Treatments for Pain

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Spinal manipulation: one of the classic treatment options. But does it actually work?

There are countless treatments for people in pain, most of them of dubious value. Scams are everywhere! But so is evidence-based hope. Get started with a big compilation of pain survival tips, with links to dozens more articles about popular DIY treatments like self-massage, ice or heat, or the amazingly controversial Epsom salts. I also review major therapy methods like massage, chiropractic, and acupuncture. Or read an opinionated guide to all the kinds of professionals who might be able to help.

See also What Works for Pain?, a more exclusive guide to only the most proven chronic pain treatments — no experimental and speculative therapies allowed.

This is a collection of reviews of treatments, but there are also many guides to common painful conditions, plus many articles about how pain works.

Exercise! The closest thing there is to a miracle drug

• Strength Training for Pain & Injury Rehab — Why building muscle is easier, better, and more important than you thought, and its role in recovering from injuries and chronic pain.
• Strength Training Frequency — Less is more than enough: go to the gym less frequently but still gain strength fast enough for anyone but a bodybuilder.
• Quite a Stretch — Stretching science has shown that this extremely popular form of exercise has almost no measurable benefits.
• The Art of Rest — The finer points of resting strategy when recovering from injury and chronic pain (hint: it’s a bit trickier than you might think).
• Sports Injury Prevention Tips — Many common causes of chronic pain are injuries that don’t heal for a simple reason: they keep getting re-injured. Prevention of re-injury is treatment in these situations.
• The Trouble with Chairs — The science of being sedentary and how much it does (or doesn’t) affect your health and back pain.
• Microbreaking — Lots of little breaks may help compensate for too much time spent in chairs.
• Mobilize! — Dynamic joint mobility drills are an alternative to stretching, a way to “massage with movement”.
• Get in the Pool for Pain — Aquatic therapy, aquajogging, water yoga, floating and other water-based treatment and injury rehab options.
• Deep Cervical Flexor Training — “Core” strengthening for the neck.
• “Windows of Opportunity” in Rehab — The importance of WOO in recovery from injury and chronic pain (using frozen shoulder as an major example).
• “Positional release” — A funny kind of “exercise,” akin to stretching. Chapters on this topic can be found in three of my books, about trigger points, neck pain, and low back pain.

Massage therapy: everyone’s favourite luxury therapy

Why so much content about massage? It’s the most popular of all the major “alternatives” to medicine for chronic pain — and the most uncritically accepted. Also, I used to be a massage therapist.

• Does Massage Therapy Work? — A review of the science of massage therapy … such as it is.
• Basic Self-Massage Tips for Myofascial Trigger Points — Learn how to massage your own trigger points (muscle knots) Or, for a lot more detail …
• The Complete Guide to Trigger Points & Myofascial Pain — An extremely detailed guide to the unfinished science of muscle pain, with reviews of every theory and treatment option. This is a huge, comprehensive guide.
• Do Massage Guns Work? — What are the biological effects of jiggling flesh with vibrating massage tools?
• Fascial Therapy — A trendy style of massage aimed “releasing” connective tissue by pulling on it artfully.
• Poisoned by Massage — Rather than being DE-toxifying, deep tissue massage may actually cause a toxic situation.
• Reassurance for Massage Therapists — How ethical, progressive, science-respecting massage therapists can thrive in a profession badly polluted with nonsense.
• How to Find a Good Massage Therapist — Lots of tips for finding good quality medical massage therapy in your area (especially trigger point therapy).
• The Pressure Question in Massage Therapy — What’s the right amount of pressure to apply to muscles in massage therapy and self-massage?
• The Bath Trick for Trigger Point Release — A clever way of combining self-treatment techniques to self-treat your trigger points (muscle knots).
• Massage Therapy Side Effects — What could possibly go wrong with massage? The risks and side effects of massage therapy are usually mild, but “deep tissue” massage can cause trouble.
• Deep Friction Massage Therapy for Tendinitis — A guide to a simple self-massage technique sometimes helpful in treating common tendinitis injuries like tennis elbow or Achilles tendinitis.
• Massage Therapy for Tension Headaches — Perfect Spot No. 1, in the suboccipital muscles of the neck, under the back of the skull. The first of a series of 14 articles about “perfect spots” around the body for massage.
• Trigger Point Doubts — Do muscle knots exist? Exploring controversies about the existence and nature of so-called “trigger points” and myofascial pain syndrome,
• Why I Quit My Massage Therapy Career — The story of how I was formally investigated for professional misconduct because I criticized pseudoscience in alternative medicine. I quit the profession instead of submitting to regulatory censure and censorship.
• 💩 Massage Therapists Say — A compilation of more than 50 examples of the bizarre nonsense spoken by massage therapists with delusions of medical knowledge.
• Foam Rolling — Coming someday. Meanwhile, rest assured that it’s just another massage delivery mechanism.

