Chronic Pain Management Without Opioids

Chronic pain is common as we age, especially for people living with arthritis, nerve pain, back problems, or other long-term conditions. While opioid medications were once commonly used, they can carry serious risks for older adults — including falls, confusion, constipation, and dependence.

The good news is that many non-opioid strategies are proven to help manage chronic pain safely and effectively.

Understanding Chronic Pain

Chronic pain is pain that lasts longer than 3 months or continues even after an injury has healed. Some of the areas chronic pain can affect are:

• Joints (arthritis)
• Muscles and ligaments
• Nerves (neuropathy, sciatica)
• The back or neck

Chronic pain can also affect sleep, mood, balance, and independence, which is why a whole-body approach works best.

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Why Opioids Are Often Avoided in Older Adults

Opioid medications may increase the risk of:

• Falls and fractures
• Drowsiness and confusion
• Constipation and nausea
• Breathing problems
• Dependence or tolerance

For many seniors, non-opioid approaches provide relief with fewer risks.

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Evidence-Based Pain Management Options (Without Opioids)

1. Physical Therapy (PT)

Physical therapy is one of the most effective treatments for chronic pain.

How it helps:

• Improves strength and flexibility
• Reduces stiffness and joint stress
• Improves balance and mobility
• Teaches safe movement techniques

💡 Even gentle, tailored exercises can reduce pain over time.

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2. Heat and Cold Therapy

Simple temperature treatments can provide meaningful relief.

Heat Therapy (best for stiffness and muscle pain):

• Warm showers
• Heating pads
• Warm compresses

Cold Therapy (best for swelling and flare-ups):

• Ice packs
• Cold gel packs

✔ Use for 15–20 minutes
✔ Protect skin with a cloth
✔ Never apply directly to numb areas

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3. TENS (Transcutaneous Electrical Nerve Stimulation)

A TENS unit uses mild electrical signals applied through pads on the skin.

May help with:

• Back pain
• Arthritis pain
• Nerve pain

Benefits:

• Drug-free
• Can be used at home
• Adjustable intensity

⚠ Always ask your provider before use, especially if you have a pacemaker or heart condition.

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4. Non-Opioid Medications (When Appropriate)

Some medications may help manage pain safely when used correctly:

• Acetaminophen (for mild–moderate pain)
• Certain topical creams or patches
• Some nerve-targeting medications

💊 Medication choices, even over-the-counter options, should always be reviewed with your healthcare provider first to male sure they are safe and appropriate for you.

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5. Mind-Body and Lifestyle Approaches

Pain affects both the body and the brain.

Helpful strategies include:

• Relaxation or breathing exercises
• Gentle stretching
• Sleep hygiene
• Stress management
• Cognitive behavioral strategies

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Daily Pain Check-In: Symptom Checklist

Use this checklist to track your pain and share with your provider:

☐ Where is my pain today?
☐ How strong is it (0–10)?
☐ What makes it better?
☐ What makes it worse?
☐ Did pain limit my activities today?
☐ Did I feel unsteady or at risk of falling?
☐ Did pain affect my sleep or mood?

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Pain Management Action Plan

My Pain Goals

• My main pain concern is: ________________________
• I will try at least ___ non-opioid strategies
• I will attend physical therapy: Yes ☐ No ☐
• I will use heat/cold safely: Yes ☐ No ☐
• I will track my pain ___ days per week
• My goal is to improve:
  ☐ Walking ☐ Sleep ☐ Daily tasks ☐ Mood

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When to Seek Medical Help

Contact your healthcare provider if you have:

🚨 New or worsening pain
🚨 Pain after a fall or injury
🚨 Numbness, weakness, or tingling
🚨 Pain that interferes with sleep or daily activities
🚨 Side effects from pain treatments
🚨 Increased falls or balance issues

Seek urgent care for sudden severe pain, loss of movement, or pain with fever.

Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.  

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Key Takeaways

• Chronic pain can often be managed without opioids
• Physical therapy is one of the most effective treatments
• Heat, cold, and TENS can be safe tools when used correctly
• Tracking pain helps guide better treatment decisions
• The goal is better function and quality of life, not just pain scores

You deserve pain care that is safe, effective, and personalized.

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Medical Disclaimer

This information is provided for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from your healthcare provider. Always talk with your doctor, nurse practitioner, or other qualified healthcare professional about any questions or concerns you have regarding your health, medications, or pain.

Do not ignore or delay seeking medical care because of information you read here. If you notice new symptoms, worsening pain, or changes in your health, contact your healthcare provider promptly.

If you are experiencing a medical emergency, call 911 or seek emergency medical care immediately.