If you have persistent or unexplained pain, it is important to discuss these concerns with your doctor. The information in this post is presented for educational purposes only, and should not be used to replace standard medical care.
Conventional Treatments
Physiotherapy
Pain may not necessarily correlate with the degree of physical damage. However, poor movement patterns and imbalances may cause the body to reduce further harm to itself by causing pain [1].
Exercise and movements help ensure that injuries heal in a way that restores functional ability [74]. Lack of movements can reduce mobility and strength after the injuries heal.
Physical therapy involves [2, 3]:
- Exercise: For some patients, exercise can help manage pain. It strengthens bones and muscles, and improves mood, self-esteem, physical capacity, and decreases stress [4].
- Corrective movements, such as strengthening muscles around the injured areas, improving postures, and correcting poor movement patterns, can help reduce pain [5].
- Massage therapy reduced pain sensitivity at tender points by relaxing muscle tissues and also reduces stress by increasing oxytocin [6].
- Education and advice can help individuals understand their condition and make the best decisions addressing their issues [7].
- Mobility aids can assist in a patient’s balance and maintain motor functions [8].
Physiotherapy should be carefully overseen by a medical professional.
Painkillers
Painkillers help with mild-to-moderate acute pain by treating the symptoms. These include Tylenol or nonsteroidal anti-inflammatory drugs (NSAIDs). Medication choice depends on the condition and risk factors of the patients. Some (cyclooxygenase-2 selective) NSAIDs can cause heart complications [9].
NSAIDs can reduce inflammation thus helping with pain. These drugs also reduce fever (antipyretic effects). These drugs include [10]:
- Aspirin
- Ibuprofen
- Naproxen
- Phenylbutazone
NSAIDs do have side effects, such as reducing the protective layers in the gut, which can cause stomach ulcers and increase intestinal permeability. In injuries, actively reducing inflammation may also prolong healing time [11, 12, 13].
General Pain
Camphor
Camphor is a compound that can be distilled from the bark and wood of the camphor tree or produced from turpentine oil. Camphor relieves pain by activating the TRPV1 and TRPV3 channels while blocking TRPA1. Topical preparations with 3-11% camphor are approved by the FDA for pain related to cold sores, insect stings and bites, burns, and hemorrhoids [14, 15, 16].
In a small trial on 20 people, a topical spray with camphor, menthol, and the essential oils of eucalyptus, clove, turpentine, and Gaultheria relieved mild to moderate pain from different conditions when applied on the joints, shoulders, and back [17].
Topical phenol-camphor relieved pain from lung inflammation in an old trial on 82 people [18].
In mice and rats, a plant extract composed of linalool and camphor relieved pain from heat, irritation with acetic acid, and inflammation [19].
Importantly, camphor should never be used at concentrations above 11%, ingested, or applied on open wounds because it can cause poisoning. However, [20].
Capsicum
Capsaicin is the compound that makes chili peppers hot. In brain cells, capsaicin activates the TRPV1 receptor. Although this protein triggers inflammatory pain, its repeated stimulation makes brain cells insensitive to pain perception. Capsaicin also seems to reduce the levels of substance P, which is involved in pain transmission, in the spinal cord [21, 22].
Multiple studies show that topical creams and patches with 8% capsaicin are as effective as some oral painkillers at relieving pain caused by nerve damage, such as from HIV, herpes, and diabetes [23, 24, 25, 26, 27].
Applied through the nose, capsaicin reduced the number and severity of cluster headache attacks in 3 small trials on 89 people [28, 29, 30].
Applied Heat or Cold
Cold exposure (e.g., with ice packs) is commonly used to reduce swelling and pain after traumatic injuries. It may also help reduce the pain and need for opioid medication after surgical procedures such as knee replacement and jaw or cruciate ligament reconstruction. The evidence is more limited in the case of pain after wise tooth removal [31, 32, 33, 34, 35, 36, 37, 38].
Immersion in cold water is moderately effective in the prevention and recovery of muscle soreness after exercise [39, 40].
Cold therapy has also been used in the treatment of migraines for over 150 years. Different devices applying cold to the head and neck have been successfully tested in several clinical trials [41, 42, 43, 44, 45, 46].
Both heat and cold have been reported to provide a small, short-term reduction of low-back pain when superficially applied. However, the evidence to support the use of these practices is limited. Similarly, a reduced number of trials suggests that applied heat or cold may help prevent perineal trauma after childbirth [47, 48, 49, 50].
Applied heat also seems effective at relieving the pain from menstrual cramps, but the evidence is based on relatively few, small trials [51].
Caffeine
According to multiple studies, the addition of caffeine to painkillers (most often ibuprofen and Tylenol) slightly but significantly improves their effectiveness for acute pain [52, 53, 54, 55].
Massage
Clinical research shows that massage helps reduce pain, anxiety, and depression in people with pain from different conditions. However, its benefits appear to be short-lived and decline after a few weeks [56, 57, 58, 59].
In a meta-analysis of over 1000 patients, massage reduced pain and anxiety associated with postoperative recovery. Massage was also found effective as an add-on to painkillers after heart surgery in a meta-analysis of 12 studies [60, 61].
In a systematic review, vaginal massage in the final month of pregnancy prepared almost 2500 women for birth, reducing the likelihood of trauma and pain, increasing flexibility, and decreasing muscle and soft tissue resistance. However, massage was only effective for women who had previously given vaginal birth [62, 63].
Palmitoylethanolamide (PEA)
Palmitoylethanolamide, or PEA, is produced in the body naturally to combat pain and inflammation. Many animals and plants also produce PEA. The highest amounts can be found in soy lecithin, soybeans, egg yolk, peanuts, and alfalfa. PEA activates the anti-inflammatory PPAR alpha while reducing the activity of the FAAH gene, which breaks down the calming cannabinoid anandamide [64].
