How to Treat Pain: Medications, Therapy, and More

Pain treatment works best when it combines more than one approach, matching the type of pain you have with the right mix of medication, physical strategies, and psychological tools. There is no single pill or procedure that reliably eliminates every kind of pain, which is why modern pain medicine leans on what clinicians call multimodal management. The specifics depend on whether your pain is acute or chronic, whether it involves inflamed tissue or damaged nerves, and how much it interferes with your daily life. What follows is a practical walkthrough of the major treatment categories, what the evidence actually supports, and where the science is heading.

Over-the-Counter Pain Relievers

For most everyday pain, acetaminophen and nonsteroidal anti-inflammatory drugs are the starting point. Acetaminophen is one of the most widely used analgesics on the planet and remains a first-line recommendation for a broad range of patients, including older adults, children, and people with gastrointestinal conditions, bleeding disorders, or cardiovascular disease.¹ A common worry is that acetaminophen harms the liver, but at recommended doses the risk of serious liver injury is extremely low. A model-based analysis found that daily doses between 1,500 and 4,000 mg carried only about a one-in-ten-thousand chance of severe liver damage compared with placebo.² Even in people who already have liver disease, studies have found acetaminophen safe at standard doses.³ The danger comes from exceeding the recommended maximum, mixing it with alcohol, or accidentally doubling up when it is hidden inside combination cold or flu products.

NSAIDs like ibuprofen and naproxen work differently. They reduce inflammation directly by blocking enzymes involved in producing prostaglandins, which makes them especially useful for pain caused by swelling, such as a sprained ankle, arthritis flare, or menstrual cramps. The trade-off is a well-documented risk of gastrointestinal damage, ranging from stomach irritation to ulcers and bleeding, along with concerns about cardiovascular events with long-term use.⁴ Not all NSAIDs carry the same balance of risks. Naproxen appears somewhat safer for your heart but harder on the stomach, while celecoxib, a selective COX-2 inhibitor, seems gentler on both the upper and lower gastrointestinal tract but carries a less favorable cardiovascular profile.⁵ Which NSAID suits you depends on your personal risk factors for heart disease, kidney problems, and stomach issues. Taking a proton pump inhibitor alongside an NSAID lowers the chance of upper gut complications, but it does not protect the lower intestine and may disrupt the gut microbiome.⁵

Medications for Nerve Pain

When pain originates from damaged or malfunctioning nerves rather than from inflamed tissue, standard painkillers often fall flat. Nerve pain, called neuropathic pain, tends to feel like burning, shooting, or electric-shock sensations. The first-line drugs for it are not traditional painkillers at all but certain antidepressants and anticonvulsants. Tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors such as duloxetine work by altering how nerve signals travel through pain pathways, and they require daily use over weeks before the full effect kicks in.⁶ A Cochrane review of 61 randomized trials found that tricyclic antidepressants achieve at least moderate pain relief in roughly one out of every three or four patients treated.⁷

Gabapentin and pregabalin, collectively known as gabapentinoids, work through a different route: they reduce the release of excitatory chemical signals at nerve terminals, which dials down the overactive firing that causes neuropathic pain.⁶ Head-to-head comparisons between tricyclic antidepressants and gabapentinoids show they perform about equally well, with no clinically relevant difference in pain scores.⁸ So the choice between them usually comes down to side-effect profiles and your other health conditions. Tricyclics can cause drowsiness, dry mouth, and heart rhythm concerns in older adults. Gabapentinoids tend to cause dizziness and weight gain. Your doctor will weigh those against whatever else is going on medically.

Where Opioids Fit In

Opioids like morphine, oxycodone, and hydrocodone are powerful painkillers, and for acute, severe pain after surgery or a major injury, they can be appropriate in the short term. The evidence supports their use for clearly defined pain states, particularly when the pain source is identifiable and time-limited.⁹ For chronic, ongoing pain, the picture is far murkier. Long-term opioid use has not been convincingly shown to improve function or quality of life, and it introduces serious risks: addiction, hormonal disruption, immune suppression, and a paradoxical condition called opioid-induced hyperalgesia, where the drug itself actually makes you more sensitive to pain.¹⁰ The use of opioids for vague or hard-to-diagnose chronic conditions like nonspecific low back pain remains especially contentious, and most guidelines now recommend exhausting other options first.⁹

Exercise and Physical Rehabilitation

If you have chronic pain, the idea of exercise might sound counterproductive. But movement is one of the most consistently supported treatments across nearly every chronic pain condition. When you exercise, your body activates its own internal painkilling systems. Contracting muscles triggers the release of endogenous opioids and endocannabinoids, natural chemicals that dampen pain signaling throughout the nervous system.¹¹ The pain-reducing effects of exercise have been documented across low back pain, osteoarthritis, fibromyalgia, and various musculoskeletal conditions.

