. Although some patients require opioids, providers must continue exploring effective alternatives to minimize harm and dependency. Assessing pain management therapies for their direct impact on pain (rather than associated symptoms or general well-being) is crucial to finding options patients can trust.


Only Doctors with an M3 India account can read this article. Sign up for free or login with your existing account.
4 reasons why Doctors love M3 India
  • Exclusive Write-ups & Webinars by KOLs

  • Nonloggedininfinity icon
    Daily Quiz by specialty
  • Nonloggedinlock icon
    Paid Market Research Surveys
  • Case discussions, News & Journals' summaries
Sign-up / Log In
M3 app logo
Choose easy access to M3 India from your mobile!

M3 instruc arrow
Add M3 India to your Home screen
Tap  Chrome menu  and select "Add to Home screen" to pin the M3 India App to your Home screen