A decent amount of evidence backs up PEA’s ability to reduce complex pain. It has been investigated in over 30 clinical trials and a total of ~6k people since the 1970s [65].
While most of the research speaks to PEA’s ability to reduce pain in general, studies often fail to make a distinction between neuropathic and non-neuropathic pain. Another limitation was that most of these studies lacked a placebo control. More high-quality research is needed to determine how effective PEA is at relieving different types of pain.
In an analysis of 12 human studies, PEA supplements taken for at least 2 weeks reduced chronic and neuropathic pain intensity without any serious adverse effects [66].
In a clinical trial on 80 people with fibromyalgia, PEA (600-1200 mg/day) as an add-on to conventional therapy reduced pain and joint tenderness when compared to the drugs alone. However, the study was poorly designed (it lacked randomization and blinding) [67].
In 2 trials of over 100 women with endometriosis, PEA (300-400 mg/day) relieved pelvic pain and improved sexual function over 6 months [68, 69].
In a small trial on 20 women, PEA (400 mg, 2x/day) in combination with transpolydatin improved the effectiveness of TENS at relieving vulvar pain [70].
Preliminary clinical research in 30 diabetics shows that PEA (300 mg/day) reduces neuropathic pain caused by this condition [71,
At high doses (600-1200 mg/day), PEA reduced carpal tunnel syndrome caused by nerve compression in 2 small trials [72, 73].
In a small trial on 24 people with jaw pain (temporomandibular disorders), taking PEA for 12 weeks (up to 900 mg/day) relieved pain better than ibuprofen (1800 mg/day) [74].
In a small trial on 30 people undergoing wise tooth removal, taking PEA tablets (300 mg, 2x/day) for 15 days reduced postoperative pain [75].
In a pivotal trial of over 600 people, PEA (300 or 600 mg/day) strongly reduced sciatic pain, higher dose having a more beneficial effect. PEA reduced pain intensity by over 50% in just 3 weeks, which is rarely seen with most painkillers. In another study, PEA improved pain in people with sciatica who didn’t respond to oxycodone [76, 77].
Psychotherapy
Thoughts and perception of threats may increase pain.
The following mental/emotional factors can affect pain [78, 79, 80]:
- Thoughts
- Emotions
- Social and familial support
- Cultural background
- Context and memory associated with the pain (through conditioning)
Cognitive behavioral therapy improved the overall quality of life in some individuals with chronic pain, with modest effectiveness [81].
Acceptance and commitment therapy focuses on the context of how the patients feel the pain [82]. Increasing the acceptance of the pain and the context can help reduce pain. This is most likely effective as a chronic pain management strategy [83].
Clinical hypnosis can reduce pain in adults and children, and has been observed to reduce acute pain, migraines, arthritic pain, cancer pain, and surgery pain [84, 85].
Acupressure
Acupressure is a form of TCM similar to acupuncture, except that it involves the use of applied pressure in place of needles. Pressure is applied using the hands, thumbs, fingers, or devices to specific places (called acupoints) on the body.
A small trial of 22 healthy women showed that acupressure might decrease the pain of needle insertion when compared to sham acupressure [86].
In another trial of 31 cancer patients, acupressure reduced the need for opioids by up to 44% [87].
In a clinical trial of 98 people with chronic migraines, acupressure enhanced the pain-relieving effects of conventional medication (sodium valproate). However, a placebo effect can’t be ruled out because the control group received the medication without sham acupressure [88].
Preliminary research suggests that acupressure improves pain and disability in people with low-back pain. However, the authors of a meta-analysis warned that the studies included were heterogeneous and had low quality [89].
Another meta-analysis found acupressure (both self-administered and delivered by a trained person) effective at relieving menstrual pain. Again, the studies were generally of low quality and had high risk of bias [90].
Acupressure has also been suggested to reduce pain intensity and the need for painkillers during labor. However, all the studies had low quality and high risk of bias [91].
Studies have also found acupressure effective at reducing postoperative pain. However, the results were mixed and better-quality, large-scale studies are still needed for a more accurate estimation [92, 93].
Biofeedback
“Biofeedback training” is a growing trend in healthcare, where people are hooked up to devices for measuring different aspects of bodily functions in order to see how these processes are taking place in real-time. People can then be trained to learn to control the way these processes are carried out [94, 95].
Clove
In a clinical trial on 73 healthy volunteers, a topical gel with clove essential oil applied on the mouth was as effective as lidocaine as an anesthetic [96].
Similarly, a topical gel with clove and papaya prevented the pain caused by an injection in a trial on 60 children [97].
Multi-ingredient formulations with the essential oils of clove and other herbs reduced pain from ear infections and muscle strain in 2 small trials [98, 17].
Lavender
Lavender essential oil applied topically to the insertion area of a needle reduced the intensity of the pain in 30 healthy volunteers and 34 dialysis patients [99, 100].
In two studies, lavender used in an aromatherapy massage to the stomach region significantly reduced the severity of menstrual cramps. Similarly, applying 3 drops of lavender oil to the hands or a piece of cotton and inhaling it reduced abdominal pain and backache during menstruation in 2 clinical trials [101, 102, 103, 104].
In a clinical trial of 47 people with migraine, the inhalation of lavender oil significantly reduced headache severity [105].
In two small trials, lavender used in an aromatherapy massage to the joints reduced pain and depression. However, the specific effects of the lavender oil itself and the massage are unknown [106, 107].
In 2 clinical trials on almost 300 pregnant women with planned C-section, aromatherapy with inhaled lavender oil, as an add-on to medication, reduced pain after the procedure. Similarly, lavender oil aromatherapy reduced the need for painkillers in a trial on 48 children undergoing tonsil removal [108, 109, 110].
