Rethinking Your Pain Management Plan

Back Massage

By Dr. Peter Abaci

It might be helpful to divide your pain treatment strategies into two categories- active and passive. Coming up with the right balance between these two types of approaches just might be the tipping point that you need to successfully control your pain and gain that boost in quality of life that you are looking for. 

Let’s start by defining the differences between active and passive approaches to treating pain. Consider passive treatment options to mean that you, as the patient in the equation, are the more passive participant in the process. That means some type of therapy or intervention is brought to you from an external source and you take it in without any real modification taking place on your end. Let’s look at some typical examples of what I call passive treatment approaches to see what I mean:

  • Massage therapy: This is a great example of a passive treatment modality because with deep tissue treatment like a massage you lie there while somebody else works on your muscles and soft tissues. The person giving the massage is really doing the work in this scenario.
  • Electrical stimulation: Devices used are often known as a TENS unit, where pads are placed on the surface in proximity to painful body parts to send small electrical currents through the skin. In some cases, this therapy can temporarily reduce pain symptoms.
  • Chiropractic treatment: Chiropractic adjustment, also referred to as spinal manipulation, is delivered when force is applied to stiffened joints within the spinal column to increase mobility and reduce pain. Again, the patient is a passive recipient with this mode of therapy.
  • Medication management: Taking into consideration over-the-counter pain relievers as well as prescription medications like opioids, anti-inflammatory agents, and nerve pain medications, pain killers are one of the most commonly used treatments for chronic pain. This approach tries to reduce perceived symptoms by modifying the chemical environment inside the body through external sources. 
  • Neuromodulation: This is a fancy term that describes therapy with spinal implantable devices used to try to reduce or modify the perceived pain signal. The most common example of this would be a spinal cord stimulator that sends electrical signals around nerve tracts on the spinal column. 

With these more passive treatments, you remain somewhat dependent on external resources for relief. For example, you may rely on seeing the chiropractor each week or taking a certain medication three times a day to reduce pain symptoms. While the more passive treatments can be effective, they often wear off when the treatment stops, which means you remain dependent on them to manage the problem. For example, pain symptoms return shortly after a TENS unit is turned off.

With more active treatment approaches, you become more involved in the therapeutic process. Here are some common examples of active treatments:

  • Exercise: Exercise has been shown to be effective in reducing pain symptoms for problems like fibromyalgia and arthritis. While moving a painful body can at first be a challenge, it eventually leads to less pain.
  • Mind/Body Therapies: This includes practices like yoga or tai chi where the focus of the mind is connected to the body through rhythmic breathing. These approaches can require a lot of mental focus along with coordinated movement of the body at the same time.
  • Breathing exercises: Practicing certain breathing exercises, like deep belly breathing, can help calm the nervous system, lower stress, and reduce pain flare-ups or.
  • Walking: Walking has been shown to significantly reduce low back pain and can help loosen stiff joints. A regular walking routine may serve as part of a maintenance program to reduce baseline pain levels.
  • Distraction: Shifting focus away from the pain and toward something else can provide in-the-moment relief. Thinking about a happy place or something you are grateful for are examples.

Take a minute to review your own strategies to managing pain. If most of what you rely on for relief falls into the more passive bucket, then consider adding some new strategies that are more aligned with active approaches. Doing so will increase your sense of control over your pain and leave you feeling less dependent on others for relief. In fact, being able to use tools to create your own relief can be empowering and liberating. Mixing active and passive strategies together can have an added benefit if they work synergistically together. For example, consider combining acupuncture or massage to an exercise or stretching program as a way of optimizing results. Finding the right balance between active and passive treatments can make the difference when it comes to taking charge of your pain.  


Image courtesy of Ambro /

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