Chiropractic: perpetually the most controversial health care profession

• The Chiropractic Controversies — An introduction to chiropractic controversies like aggressive billing, treating kids, and neck manipulation risks.
• Spinal Subluxation — Can your spine be out of alignment? Chiropractic’s big idea has been misleading patients for more than a century Probably not.
• Does Spinal Manipulation Work? — Spinal manipulation, adjustment, and popping of the spinal joints and the subluxation theory of disease, back pain and neck pain.
• Organ Health Does Not Depend on Spinal Nerves! — One of the key selling points for chiropractic care is the anatomically impossible premise that your spinal nerve roots are important to your general health.
• Digital Motion X-Ray — What’s the risk from the radiation exposure? Is the diagnostic potential worth it?
• Scraping massage — Mostly practiced by chiropractors, this a form of intense massage using hard, edged tools.

Medications & supplements

• NEW! The Science of Pain-Killers — A user’s guide to over-the-counter analgesics like acetaminophen, ibuprofen, and more
• NEW! Marijuana for Pain — The hype versus the science! What does the evidence actually show about cannabis and chronic pain?
• Does Epsom Salt Work? — The science and mythology of Epsom salt bathing for recovery from muscle pain, soreness, or injury. Also explores magnesium deficiency in considerable detail (Epsom salt bathing is widely regarded as an Mg delivery system).
• Does Arnica Gel Work for Pain? — A detailed review of popular homeopathic (diluted) herbal creams and gels like Traumeel, used for muscle pain, joint pain, sports injuries, bruising, and post-surgical inflammation.
• Voltaren Gel: Does It Work? — The science of the topical pain-killers, which can be effective without dosing your entire system.
• Opioids for Chronic Aches & Pains — The nuclear option: “Hillbilly heroin” (Oxycontin), codeine and other opioids for musculoskeletal problems like neck and back pain.
• Vitamins, Minerals & Supplements for Pain & Healing — Critical analysis of most popular “nutraceuticals” — food-like pseudo-medicines taken for medicinal purposes, especially glucosamine and creatine, mostly as they relate to pain, arthritis, and recovery from exercise and injury.
• Vitamin D for Pain — Is it safe and reasonable for chronic pain patients to take higher doses of Vitamin D? And just how high is safe?
• Muscle relaxants — This topic is covered in several of my books in detail — low back pain, neck pain, trigger points, frozen shoulder, headaches. There is also condensed (but free) information about them in Cramps, Spasms, Tremors & Twitches.