Licorice
In a clinical trial on almost 2500 terminal cancer patients, a combination of licorice root and peony root, along with a Taiwanese tonic vegetable soup, reduced pain better than the soup alone or regular hospital diet [111].
Vitamin D
A meta-analysis of 19 clinical trials found that taking vitamin D supplements for 1-24 months reduces the intensity of chronic pain. However, the final follow-up pain score was similar in the vitamin D and placebo groups [112].
In a clinical trial of almost 900 teenage girls, supplementation with high-dose vitamin D reduced pain and PMS symptoms [113].
In a clinical trial on 30 women with fibromyalgia and vitamin D deficiency, supplementation to maintain adequate levels of this vitamin reduced pain [114].
The evidence for the use of vitamin D for osteoarthritis is contradictory. A trial on over 100 people found supplementation effective to reduce pain in people with vitamin D deficiency, but a longer-term study on almost 150 people found it ineffective. Based on these discrepancies, the American College of Rheumatology recommends against the use of vitamin D supplementation [115, 116, 117].
Chronic Pain
Acupuncture
Acupuncture is a form of alternative treatment developed by practitioners of Traditional Chinese Medicine. During acupuncture, thin metal needles are inserted at acupuncture points, or acupoints [118, 119].
These thin metal needles are briefly manipulated manually to penetrate the skin. The needles are then left in the skin for a period of time (30 minutes – hours). Some practitioners believe that electrical stimulation of the needle can enhance the stimulation of the acupoints [120].
Acupuncture may be effective at pain management without the side effects of opiates. It may even help patients wean off from opiate drugs [121, 122].
Perhaps the most common use of acupuncture is to manage chronic pain [123].
Stimulation of acupoints is believed to release endorphins and natural opioids in the body, thus reducing the perception of pain. In addition, it also reduces stress and tension [124].
However, the role of acupuncture in pain management is controversial. Some researchers have hypothesized that a combination of neural signaling, opioids, glutamate, and adenosine are involved [124].
Cannabis
According to some estimates, medical use of cannabis dates back as far as the 16th century B.C. in ancient Egypt [125].
Nabiximols (Sativex) is a cannabis extract formulated as a spray that contains similar amounts of THC and CBD (2.7 mg THC and 2.5 mg CBD per spray). It has been approved in Canada and the UK as an add-on treatment for the symptomatic relief of neuropathic pain in adults with treatment-resistant multiple sclerosis [126, 127].
An analysis of five small clinical studies concluded that inhaled cannabis (providing 1.6-96 mg THC daily) reduces the intensity of neuropathic pain caused by HIV, trauma, diabetes, chemotherapy, and other conditions in up to 2 weeks [128].
In one small clinical trial, inhaled cannabis (containing 2.9% or 6.7% THC) reduced neuropathic pain due to spinal cord injury. The effect was immediate and lasted less than 2 hours [129].
Some human studies showed mixed results regarding THC’s effectiveness for other types of pain, as is the case with sunburns and capsaicin-triggered pain and inflammation in healthy volunteers [130, 131].
Chronic pain is an occasional adverse effect of kidney transplantation. People normally manage it with painkillers, which can damage the kidneys. In a small trial on 7 people with kidney transplants, CBD was safe and reduced pain in all but one person [132].
Therapeutic Baths
Therapeutic baths—or balneotherapy—are sometimes used to reduce inflammation. Therapeutic baths can simply be set to a particular temperature (to trigger a heat shock response) or can have minerals added. In the case of baths in natural springs, some of the observed therapeutic effects may be due to the presence of small amounts of stressors like hydrogen sulfide or even radon [133].
A meta-analysis found that two weeks of therapeutic mineral baths somewhat reduced pain and tenderness in people with fibromyalgia [134].
Therapeutic baths have also been found to improve chronic pain in patients with ankylosing spondylitis, psoriatic arthritis, and other painful disorders. Studies on balneotherapy are typically at least two weeks long, with at least daily 20 minute mineral baths [135, 136, 137]
CoQ10
Coenzyme Q10 (CoQ10) is an important compound found in every cell in the body. It is a type of coenzyme, which means that it helps enzymes work more effectively. CoQ10 is mainly located in the membrane of mitochondria, where it is used to make energy [138].
Fibromyalgia is characterized by altered CoQ10 distribution in the body and increased oxidative stress. CoQ10 levels may be high in the blood, but low in immune cells. Supplementation can increase CoQ10 levels in immune cells, which protects them and lowers oxidative stress [139].
In multiple studies, CoQ10 supplementation (100 – 300 mg/day) improved symptoms of fatigue, pain, headache, and depression. Supplementation also reduced inflammation and improved mitochondrial function [140, 141, 142, 143, 144, 145].
In 24 diabetics suffering from neuropathy, 400 mg/day CoQ10 improved nerve function and symptoms of nerve damage, including pain [146].
CoQ10 given within 3 days of a heart attack reduced heart pain, irregular heartbeat, and improved heart function in 144 people. The number of new heart attacks as well as deaths was also reduced in the group taking CoQ10 [147].
Magnesium
Magnesium is the fourth most abundant mineral found in our body. It is essential to all living cells and vital for numerous physiological functions [148, 149].
In multiple clinical trials, supplemental magnesium significantly reduced the pain associated with fibromyalgia. In the form of both magnesium citrate and magnesium hydroxide, these supplements reduced the number and severity of tender points. Perhaps as a consequence, they also improved measures of psychological health in fibromyalgia patients [150, 151].
Magnesium stores may be unusually low in patients with fibromyalgia, migraine, and other pain disorders. Taking magnesium supplements may reduce pain by correcting this deficiency [152, 153].
