Treatments for Pain
An index of science-based, opinionated reviews about what works for pain, what doesn’t, and why
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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.
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.” 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, 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?
Medications & supplements
- 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.
- 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 Review — Topical diclofenac is a useful rub-on anti-inflammatory medication for arthritis, tendonitis, bursitis, runner’s knee, and muscle strain.
- Opioids for Chronic Aches & Pains — The nuclear option: “Hillbilly heroin” (Oxycontin), codeine and other opioids for musculoskeletal problems like neck and back pain.
- Can Supplements Help Arthritis and Other Aches and Pains? — Debunkery and analysis of supplements and food-like medicines (nutraceuticals), especially glucosamine, chondroitin, and creatine, mostly as they relate to pain.
- 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?
Tools, gadgets & hardware
- Vibration Therapy — Massage guns and thumpers, exercise plates, jacuzzis, and more — 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).
- Kinesio Taping Review — A quick analysis of that colourful therapy tape that was so popular at the Olympics. Does it help?
- 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.
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 — An overview.
- 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.
- Tissue Provocation Therapies — Can healing be forced? The laws of tissue adaptation & therapies like Prolotherapy & Graston Technique.
- Knee Replacement Surgery Doubts — Knee replacement is extremely popular, but still 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).
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.
- Placebo Power Hype — The placebo effect is fascinating, but its “power” isn’t all it’s cracked up to be.
- 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
- “Mind over pain” — The second half of my main review of pain science gets as practical as possible about the “mind over pain” idea.
- 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, can 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.
- Civilization Survival Tips — Coping with stress and anxiety in the modern world (without drugs).
- 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.
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”.
- Choose Cheaper, Safer Treatments — All other things being equal, always choose the cheapest and safest treatment option for your pain problem.
- 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.