Non-medical treatments for pain
Non-medical treatments may be used along with pain medicine, though they can also be used alone for mild pain or discomfort. Some people find they can take a lower dose of pain medicine when they also use non-medical treatments. These methods include things like relaxation, biofeedback, imagery, distraction, hypnosis, skin stimulation, transcutaneous electric nerve stimulation (TENS), acupuncture, exercise or physical therapy, and emotional support and counseling.
We give you some basic tips here, but you may need the help of health professionals – social workers, physical therapists, psychologists, nurses, or others – to learn to use these techniques. Family and friends can also help. To find someone who specializes in these techniques or learn more about them:
- Talk with your doctor or nurse.
- Contact a local hospice, cancer treatment center, or pain clinic.
- Visit your local bookstores or library.
- You can also contact the National Center for Complementary and Alternative Medicine Clearinghouse to learn more about these techniques.
National Center for Complementary and Integrative Health (NCCIH)
Toll-free number: 1-888-644-6226
Pain may be a sign that the cancer has spread, an infection has started, or there are problems caused by the cancer treatment. Because of this, you should report any new pain problems to your cancer care team before trying any medical or non-medical treatments to relieve the pain on your own.
Some general guidelines for managing pain with non-medical methods include:
- Try using a non-medical method along with your regular pain medicines. For instance, you might use a relaxation technique (to lessen tension, reduce anxiety, and manage pain) at the same time you take medicine.
- Know yourself and what you can do. Often when people are rested and alert, they can use a method that demands more attention and energy. When tired, people may need to use a method that requires less effort. For example, try distraction when you are rested and alert; use hot or cold packs when you’re tired.
- Try different methods to learn which ones work for you. Be open-minded, and keep a record of what makes you feel better and what doesn’t help.
Relaxation helps relieve pain and/or keep it from getting worse by reducing muscle tension. It can help you fall asleep, give you more energy, make you less tired, reduce your anxiety, and help other pain-relief methods work better.
How to use relaxation
Relaxation may be done sitting up or lying down. Choose a quiet place whenever possible. Close your eyes. Do not cross your arms and legs because that may cut off circulation and cause numbness or tingling. If you’re lying down, be sure you are comfortable. Put a small pillow under your neck and under your knees or use a low stool to support your lower legs.
You can also ask your cancer care team to recommend relaxation CDs for you. These recordings provide step-by-step instructions in relaxation techniques.
There are many relaxation methods. Here are some for you to try:
Visual concentration and rhythmic massage:
- Open your eyes and stare at an object, or close your eyes and think of a peaceful, calm scene.
- With the palm of your hand, firmly massage near the area of pain in a circular movement. Avoid red, raw, or swollen areas. A family member or friend can do this for you.
- Breathe in deeply. At the same time, tense your muscles or a group of muscles. For example, you can squeeze your eyes shut, frown, clench your teeth, make a fist, stiffen your arms and legs, or draw up your arms and legs as tightly as you can.
- Hold your breath and keep your muscles tense for a second or two.
- Let go. Breathe out and let your body go limp.
Slow, rhythmic breathing:
- Stare at an object or close your eyes and focus on your breathing or on a peaceful scene.
- Take a slow, deep breath and, as you breathe in, tense your muscles (such as your arms).
- As you breathe out, relax your muscles and feel the tension draining.
- Now stay relaxed and begin breathing slowly and comfortably. Focus on your breathing, taking about 9 to 12 breaths a minute. Breathing too fast or too deeply can cause dizziness or other symptoms.
- To keep a slow, even rhythm as you breathe out, you can say silently to yourself, “In, 1, 2; out, 1, 2.” It may be helpful at first if someone counts out loud for you. If you ever feel out of breath, take a deep breath and then continue the slow breathing. Each time you breathe out, feel yourself relaxing and going limp. If some muscles, such as your shoulder muscles, aren’t relaxed, tense them as you breathe in and relax them as you breathe out. Do this only once or twice for each muscle group.
- Continue slow, rhythmic breathing for a few seconds up to 10 minutes, depending on your need.