Massage
A meta-analysis showed that massage therapy for over 5 weeks modestly improves pain, anxiety, and depression in patients with fibromyalgia [154].
Chronic pain is a common symptom of multiple sclerosis. Some trials show that massage therapy reduced pain, fatigue, and spasticity. However, a meta-analysis concluded that the evidence was insufficient [155, 156, 157].
SAM-e
SAM-e (S-Adenosyl-L-methionine or AdoMet) occurs naturally in the human body and enables a range of essential metabolic reactions. As a supplier of a methyl group and organic sulfur, SAM-e drives complex metabolic reactions that control cell growth and lifecycle, inflammation, brain chemistry, and more [158, 159].
Studies exploring complementary approaches to fibromyalgia are underway, and SAM-e is among them. According to a review of 70 clinical trials, SAM-e, magnesium, and L-carnitine showed the best results and the most potential for further research [160, 161].
In 44 patients with fibromyalgia, SAM-e (800 mg daily for 6 weeks) reduced muscle pain, fatigue, and morning stiffness [162].
It also relieved depression and increased pain tolerance in 17 fibromyalgia patients. In another trial of 34 patients, injected SAM-e had no influence on pain; it did, however, slightly improve fatigue, sleep quality, and stiffness [163, 164].
In studies of elderly patients, SAM-e was about as effective as NSAID painkillers, but produced fewer side effects. SAM-e also reduced functional abdominal pain in children [165, 166].
Tai Chi
Tai chi is an exercise therapy that integrates moderate physical activity, deep breathing, and meditation to promote stress reduction and relaxation, which can beneficially influence the immune system and overall health [167, 168].
Tai chi may be a good form of exercise for people with chronic pain. A handful of clinical studies have found that fibromyalgia patients who practiced tai chi as little as once or twice weekly for 12 weeks reported less pain and better quality of life [169, 170].
Studies on other chronic disorders that cause pain, such as osteoarthritis and rheumatoid arthritis, produced similar results [171, 172].
Sickle Cell Disease
Glutamine
L-glutamine was recently approved by the FDA for the management of sickle cell anemia. It reduces acute complications of sickle cell disease in adults and children 5 years of age and older. Taking 5-15 grams (both alone and combined with hydroxyurea) reduces the number of pain crises by 25-30% [173, 174].
Zinc
People with sickle cell disease are at increased risk of zinc deficiency. Oral supplementation with zinc seems to reduce the symptoms of this condition and the number of crises and infections [175, 176, 177].
Arthritis/Osteoarthritis
Aquatic Exercise
A meta-analysis of 10 clinical trials showed that aquatic exercise improves pain, disability, and quality of life in people with knee and hip osteoarthritis. Another analysis of 8 studies found that, although aquatic exercise is as effective as land-based exercise, patients tend to prefer and better adhere to aquatic exercise [178, 179].
However, adding aquatic exercise to other types of exercise doesn’t seem to provide additional benefits in terms of pain reduction [180].
In 2 clinical trials on over 250 people with rheumatoid arthritis comparing different exercise modalities, aquatic exercise produced the greatest pain reduction [181, 182].
Arnica
In a clinical trial of 79 people with knee arthritis, arnica gel (2.5% arnica extract) applied 2x/day for up to 6 weeks reduced pain, stiffness, and disability. The same gel 3x/day for 3 weeks reduced hand arthritis symptoms as effectively as a 5% ibuprofen gel in a clinical trial on almost 200 people [183, 184].
In rats with arthritis, a high-dose arnica extract (up to 500 mg/kg body weight) reduced joint damage, inflammation, and increased antioxidants [185].
Borage
Borage is a flowering herb whose oil is especially rich in the omega-6 PUFA gamma-linolenic acid.
In 2 trials of 187 people with rheumatoid arthritis, taking borage seed oil capsules for up to 18 months reduced the symptoms [186, 187].
Several studies demonstrated that borage seed oil reduced inflammation in the lining of joints (synovitis), thus reducing the need for anti-inflammatory drugs [188, 189, 190].
A GLA-rich diet reduced short- and long-term inflammation in rats with arthritis [191].
Boswellia
Boswellia resins, also known as frankincense/olibanum, are obtained from Boswellia trees. In two clinical trials of 135 osteoarthritis patients, a specific boswellia extract, 5-Loxin (100-250 mg/day for 3 months), significantly improved joint pain and functionality. Patients began to experience significant improvement after 7 days of treatment with a higher dose [192, 193].
Different types of Boswellia extract were able to reduce pain and improve knee function in three studies of 145 osteoarthritis patients [194, 195, 196].
Boswellic acids reduced swelling and showed anti-arthritic activity in studies on rats and mice with joint disorders [197].
Camphor
A preparation with camphor, glucosamine sulfate, and chondroitin sulfate relieved pain within 4 weeks in a clinical trial on 63 people with osteoarthritis of the knee [198].
Capsicum
Topical capsaicin is as effective as NSAIDs at relieving pain from knee osteoarthritis. However, the American College of Rheumatology doesn’t recommend capsaicin for hip osteoarthritis due to the depth of the joint beneath the skin surface, nor for hand osteoarthritis due to the risk for contamination of the eye [199, 117].
Cat’s Claw
Cat’s claw’s anti-inflammatory effects have been commonly used to treat both rheumatoid arthritis and osteoarthritis [200].
In a clinical trial on 40 rheumatoid arthritis patients, cat’s claw combined with conventional treatments (sulfasalazine/hydroxychloroquine) reduced tender and painful joints [201].
Both alone and combined with maca, cat’s claw improved joint pain, stiffness, and function in two trials on almost 150 people with knee osteoarthritis [202].