Tools, gadgets & hardware

• Vibration Therapies, from Massage Guns to Jacuzzis — What are the medical benefits of vibrating massage and other kinds of tissue jiggling?
• Zapped! Does TENS work for pain? — The peculiar popularity of being gently zapped with electrical stimulation therapy.
• Does Ultrasound Therapy Work? — Many concerns about the widespread usage of therapeutic ultrasound, especially extracorporeal shockwave therapy (ESWT).
• The Dubious Science of Kinesiology Tape — The origin story and science of therapy tapes like Kinesio Tape, KT Tape, Spider-Tech, RockTape
• Cold Laser Therapy Reviewed — A critical analysis of treating pain and injury with frickin’ laser beams.
• Spinal Fracture Bracing — My wife’s terrible accident, and a whirlwind tour of the science and biomechanics of her spine brace.
• Are Orthotics Worth It? — A consumer’s guide to the science and controversies of custom orthotics, orthopedic shoes, and other allegedly corrective foot devices.
• Does barefoot running prevent injuries? — A dive into the science so far of barefoot or minimalist “natural” running.
• Scraping massage — Mostly practiced by chiropractors, this a form of intense massage using rigid tools.

Hydrotherapy

• Hydrotherapy, Water-Powered Rehab — A guide to using warm and cold water as a treatment for pain and injury.
• Icing for Injuries, Tendinitis, and Inflammation — Become a cryotherapy master.
• (Almost) Never Use Ice on Low Back Pain! — An important exception to conventional wisdom about icing and heating.
• Ice versus Heat for Pain and Injury — When to use ice, when to heat, when not to, and why.
• Heat for Pain and Rehab — A detailed guide to using heat as therapy for acute and chronic pain and recovery from injury.
• Hot Baths for Injury & Pain — Tips for getting the most benefit from a hot soak, the oldest form of therapy.
• Contrast Hydrotherapy — “Exercising” tissues with quick changes in temperature, to help with pain and injury rehab (especially repetitive strain injuries).
• Does Epsom Salt Work? — The science and mythology of Epsom salt bathing for recovery from muscle pain, soreness, or injury.
• Icing, Heating & Tissue Temperature — How much do ice packs and heating pads change the temperature of muscle and joints?.

Injections, surgeries (mostly minor surgeries)

• Regenerative Medicine:
• Does Platelet-Rich Plasma Injection Work? — An interesting treatment idea for arthritis, tendinopathy, muscle strain and more.
• Does Cartilage Regeneration Work? — A review of knee cartilage “patching” with autologous chondrocyte implantation (ACI).
• Stem Cell Therapy — See the platelet-rich plasma article — the topics overlap so much they are almost the same thing. What I have written about PRP is nearly a clone of what I would write about stem cell therapy.
• Should You Get A Lube Job for Your Arthritic Knee? — Reviewing the science of injecting artificial synovial fluid, especially for patellofemoral pain.
• Do Nerve Blocks Work for Neck Pain and Low Back Pain? — Analysis of the science of stopping the pain of facet joint syndrome with nerve blocks, joint injections, and nerve ablation.
• Knee Surgery Sure is Useless! — Evidence that arthroscopic knee surgery for osteoarthritis is about as useful as a Nerf hammer.
• Extracorporeal shockwave therapy (ESWT) — expensive, hyped and totally unproven for most conditions.
• Knee Replacement Surgery Doubts — Is it legit? Knee replacement is extremely popular, but not yet based on good evidence of efficacy.
• Corticosteroid Injections (for overuse injuries) — Several of my books have chapters devoted to this topic as well, covered most thoroughly in the two runners’ knee books (iliotibial band syndrome and patellofemoral syndrome).
• Prolotherapy — Injections to “toughen up” ligaments by injecting them with an irritant, mostly as a back pain treatment, but now used for many conditions. A more detailed discussion is available in my back pain book.