- To end your slow, rhythmic breathing, count silently and slowly from 1 to 3. Open your eyes. Say silently to yourself, “I feel alert and relaxed.” Begin moving about slowly.
Some people who have used relaxation for pain relief have noticed some common problems and have made these suggestions:
- Relaxation may be hard to use when you have severe pain. Try quick and easy relaxation methods such as rhythmic massage or breathe in/tense, breathe out/relax. Or you can wait until your pain medicine starts working before you start with the relaxation methods.
- Sometimes breathing too deeply for a while can make you feel short of breath. If this happens, take shallow breaths and/or breathe more slowly.
- You may fall asleep. This can be a good thing if you’re ready to go to bed. If you don’t want to fall asleep, sit in a hard chair while doing the relaxation exercise or set a timer or alarm.
If you have trouble using these methods, ask your cancer care team to refer you to someone experienced in relaxation techniques. Do not keep using any technique that increases your pain, makes you feel uneasy, or causes unpleasant effects.
You’ll need the help of a licensed biofeedback technician to learn this technique. With the help of special machines that give you instant feedback on the state of your body, you can learn to control certain body functions such as heart rate, blood pressure, and muscle tension. Biofeedback is sometimes used to help people learn to relax and cope with pain. This technique is usually used with other pain-relief methods.
Imagery is using your imagination to create mental pictures or situations. The way imagery relieves pain is not fully understood, although it may be simply a combination of relaxation and distraction. Imagery can be thought of as a deliberate daydream that uses all of your senses – sight, touch, hearing, smell, and taste. Some people believe that imagery is a form of self-hypnosis.
Certain images may reduce your pain both during imagery and for hours afterward. If you must stay in bed or can’t leave the house, you may find that imagery helps you feel less closed in – you can imagine and revisit your favorite spots in your mind. Imagery can help you relax, relieve boredom, decrease anxiety, and help you sleep.
How to use imagery
Imagery usually works best with your eyes closed. The image can be something like a ball of healing energy moving through your body, or a picture drawn in your mind of yourself as a person without pain. (For example, imagine that you’re cutting the wires that send pain signals from each part of your body to your brain.) Or think of a pleasant, safe, relaxing place or activity that has made you happy. Exploring this place or activity in your mind can help you feel calm.
Here’s an exercise with the ball of energy.
- Close your eyes. Breathe slowly and feel yourself relax.
- Focus on your breathing. Breathe slowly and comfortably from your abdomen (belly). As you breathe in, say silently and slowly to yourself, “In, 1, 2.” As you breathe out, say, “Out, 1, 2.” Breathe in this slow rhythm for a few minutes.
- Imagine a ball of healing energy forming in your lungs or on your chest. It may be like a white light. It can be vague – it doesn’t have to be clear or vivid. Imagine this ball forming, taking shape.
- When you’re ready, imagine that the air you breathe in blows this healing ball of energy to the area of your pain. Once there, the ball heals and relaxes you.
- When you breathe out, imagine the air blows the ball away from your body. As it goes, the ball takes your pain with it.
- Repeat the last 2 steps each time you breathe in and out.
- You may imagine that the ball gets bigger and bigger as it takes more and more discomfort away from your body.
- To end the imagery, count slowly to 3, breathe in deeply, open your eyes, and say silently to yourself, “I feel alert and relaxed.” Begin moving about slowly.
Problems that may occur with imagery are much like the ones that occur with the relaxation techniques.
Distraction means turning your attention to something other than the pain. People often use this method without realizing it when they watch television or listen to music to take their minds off a worry.
Distraction may be used alone to manage mild pain or used with medicine to manage brief bouts of severe pain, such as pain related to procedures. Distraction is useful when you’re waiting for pain medicine to start working.
How to use distraction
Any activity that you must focus on can be used for distraction. Distractions can be internal, such as counting, singing to yourself, praying, or repeating statements in your head such as “I can cope.” Or distractions can be external, such as needlework, model building, or painting. Losing yourself in a good book might divert your mind from pain. Watching TV and listening to music are also good distractions. Slow, rhythmic breathing can be used along with distraction to help you relax. Visiting with friends or family is another useful distraction technique.