Chondroitin Sulfate
Meta-analyses of clinical studies often concluded that chondroitin sulfate improves pain better than placebo in people with knee and hip osteoarthritis. Some studies found no benefits, possibly due to the use of lower-quality supplements. Studies with pharmaceutical-grade chondroitin sulfate typically reported effective pain reduction. However, some of them were sponsored by the manufacturer [203, 204, 205, 206].
Due to these discrepancies, the American College of Rheumatology (ACR) recommends against the use of chondroitin for any form of osteoarthritis. Conversely, the European Society of Clinical and Economic Aspects of Osteoarthritis (ESCEO) strongly recommends the use of pharmaceutical-grade chondroitin products [117, 207].
Curcumin/Turmeric
Research suggests that curcumin and turmeric extracts, alone or in combination with other herbs, may reduce pain and improve function in people with knee osteoarthritis. Although curcumin is less effective than ibuprofen, it also produces fewer adverse effects [208, 209, 210]
Three-month supplementation with 200 mg/day of a curcumin-phosphatidylcholine complex decreased pain scores by 58% and increased walking distance by over 400% in osteoarthritis [211].
Curcumin has also been clinically researched for its potential to regenerate cartilage [212].
Fish Oil
A meta-analysis of 17 trials found that supplemental fish oil reduces inflammatory joint pain from rheumatoid arthritis and other inflammatory conditions [213].
Omega-3’s were as effective as ibuprofen in reducing pain caused by arthritis, according to a study of 250 patients [214].
Resolvins found in EPA and DHA appear to prevent certain inflammatory cytokines such as TNF-α from inducing pain [215].
Lactobacillus Probiotics
In 2 clinical trials on over 100 people with rheumatoid arthritis, supplementation with a Lactobacillus casei strain for 8 weeks reduced joint pain and inflammation [216, 217].
This strain also relieved rheumatoid arthritis in mice and rats [218, 219, 220].
L. casei, as an add-on to glucosamine, improved osteoarthritis treatment in rats by reducing pain, inflammatory responses, and articular cartilage degradation [221].
Stinging Nettle
Stinging nettle (Urtica dioica) is an herb native to parts of Europe, Africa, Asia, and North America. Civilizations as old as Ancient Greece used this plant for its medicinal properties, though our modern names for it come from the Anglo-Saxon “noedl” (needle) and the Latin “urtica” (to burn) [222, 223].
Stinging nettle’s anti-inflammatory properties could potentially help relieve arthritis symptoms. A combination of stinging nettle leaf extract and devil’s claw significantly reduced symptoms of arthritis compared to a placebo in a 12-week study of 92 arthritis patients [224].
These arthritis-relieving properties may be due to nettle’s ability to inhibit the activation of a protein called NF-κB, which would otherwise increase the production of inflammatory compounds. NF-κB is often overactive in people with arthritis [225, 226].
Stinging nettle is often used by traditional practitioners. Urtication, also known as ‘flogging with nettles,’ is a technique where users apply raw, unprocessed stinging nettle leaves or stems to the body to generate inflammation. This has been used since Ancient Roman times for relieving chronic rheumatism, but researchers have only just begun to investigate its effectiveness [227].
Superoxide Dismutase
Superoxide dismutases are enzymes that transform the superoxide (O2-) radical into either ordinary oxygen (O2) or hydrogen peroxide (H2O2) [228].
Scientists think that SOD plays a protective role against oxidative stress, ionizing radiation, and inflammatory cytokines [228, 229].
Superoxide dismutase treatments reduced the pain associated with osteoarthritis and rheumatoid arthritis in a handful of studies. However, in all of these, superoxide dismutase was administered as an injection into the problem joints; there is no data supporting the use of superoxide dismutase as a supplement for arthritis [230, 231, 232, 233].
Thunder God Vine
Thunder god vine (Tripterygium wilfordii), known as Lei Gong Teng in Chinese, is a woody plant that grows wild in the mountainous regions of southern China, Korea, Japan, and Taiwan [234].
In 2 clinical trials on over 100 people with Rheumatoid Arthritis, thunder god vine extract (60-360 mg/day) improved joint inflammation, pain, and physical health. It was more effective than the anti-rheumatic drug sulfasalazine in another trial on 62 people [235, 236, 237].
Similarly, its tincture applied on the skin throughout the day improved arthritis in a trial on 61 people [238].
When combined with the immunosuppressant methotrexate, lower doses of the extract can be used (20 mg, 2x-3x per day), according to trials on over 400 people [239, 240, 241, 242].
Thunder god vine and its active components also improved arthritis in multiple animal studies [243, 244, 245, 246, 247, 248, 249, 250, 251, 252, 253, 254].
Ankylosing spondylitis is a type of spine arthritis. In 2 clinical trials on 48 people, thunder god vine (60 mg/day) improved pain, swelling, inflammation, and mobility. Yet, an analysis of studies on over 800 people couldn’t find enough proof of its effectiveness [255, 256, 257].
Vitamin E
Vitamin E is a broad term for two types of fat-soluble nutrients—tocopherols and tocotrienols—each comprising four different classes: alpha, beta, gamma, and delta. The most abundant forms in food are alpha- and gamma-tocopherol [258, 259].
One study found that vitamin E supplements (600 mg twice a day for twelve weeks), when added to conventional therapy, improved pain but not inflammation [260].
Massage
Massage therapy relieved pain and stiffness in 2 clinical trials on over 150 people with knee arthritis [261, 262].
Migraine
Caffeine
Caffeine is a part of different FDA-approved drugs for migraine and tension headaches, along with Tylenol, aspirin, sumatriptan, diclofenac, and others [263, 264, 265, 266, 267, 268, 269].
