Treating Pain Without Opioids:  A Physical Therapist's Toolbox

The opioid epidemic is a massive problem in the United States.  The prescribing of these powerful drugs in order to control pain has caused many people to depend on these drugs for pain relief, which can result in addiction, numerous health-related problems and even death.  

There are other options to treat pain. Physical therapists are specifically trained in the musculoskeletal system and can help identify the root cause of pain. Here are a few ways that physical therapists help to treat pain naturally.

Ways A Physical Therapist Can Treat Pain Without Opioids


therapist applying ice for pain treatmentCryotherapy is the use of cold or ice to treat pain and swelling. Cold has a number of positive effects on injury – like limiting local bleeding and swelling in the tissue and reducing collateral tissue damage. During the recovery and rehabilitation process, physical therapists may apply ice packs to the area or use cold submersion tanks or cryotherapy chambers for treating larger areas. Not only does the cold help, but the compression does too.



heat packs applied to knee to reduce painThermotherapy, or the use of heat for therapeutic goals, can be quite effective in relieving pain for affected joints and muscles. Heat acts to warm up the tissue which produces improved extensibility or elasticity of the connective tissue and muscles.  If a muscle is in spasm, heat will help to relax the muscle. This reduces pain and improves mobility and allows for participation in physical activity.



ultrsound treatment on neck for pain treatmentUltrasound uses sound wave currents to treat pain in soft tissue. Therapeutic ultrasound is often used at frequencies of 1 to 3 megahertz (that’s 1-3 MILLION sound pulses per second).  At the appropriate intensity, these sound waves act to vibrate soft tissue creating friction and subsequently heat in a targeted area. In addition, due to the mechanical nature of the sound waves, there is a pulse pressure that tends to remove waste accumulated in a particular region.  The heat and mechanical properties of the ultrasound wave provide relaxation of muscle spasm and reduce the frequency of nerve impulses and thus reduce pain.


Electrical Stimulation and TENS

tens therapy applied to back for pain treatmentTranscutaneous electrical nerve stimulation, or TENS, uses electricity to reduce or control pain by sending tiny electrical impulses through electrodes placed on the painful joint or area of the body. There are two main theories about how TENS helps to relieve pain, one deals with blocking nerve impulses from the brain that sense pain. The other theory explains the benefits through endorphins, which are created in greater quantity by your body as a result of the TENS treatment and help to reduce pain naturally. Electrical stimulation is often used in physical therapy clinics as part of initial treatment, but there are home-based units available as well.  If a patient receives a prescription from a physician, then your physical therapist can help you acquire a small, portable unit that you can use at home in order to control your pain. Patients can expect to reduce or eliminate the need for pain medications by using this type of unit.


Manual Therapy

therapist helps stretch a patient's legThe term manual therapy is an umbrella term to describe various techniques where a clinician or physical therapist uses their hands to provide a therapeutic outcome, like decreased pain. Physical therapists use a variety of manual therapies to reduce pain. This can include specific positioning to off-load tension in a muscle, using trigger points, therapeutic massage and stretching. Physical therapists are experts in body mechanics. A good physical therapist will share how to continue some manual therapy on your own at home.


Therapeutic Exercise (The FIX!)

physical therapist instructing proper exercise formWhile all of the above techniques are quite helpful in reducing or treating painful tissues, the fix is in the prescription of therapeutic exercise.  Both acute and chronic injuries often reduce physical capacity and the ability for individuals to perform normal daily tasks and participate in activities that they need or want to do – like school, caregiving, work, sports, travel, recreation, etc. Physical therapists are experts at prescribing exercise that is specifically targeted to improve your condition. Working with a PT over time is an excellent way to recover from recent or longterm injuries, reduce your pain and return to those things you love to do.


If you have questions about how physical therapy can help with pain, contact us!

Most insurances cover physical therapy services, and you don’t need a physician’s referral to get started.


About the Author

Eric Greeno, DPT, SCS, CSCS is a physical therapist with board certifications in sports physical therapy and strength and conditioning. He is co-owner of Orlando Sports Medicine, a physical therapy clinic with multiple locations in Orlando. Eric is dedicated to providing the most effective, research-based care to his patients and ensures that OSM provides patients with the best technology and techniques to optimize their recovery.