Energy medicine & “subtle” therapies

• Does Acupuncture Work for Pain? — A review of modern acupuncture evidence and myths, focused on treatment of back pain & other common chronic pains.
• The Myth of Healing Hands — Reiki, therapeutic touch, and other “energy medicine” methods are culturally rich but scientifically bankrupt.
• Homeopathy Schmomeopathy — Homeopathy is not a natural or herbal remedy: it’s a magical idea with no possible basis in reality.
• Does Craniosacral Therapy Work? — Craniosacral therapists make big promises, but their methods have failed to pass every fair scientific test of efficacy or plausibility.
• Do You Believe in Qi? — How to embrace a central concept of Eastern mysticism without being a flake.
• T’ai Chi Helps Fibromyalgia, but It’s Not “Alternative” Medicine — Despite a high profile boost from the New England Journal of Medicine, it’s still just gentle, elegant, and pleasant exercise.

Mind-body and psychology

• Mind Over Pain — Pain can be profoundly warped by the brain, but does that mean we can think the pain away?
• Counterstimulation — Minor but reliable, counterstimulation is one of the most basic pain-killing mechanisms in biology… and maybe there’s a fancier version that’s more useful.
• Cognitive Behavioural Therapy for Chronic Pain — The science of CBT and other psychotherapies for chronic pain.
• Chronic Pain as a Conditioned Behaviour — If pain can be learned, perhaps it be unlearned
• “Windows of Opportunity” in Rehab — The importance of WOO in recovery from injury and chronic pain (using frozen shoulder as an major example).
• The Tyranny of Yoga, Meditation, and Mindfulness — Do you really need to try them? How much do they matter for recovery from conditions like low back pain?
• Pain Relief from Personal Growth — Treating tough pain problems with the pursuit of emotional intelligence, life balance, and peacefulness.
• Anxiety & Chronic Pain — A self-help guide for people who worry and hurt
• The Art of Bioenergetic Breathing — A potent tool for personal growth and transformation by breathing quickly and deeply.
• T’ai Chi Helps Fibromyalgia, but It’s Not “Alternative” Medicine — Despite a high profile boost from the New England Journal of Medicine, it’s still just gentle, elegant, and pleasant exercise.
• A Cranky Review of Dr. John Sarno’s Books & Ideas — Sarno’s methods are historically important, based on a kernel of an important truth that has been blown waaaay out of proportion.
• Autonomous Sensory Meridian Response — That nice, weird tingly head feeling (and its possible relevance to healthcare and treating pain, especially with massage).

Consumer tips, advocacy & anti-quackery activism

• The False Humility of “Facilitating” Healing — Facilitating self-healing is either real but trivial, or interesting but wrong.
• Chronic Pain and Inequality — The role of racism, sexism, queerphobia, and poverty in health and chronic pain
• Reviews of Pain Professions — An opinionated guide to the most popular sources of professional help for injuries and chronic pain.
• Modality Empires — The trouble with the toxic tradition of ego-driven, trademarked treatment methods in massage therapy, chiropractic, and physiotherapy.
• Healer Syndrome — The problem with health care professionals, especially in alternative medicine, who want to be known as “healers”.
• Popular but Weird & Dangerous Cures — The most dangerous, strange, and yet popular snake oils and “treatments” in history (and why anecdotes and testimonials cannot be trusted).
• Alternative Medicine’s Choice — What should alternative medicine be the alternative to? The alternative to cold and impersonal medicine? Or the alternative to science and reason?
• Extraordinary Health Claims — A guide to critical thinking, skepticism, and smart Internet reading about health care.
• Pseudo-Quackery in the Treatment of Pain — The large, dangerous grey zone between evidence-based care and overt quackery in musculoskeletal and pain medicine.

Hard to categorize, but still important

• Posturology — Treatment based on correcting posture, to address alleged links between posture, pain, and even diseases.
• Sleep Compression Therapy — A method of treatment for insomnia based on a strictly and precisely limited sleeping schedule.
• Tissue Provocation Therapies — Can healing be forced? The laws of tissue adaptation & therapies like Prolotherapy & Graston Technique.
• Placebo Power Hype — The placebo effect is fascinating, but its “power” isn’t all it’s cracked up to be.
• Neurodynamic Stretching — Stretching and stimulating nerves to treat neuropathy… hopefully.