In 2 clinical trials on almost 350 people, caffeine (both oral and intravenous) helped prevent postoperative headaches [270, 271].
Ironically, headache is one of the most common symptoms of caffeine withdrawal, which can be a limitation for its long-term use [272].
Acupuncture
Acupuncture is a form of alternative treatment developed by practitioners of Traditional Chinese Medicine. During acupuncture, thin metal needles are inserted at acupuncture points, or acupoints [118, 119].
These thin metal needles are briefly manipulated manually to penetrate the skin. The needles are then left in the skin for a period of time (30 minutes – hours). Some practitioners believe that electrical stimulation of the needle can enhance the stimulation of the acupoints [120].
Adding acupuncture to the standard of care reduced the frequency of migraine attacks in multiple clinical studies [273, 274].
However, in clinical studies, acupuncture treatment for headaches and migraines have conflicting results.
In a randomized control study of 270 patients, those in both the acupuncture and sham acupuncture groups experienced greater relief for tension headaches than patients with no acupuncture treatment. However, there was no significant difference between the acupuncture group and the sham control group [275].
In 2 different studies, acupuncture was more effective than placebo, reducing both the number of headache attacks and the duration of the headaches [276, 277].
A 2016 meta-analysis found that acupuncture is effective at treating frequent episodic or chronic tension-type headaches [278].
For episodic migraines, true acupuncture was more effective than sham acupuncture and traditional painkillers [273].
Butterbur
Butterbur (any of the plants of the Petasites genus), a type of coltsfoot, is a flowering plant native to Asia, Europe, and North America. It has been used in traditional medicine for thousands of years and was even used to treat plague and fever during the Middle Ages [279, 280].
Butterbur is commonly used for migraine and allergy relief and has been the subject of multiple clinical trials suggesting that it is an effective treatment for both conditions. It contains beneficial chemicals that may reduce inflammation, oxidation, and pain [281, 282, 283, 284].
Butterbur may relieve pain by decreasing the sensitivity of the brain cells that perceive it. Isopetasin decreased the activity of the protein TRPA1, which is found on the surface of sensory neurons, decreasing neuron sensitivity and pain [285, 286, 287].
Chiropractic Manipulation
Chiropractic treatment is a school of complementary healthcare that seeks to treat disorders related to the muscular and skeletal system. Chiropractors typically accomplish their goals through manipulation of the patient’s spine [288, 289].
Chiropractic spinal manipulation has been found to reduce the frequency and duration of migraine when used as a preventative therapy [290, 291, 292].
However, some studies with more robust methodology have found no benefit to chiropractic treatment relative to non-chiropractic controls [292, 293].
CoQ10
Coenzyme Q10 (CoQ10) is an important compound found in every cell in the body. It is a type of coenzyme, which means that it helps enzymes work more effectively. CoQ10 is mainly located in the membrane of mitochondria, where it is used to make energy [138].
CoQ10 levels are often lower in people who experience migraines [294].
In multiple studies, CoQ10 (100 – 300 mg/day) reduced the duration, frequency, and severity of migraines. In one study, 150 mg/day reduced the number of migraines by over 50% after 3 months [295, 296, 297, 294].
Feverfew
Sometimes called medieval aspirin, feverfew has been traditionally used as a treatment for fever, rheumatism, arthritis, toothache, psoriasis, insect bites, asthma, stomachache, headaches, infertility, tinnitus, dizziness, nausea, vomiting, menstrual problems and migraine [298].
An active compound in feverfew reduces serotonin release by platelets and white blood cells and blocks serotonin receptors. During a migraine attack, increased serotonin release may cause inflammation and stimulate nerves, causing pain [299, 300, 301, 302].
In 3 clinical trials on almost 400 people, feverfew extract reduced the number and severity of the attacks, the number of attacks requiring bed rest, and the frequency of vomiting. [303, 304, 305].
In another trial on 69 women with frequent migraines, the combination of feverfew and acupuncture had better effects on pain management and quality of life than either of these strategies alone [306].
Combinations of feverfew and ginger (LipiGesic and Gelstat) were also effective in 2 trials of 89 people. Similarly, another combination of feverfew and willow extract (Mig-RL) prevented migraine attacks and reduced their intensity in a small trial on 12 people [307, 308, 309].
In a small trial on 17 people, capsules with freeze-dried feverfew prevented the worsening of headaches, nausea, and vomiting but caused a withdrawal-like syndrome with migraine symptoms and joint stiffness when they switched from feverfew to placebo [310].
However, feverfew extract (standardized to 0.5 mg parthenolide) did not improve migraine symptoms in a trial on 50 people [311].
In another trial on 49 people, feverfew combined with riboflavin and magnesium had no benefit over riboflavin alone at preventing migraine attacks [312].
Massage
A meta-analysis of 7 clinical trials found that massage and other manual therapies may be as effective as conventional drugs to reduce the intensity and frequency of migraine attacks. However, they warned that the quality of the studies was low. Massage seems to help by reducing stress (a common migraine trigger) [313, 314].
In 3 clinical trials on almost 200 people, massage reduced the frequency and intensity of tension headaches by reducing stimulation of the trigger points on the neck and shoulder [315, 316, 317].
Riboflavin/Vitamin B2
Vitamin B2, also known as riboflavin, is a vitamin that plays an integral role in the body. It is activated to produce the cofactors flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD), which are necessary for many biological reactions such as those required for breaking down fats, proteins, and carbohydrates [318, 319].
Three studies on over 100 adults showed that riboflavin supplementation helped prevent migraine attacks. Its combination with ubiquinone and magnesium was similarly effective in another trial on130 people [320, 321, 322, 323].
However, 2 studies on 60 children found riboflavin ineffective [324, 325].