You may find it helpful to listen to rather fast music through a headset or earphones. To help keep your attention on the music, tap out the rhythm. This technique doesn’t require much energy, so it may be useful when you’re tired.
After using some distraction techniques, people have reported feeling tired, irritable, and in more pain. If this happens to you, try different techniques, and use them only when you have mild pain.
Hypnosis is the trance-like state of high concentration in which you are awake but calm and still. In this relaxed state, people might become more open to suggestion. Hypnosis can be used to blunt the awareness of pain, to substitute another feeling for the pain, or to change the feeling to one that’s less painful. You can be hypnotized by a person trained in hypnosis, often a psychologist, psychiatrist, or other mental health therapist. You can also be taught to hypnotize yourself.
During hypnosis, many people feel much like we do when we begin to wake up in the morning. Even with our eyes closed, we are very aware. We can hear sounds inside or outside our house. We may feel as though we either can’t or don’t want to wake up and open our eyes.
A trained hypnotherapist can teach people to put themselves in a hypnotic state, make positive suggestions to themselves, and leave the hypnotic state when they’re ready.
Choose a hypnotherapist who’s licensed in the healing arts or who works under the supervision of someone who is licensed. To find a therapist skilled in hypnosis, ask your cancer care team, or contact a large cancer center near you.
In this series of techniques, pressure, warmth, or cold is used on the skin, while the feeling of pain is lessened or blocked. Massage, pressure, vibration, heat, cold, and menthol preparations can also be used to stimulate the skin. These techniques also change the flow of blood to the area that’s stimulated. Sometimes skin stimulation will get rid of pain or lessen pain during the stimulation and for hours after it’s finished.
Skin stimulation is done either on or near the area of pain. You can also use skin stimulation on the side of the body opposite the pain. For example, you might stimulate the left knee to decrease pain in the right knee.
What you should know about skin stimulation
If you’re getting radiation therapy, check with your cancer care team before using skin stimulation. You shouldn’t put ointments, salves, menthol, or liniments on the treatment area, and you shouldn’t use heat or extreme cold on treated areas. If you’re getting chemotherapy, check with your team before using hot or cold packs.
Massage: Using a slow, steady, circular motion, massage over or near the area of pain with just your bare hand or with any substance that feels good, such as talcum powder, warm oil, or hand lotion. Depending on where your pain is, you may do it yourself or get help from a family member, friend, or a massage therapist. Some people find brushing or stroking lightly feels better than deep massage. Use whatever works best for you.
Precautions: If you’re getting radiation therapy, avoid massage in the treatment area as well as in any red, raw, tender, or swollen areas.
Pressure: To use pressure, press on various areas over and near your pain with your entire hand, the heel of your hand, your fingertip or knuckle, the ball of your thumb, or by using one or both hands to encircle your arm or leg. You can test this by applying pressure for about 10 seconds to see if it helps. You can also feel around your pain and outward to see if you can find “trigger points,” small areas under the skin that are very sensitive or that cause more pain. Sometimes gradual pressure on the trigger points helps to relieve pain. Pressure usually works best if it’s applied as firmly as possible without causing more pain. You can use pressure for up to 1 minute. This often will relieve pain for several minutes to many hours after the pressure is released.
Vibration: Vibration over and near the area of the pain may bring short-term relief. For example, the scalp attachment of a hand-held vibrator often relieves a headache. For low back pain, a long, slender battery-operated vibrator placed at the small of the back may be helpful. You can use a vibrating device such as a small battery-operated vibrator, a hand-held electric vibrator, or a large heat-massage electric pad.
Precautions: If you’re getting radiation therapy, avoid vibration in the treatment area. Do not use a vibrator on the stomach or over red, raw, tender, or swollen areas.
Cold or heat: Heat often relieves sore muscles. Cold can lessen the feeling of pain by partly numbing the painful area. You can also switch back and forth between heat and cold for added relief in some cases.
For cold, try gel packs that are sealed in plastic and stay soft and flexible even when frozen. You can get them at drugstores and medical supply stores. They can be stored in the freezer and reused.
You may want to wrap the pack in a towel to make it more comfortable. An ice pack, ice cubes wrapped in a towel, frozen peas, or water frozen in a paper cup also works.
