Best and Safest Strategies for Pain Relief

If you spend the day wincing from arthri­tis, back pain, a recent surgery, or serious headaches, your doctor might suggest that you try a powerful opioid medication. But that's not your only option, and it shouldn't be your first.

Nearly a third of adults ages 50 to 80 report filling such a prescription within the past two years, according to a July University of Michigan poll.

These drugs can be risky: As many as a quarter of people taking opioids long-term end up battling addiction. But doctors still handed out more than 191 million opioid prescriptions in 2017 alone.

"Many older adults may be taking opioids unnecessarily," says David Ring, M.D., Ph.D., professor of surgery and psychiatry at Dell Medical School at the University of Texas at Austin and a spokesperson for the American Academy of Orthopaedic Surgeons.

Lower back pain affects nearly half of healthy, active people 60 and older. Most of the time it can be successfully treated and managed with nondrug measures: The American College of Physicians (ACP) recommends therapies such as heating pads, massage, acupuncture, tai chi, and yoga as first-line treatment.

"The safety profile is much better, and the effectiveness is quite similar to most drug therapies," says Roger Chou, M.D., professor of medicine at Oregon Health & Science University in Portland.

If you've thrown out your back and are in terrible pain, try over-the-counter ibuprofen (Advil and generic) or naproxen (Aleve and generic) for a week or two, Chou says.

These may be a better choice than acetaminophen, which the ACP didn't find to be effective.

Recent research has also found that people who stay active—with gentle activities such as walking and stretching—have a faster recovery and less discomfort than people who stay in bed.

If pain lasts longer than a week or two, see your doctor, who can prescribe physical therapy or, in some cases, a limited course of spinal manipulation (three to four weeks) with a licensed chiropractor.

For chronic back pain that's not respond­ing to these measures or to prescription-­strength nonsteroidal anti-inflammatory drugs (NSAIDs), the ACP recommends the prescription pain pill tramadol (Ultram and generic) or the anti­depressant duloxetine (Cymbalta and ­generic). But both have a small effect; you'll still need to use nondrug methods.

If you're having surgery, your plan for managing pain afterward should begin before the operation: Ask your surgical team whether it's possible to get regional anesthesia (instead of general), including a peripheral nerve block.

Both can help reduce the need for opioids after surgery, says Stavros G. Memtsoudis, M.D., Ph.D., director of critical care services in the department of anesthesiology at the Hospital for Special Surgery in New York City.

While opioids may be a useful part of a postsurgical pain plan in the short term, they are not a cure-all.

Research published in the journal Anesthesiology last May on more than 1.5 million surgical patients found that those who got at least two other forms of pain medication, such as acetaminophen and an NSAID, along with an opioid did better overall.

In general, you should take opioids only as necessary to relieve breakthrough pain and for no longer than three weeks after a procedure.

People coming out of surgery should also "have realistic expectations—they can't expect to go home from the hospital feeling absolutely pain-free," Memtsoudis says. "But they should be able to read without being distracted by pain."

About 17 percent of adults older than 65 have reported headaches more than twice a month. For people prone to ­migraines, first-line treatment is usually a class of drugs called triptans, which ­reduce inflam­ma­tion and constrict blood vessels.

But these need to be prescribed with caution for anyone who already has heart disease, high blood pressure, or other risk factors.

Opioids have not been shown to improve migraine symptoms and may make triptans less effective, says Alan M. Rapoport, M.D., clinical professor of neurology at the David Geffen School of Medicine at UCLA in Los Angeles.

If you have the dull ache of a tension headache—the most common type—once or twice a month, you can treat it with an OTC pain reliever, such as ibuprofen or acetaminophen. Exercise or relaxation can help, too.

But if you're getting them more frequently—say, every week—see your doctor. People who self-treat more than twice a week can develop a medication-overuse headache, Rapoport says.

For frequent headaches of any kind, research has found that complementary therapies, such as acupuncture, massage, and biofeedback, may be effective in some cases.

Others benefit from a daily preventive, such as a tricyclic anti­depressant or the blood pressure drug propranolol (Inderal and generic).

Of people 65 and older, more than 55 percent of men and almost 70 percent of women may have arthritis. The most common form is osteoarthritis, where cartilage in joints breaks down, causing pain, swelling, and problems moving.

But research has shown that opioids should generally not be used to treat OA; the potential harms outweigh the benefits.

Instead, try wrapping a bag of ice in a towel, and apply to the affected area for up to 20 minutes at a time—cold can help ease acute joint pain.

If a joint feels stiff but not painful, apply a heating pad to the area for 15 to 20 minutes. Then try some low-impact activity, such as walking, which can relieve pain as effectively as an over-the-counter NSAID, such as ibuprofen or naproxen.

Naproxen appears to be the most effective oral pain reliever for joint pain, but don't use it for more than a week without consulting your doctor. Yoga, tai chi, and swimming can also help.

If these steps don't help, consider trying a topical prescription NSAID. But think twice about using diclofenac (Voltaren and generic), which has been linked to an ­increased risk of heart attack and stroke.

You can also help deter OA flare-ups by trying to stay at a healthy weight. Research has shown that for those who are overweight or obese, losing weight can help reduce pain and inflammation.

Cannabidiol, or CBD, is a chemical compound that comes from marijuana or its cousin, hemp, but doesn't get users high. Found in oils, creams, tinctures, vapes, and more, CBD is often touted as a panacea for a variety of health conditions, including chronic pain.

Yet while CBD does seem to be an anti-­inflammatory, which theoretically could help relieve pain, "it's overhyped right now," says Donald Abrams, M.D., a cancer specialist and practitioner of integrative medicine at Zuckerberg San Francisco General Hospital and Trauma Center.

A report co-written by Abrams in 2017 on medical benefits of cannabis found that while there was evidence that cannabis, or marijuana, can relieve pain in humans, there wasn't any good research that looked specifically at CBD. "We need to see firm evidence that using it has benefits and is safe," he says.

And depending on which state you live in, CBD products might not be legal or regulated, so you might not be getting what you pay for.

This is especially true for products sold online: A 2017 study in JAMA found that only 26 percent of CBD products purchased online contained the amount of the compound claimed on their labels.