Based on the available evidence, 2 meta-analyses concluded that supplementation with vitamin B2 is a safe, inexpensive, and effective way to prevent migraine attacks in adults, but not in children [326, 327].
TENS
TENS is short for transcutaneous electrical nerve stimulation. It is generally considered a safe (when used correctly), inexpensive, and non-invasive method of stimulating nerves by applying electricity to the surface of the skin.
The most common explanation of how TENS works for pain relief involves the “gate control” theory of pain. The basic idea is that stimulating large areas of the skin may shut off or suppress the nervous system in the upper part of the spinal cord. Closing this “gate” may prevent pain signals from passing to the brain from the rest of the body [328].
A study of 110 patients found that applying TENS at the base of the head (occipital nerve) decreased the duration of headaches in migraine sufferers. It also had low rates of side effects, making it a possible option for patients that did not want to take medications for their migraines [329].
Similarly, a study of 57 patients found that using a TENS unit reduced both the number and intensity of pain episodes in a headache and migraine sufferers [330].
Another study found that the use of TENS for headaches decreased medication use and helped patients manage their chronic migraine symptoms better [331].
Finally, another study of migraine patients reported that TENS treatment reduced the total amount of days with a headache. 66% of the patients in this study decided to continue using a TENS unit to keep their headaches at bay, although the patients who followed the TENS directions the best reported the greatest benefits at a follow-up [332].
Post-Traumatic Pain
Arnica
Arnica (Arnica montana L.), also known as mountain daisy, mountain tobacco, and leopard’s bane, is a plant with orange-yellow flowers that belongs to the same family as sunflowers, dandelions, daisies, and marigolds (Asteraceae). It has a long history in traditional medicine, but contains potentially dangerous compounds [333, 334].
A spray for sports injuries with 10% arnica tincture and an anti-inflammatory painkiller (hydroxyethyl salicylate) reduced the pain from ankle distortion and sports injuries in two clinical trials of over 600 people. The combination worked better than either substance alone [335, 336].
Neck & Back Pain
Chiropractic Manipulation
Chiropractic treatment is a school of complementary healthcare that seeks to treat disorders related to the muscular and skeletal system. Chiropractors typically accomplish their goals through manipulation of the patient’s spine [288, 289].
Many studies have found that chiropractic therapy reduced neck pain. However, it seems to be at its most effective in combination with other strategies, including exercise [337, 338, 339, 340, 292, 293].
Massage
The 2017 guidelines of the American College of Physicians recommend massage for both acute and chronic low-back pain. Most clinical trials show that massage provides at least temporary relief, especially when combined with exercises and education. Massage seems less effective than immediate spinal manipulation but more than acupuncture [341, 342, 343, 344, 345].
Massage increases blood flow, blocks pain receptors in muscle tissue, and signals the brain to relax the body [346, 347].
More limited evidence suggests that massage may also help with neck and shoulder pain [348, 349].
Acupressure
Acupressure is a form of TCM similar to acupuncture, except that it involves the use of applied pressure in place of needles. Pressure is applied using the hands, thumbs, fingers, or devices to specific places (called acupoints) on the body.
One clinical study has found that one month of acupressure treatment significantly reduced chronic back pain. In another study, adding acupressure to conventional treatment significantly improved both pain and walking ability in elderly patients with lower back pain [350, 351].
Acupuncture
Acupuncture is a form of alternative treatment developed by practitioners of Traditional Chinese Medicine. During acupuncture, thin metal needles are inserted at acupuncture points, or acupoints [118, 119].
These thin metal needles are briefly manipulated manually to penetrate the skin. The needles are then left in the skin for a period of time (30 minutes – hours). Some practitioners believe that electrical stimulation of the needle can enhance the stimulation of the acupoints [120].
A meta-analysis of 22 randomized clinical trials found that acupuncture is an effective treatment for chronic lower back pain but it was inconclusive for acute low back pain. However, despite these results, the study found that other active therapies were just as effective for treating chronic low back pain as acupuncture [352].
In several clinical studies, patients in both the acupuncture and the sham (minimal fake acupuncture control) acupuncture groups experienced more benefit to their lower back pain than patients with no acupuncture treatment or conventional therapies. However, there was no significant difference between the acupuncture group and the sham control group [353, 354].
Potentially, acupuncture treatment may have psychological placebo effects without having physical effects on the body. The acupuncture treatment outperformed other groups (conventional treatments and no treatments) but did not outperform the sham control group.
However, brain imaging studies have shown that acupuncture and sham acupuncture had different effects on the brain (limbic structures), despite similar levels of pain relief [355].
According to a meta-analysis, some studies demonstrated low to moderate evidence of acupuncture’s effectiveness for chronic lower back pain. These benefits were short-term (less than 3 months) [356].
Biofeedback
“Biofeedback training” is a growing trend in healthcare, where people are hooked up to devices for measuring different aspects of bodily functions in order to see how these processes are taking place in real-time. People can then be trained to learn to control the way these processes are carried out [94, 95].
A type of biofeedback called EMG biofeedback has been found to moderately reduce back pain compared to psychological or physiotherapeutic treatments [357, 358].
In fact, this form of biofeedback is recommended by the American College of Physicians as a non-drug treatment for chronic pain in the lower back. If you are struggling with back pain, you can ask your doctor about this option [341].
Capsicum
Capsaicin is the compound that makes chilli peppers hot. In the brain cells, capsaicin activates the TRPV1 receptor. Although this protein triggers inflammatory pain, its repeated stimulation makes brain cells insensitive to pain perception. Capsaicin also seems to reduce the levels of substance P, which is involved in pain transmission, in the spinal cord [21, 22].
The benefits of capsaicin ointments and plasters are modest in the case of low-back pain, but they provided some relief and a meta-analysis concluded that they may be especially useful in patients who don’t respond to or tolerate other treatments [359, 360, 361].