Precautions: If you start to shiver when using cold, stop right away. Do not use cold so intense or for so long that the cold itself causes more pain.
Avoid cold over any area where you are getting radiation treatments and for 6 months after it has ended.
If you’re getting chemotherapy, check with your cancer care team before using a cold pack. Do not use cold over any area where your circulation or sensation is poor.
Do not apply cold for more than 5 to 10 minutes at a time.
To use heat for pain relief, a heating pad with a moisture option is handy. You can also try gel packs warmed in hot water; hot water bottles; a hot, moist towel; a regular heating pad; or a hot bath or shower. You might want to try one of the heat patches you can buy at the drugstore. For aching joints, such as elbows and knees, wrap the joint in a lightweight plastic wrap (tape the plastic to itself). This retains body heat and moisture.
Precautions: Do not use a heating pad on bare skin. Do not fall asleep with the heating pad turned on. Be very careful if you are taking medicines that make you sleepy or if you don’t have much feeling in the area.
Do not use heat over a new injury because heat can increase bleeding.
Avoid heat over any area where you’re getting radiation treatments and for 6 months after treatment has ended.
Do not use heat over any area where your circulation or sensation is poor. Do not apply heat for more than 5 to 10 minutes at a time.
Menthol: Many menthol preparations – creams, lotions, or gels – are available for pain relief. When they’re rubbed into the skin, they increase blood circulation to the affected area and produce a warm (or sometimes cool) soothing feeling that lasts for several hours.
To use menthol, test your skin by rubbing a small amount of the substance in a circle about the size of a quarter in the area you want to treat. This will let you know if menthol is uncomfortable to you or irritates your skin. If the menthol doesn’t cause a problem, rub some more into the area. The feeling from the menthol slowly increases and lasts up to several hours.
Precautions: Do not rub menthol near your eyes, or over broken skin, a skin rash, or mucous membranes (such as inside your nose or mouth, or around your genitals and rectum).
Make sure you do not get menthol in your eyes. Wash your hands well with soap and warm water after using menthol.
Do not use menthol on the skin of the treatment area during radiation therapy.
Transcutaneous electric nerve stimulation (TENS): This is a technique in which mild electric currents are applied to some areas of the skin through electrodes attached to a small power pack. The feeling is described as a buzzing, tingling, or tapping feeling. The small electric impulses seem to interfere with pain sensations for some people. The current can be adjusted so that the sensation is comfortable or even pleasant. Your doctor or a physical therapist can tell you where to get a TENS unit, and how to use it.
In acupuncture, very thin needles are put into the body at certain points and at various depths and angles. Each point is thought to control the feeling of pain in a different part of the body. When the needle is put in, some people feel a slight ache, dull pain, tingling, or electrical sensation for a few seconds. Once the needles are in place, they shouldn’t hurt. The needles are usually left in for 15 to 30 minutes. It doesn’t hurt when the needles are removed. Acupuncture is now widely available, but it should only be done by a licensed, certified acupuncturist. Ask your cancer care team where to get acupuncture.
Precaution: If you are getting chemotherapy, talk to your doctor before starting acupuncture.
If you feel anxious or depressed, your pain may feel worse. Pain also can make you feel worried, depressed, or easily discouraged. Some people feel hopeless or helpless. Others may feel embarrassed, inadequate, angry, frightened, lonely, or frantic. These are all normal feelings.
Try to talk about your feelings with someone you feel comfortable with – doctors, nurses, social workers, family or friends, a member of the clergy, or other people with cancer. You may also wish to talk to a counselor or a mental health professional. Your cancer care team can help you find a counselor who is specially trained to help people with chronic illnesses.
You may want to try a support group where people with cancer meet and share their feelings. Support groups can be face-to-face meetings, or you can meet in a group online. For information about support groups in your community and online, ask your cancer care team or call the American Cancer Society at 1-800- 227-2345. Also, many newspapers carry a special health supplement with information about where to find local support groups.
To learn more about cancer pain
More information from your American Cancer Society
www.cancer.org, or order free copies from the toll-free number at 1-800-227-2345.