Devil’s Claw
Devil’s claw (Harpagophytum procumbens) is a South African plant traditionally used to relieve pain [362].
Several studies have found that devil’s claw extracts reduced lower back pain. According to a meta-analysis, devil’s claw extract may be as effective as NSAIDs for this purpose [363, 364, 365, 366, 367].
Tai Chi
Tai chi is an exercise therapy that integrates moderate physical activity, deep breathing, and meditation to promote stress reduction and relaxation, which can beneficially influence the immune system and overall health [167, 168].
TENS
TENS is short for transcutaneous electrical nerve stimulation. It is generally considered a safe (when used correctly), inexpensive, and non-invasive method of stimulating nerves by applying electricity to the surface of the skin.
The most common explanation of how TENS works for pain relief involves the “gate control” theory of pain. The basic idea is that stimulating large areas of the skin may shut off or suppress the nervous system in the upper part of the spinal cord. Closing this “gate” may prevent pain signals from passing to the brain from the rest of the body [328].
Insufficient evidence suggests that the TENS unit may help people suffering from chronic pain. In a small observational study of 33 people with chronic back pain, 14 (42%) of them experienced at least a 30% pain reduction from TENS. And out of the 14, 13 felt the benefits within an hour or less of using the TENS unit. This study had many limitations [368].
A study of 60 patients with upper back pain found that using a TENS unit reduced pain better than placebo [369].
In another study of patients with back pain, those who used TENS ended up making fewer hospital and clinic visits [370].
Willow Bark
Willow bark contains salicin, a precursor to aspirin. Willow bark extracts containing high concentrations of salicin have been found to moderately reduce back pain. However, salicin was at its most effective only after a full week of daily supplementation [371, 372, 373, 374].
Yoga
Yoga is an exercise therapy that integrates moderate physical activity, deep breathing, and meditation to promote stress reduction and relaxation, which can beneficially influence the immune system and overall health [167, 168].
Long-term commitment to practicing yoga has been found to reduce back pain in some people: chronic back pain patients who practiced yoga at least once a week for two years reported feeling less pain than those who did not practice [375, 341].
Aquatic Exercise
A meta-analysis of 8 preliminary clinical trials concluded that aquatic exercise is effective to reduce pain and disability in people with low-back pain. However, some of these studies found aquatic exercise to be no better than exercise on land [376].
Surgical/Postoperative Pain
Caffeine
The combination of ibuprofen (100-200 mg) with caffeine (100 mg) reduced postoperative pain in multiple studies. Although less effective than higher ibuprofen doses (400 mg) with codeine or oxycodone, the ibuprofen-caffeine combination had fewer side effects [377, 378, 379].
Acupressure
Acupressure is a form of TCM similar to acupuncture, except that it involves the use of applied pressure in place of needles. Pressure is applied using the hands, thumbs, fingers, or devices to specific places (called acupoints) on the body.
One study suggests that ear acupressure reduced post-surgical pain. However, other studies have found no significant post-surgical pain relief from acupressure [380, 92].
TENS
TENS is short for transcutaneous electrical nerve stimulation. It is generally considered a safe (when used correctly), inexpensive, and non-invasive method of stimulating nerves by applying electricity to the surface of the skin.
The most common explanation of how TENS works for pain relief involves the “gate control” theory of pain. The basic idea is that stimulating large areas of the skin may shut off or suppress the nervous system in the upper part of the spinal cord. Closing this “gate” may prevent pain signals from passing to the brain from the rest of the body [328].
A study with 54 patients that underwent spinal surgery found that TENS had a pain-reducing effect (analgesia). It reduced the number of needed painkillers and their side effects [381].
Patients who used a TENS machine after surgery required less pain-relieving medication in another large study of 1,350 people [382].
Those who used a TENS unit after surgery had lower levels of pain than those in the control group in a study of 40 patients who underwent surgery that required a large chest incision (a procedure called posterolateral thoracotomy, often used for lung or heart surgery) [383].
In a study with 40 patients who underwent open-heart surgery, using the TENS unit at acupuncture points (“Acu-TENS”) helped to return blood pressure and heart rate to normal more quickly and using fewer medications (compared to patients who did not use TENS) [384].
Both high- and low-intensity TENS treatment helped relieve pain following major surgery in another study of 64 patients [385].
Patients who used TENS after surgery had improved breathing, less pain, and required less pain-killing drugs than patients who did not use TENS in a study with 50 patients who underwent chest surgery. A related study concluded that using a TENS unit alongside painkillers may relieve pain better than just the medication [386, 387].
Cancer Pain
Massage
In a meta-analysis of 12 studies, massage reduced pain in cancer patients, especially those suffering from postoperative pain. Massage increases dopamine, serotonin, endorphins, and enkephalins, which increase relaxation and reduce pain [388, 389, 390].
More than one in five women with breast cancer develop swollen lymphs from the surgery and radiation therapy, which causes pain and discomfort in the affected areas (neck, breast, arms, or hands). Manual lymphatic drainage provides relief by increasing circulation and redirecting waste away from the lymph nodes [391].
Learn More
- How Pain Works & 10 Natural Ways to Relieve It
- 11 Benefits of Capsaicin + Dosage & Safety
- 10 Benefits of Cold Exposure & Cold Showers + Precautions
- 8+ Science-Based Benefits of Massage
- 10 Health Benefits of Lavender + Side Effects
- What is Acupuncture and Does it Work?
- Can CBD Oil Relieve Pain?
- 3 Benefits of Topical Arnica (incl. Pain Relief) + Side Effects
- 4 Butterbur Benefits (Migraines, Allergies) + Side Effects