The key is that the type and intensity of exercise should be matched to your condition and current fitness. A graded approach, where you start well below what triggers a flare and slowly build up, tends to work better than jumping into an aggressive routine. Physical therapy programs also incorporate hands-on techniques, stretching, and movement retraining that go beyond generic exercise advice. Heat therapy is another practical and accessible tool for musculoskeletal pain, offering pain relief, promoting tissue healing, and helping restore normal movement and function.¹² Something as simple as a hot pack or warm bath before exercise can lower the barrier to getting started.

Cognitive Behavioral Therapy for Pain

Chronic pain is not just a physical event. How your brain processes pain signals, how you think about your pain, and how anxious or catastrophic those thoughts become all shape how much suffering you experience. Cognitive behavioral therapy targets those mental patterns directly, and the research supporting it for pain conditions like fibromyalgia is surprisingly strong. In trials comparing CBT with general health education, patients receiving CBT showed significantly greater reductions in how much pain interfered with daily life and in pain catastrophizing, which is the tendency to ruminate on pain, magnify it, and feel helpless about it.¹³

This is not just people feeling better about the same amount of pain. Brain imaging studies show that CBT produces measurable physical changes in how the brain is wired. Patients who went through CBT showed reduced connectivity between brain regions involved in processing pain sensations and emotional responses to pain, and those connectivity changes tracked with improvements in catastrophizing.¹⁴ Another study found that CBT actually increased gray matter volume in prefrontal brain regions involved in top-down control over pain, suggesting the therapy strengthens the brain’s ability to regulate and reappraise pain signals.¹⁵ Meditation practices appear to work through overlapping brain mechanisms, altering how cortical regions respond to pain stimuli, though the research base is still developing.¹⁶

Interventional Procedures

When medications, exercise, and therapy are not enough, pain specialists can offer procedures that target pain at its source. Two common options for joint-related back pain are steroid injections and radiofrequency ablation. Steroid injections deliver anti-inflammatory medication directly to the affected joint or nerve, providing temporary relief. Radiofrequency ablation uses heat to disrupt the nerve fibers that carry pain signals from the joint to the brain. Meta-analyses comparing the two have found that radiofrequency ablation delivers greater pain reduction and longer-lasting effects, with significantly better pain scores at both three and six months after the procedure.¹⁷ That said, the choice between them depends on your situation: steroid injections are less invasive and can serve as both a diagnostic test and a treatment, while ablation is more involved but often provides months of relief.¹⁸

For more widespread or severe chronic pain, spinal cord stimulation is another option. A small device is implanted near the spinal cord that delivers mild electrical pulses to interrupt pain signals before they reach the brain. The concept traces back to gate control theory, the idea that non-painful input can “close the gate” on pain signals at the spinal cord level. Spinal cord stimulation has been used successfully for intractable chronic pain, particularly failed back surgery syndrome and complex regional pain syndrome.¹⁹ It is typically reserved for patients who have not responded to more conservative measures, and a trial period with temporary leads precedes permanent implantation.

Trigger point dry needling offers a less invasive procedural option for myofascial pain, the deep aching and stiffness that comes from knotted muscle fibers. Inserting a thin needle into a trigger point can reduce nervous system excitability by calming overactive pain signaling at both the peripheral and spinal cord level, though the effects tend to be short-lived and the size of the benefit is modest.²⁰

Why Sleep Matters More Than You Think

If you are dealing with chronic pain and sleeping poorly, those two problems are feeding each other. Sleep deprivation does not just make pain feel worse by lowering your tolerance; it actively ramps up inflammation in the central nervous system. Animal research has shown that chronic sleep deprivation activates inflammatory pathways in the brain and triggers immune cells called microglia, leading to increased pain sensitivity.²¹ When those inflammatory pathways were blocked in the studies, the extra pain sensitivity caused by sleep loss was reversed. The practical implication: treating your sleep problem may be one of the most effective things you can do for your pain. This might mean addressing sleep apnea, improving sleep hygiene, or working with your doctor on sleep medication if necessary.

How Age Changes the Approach

Pain treatment is not one-size-fits-all across the lifespan. In children, pain is frequently underestimated because young kids cannot articulate what they feel, and their behavioral responses to pain look different from adults. Specialized assessment tools and a combination of medication and distraction or play-based techniques are standard.²² In older adults, pain tends to be less intense at its peak but lasts longer and comes packaged with complicating factors: multiple existing health conditions, a medicine cabinet full of other drugs, and age-related changes in how the body absorbs and processes medications.²² NSAIDs, for instance, carry significantly higher risks of kidney damage and gastrointestinal bleeding in older adults, making acetaminophen the safer default. Opioids also require extra caution in this group because of increased sensitivity and fall risk.

The Placebo Effect Is Real Medicine

You might think of a placebo as a sugar pill that tricks you into feeling better. But placebo analgesia involves actual physiological changes. When a person expects pain relief, the brain releases its own opioids, the same class of chemicals that morphine mimics, activating the body’s built-in pain-control pathways.²³ This is not willpower or imagination. Brain imaging confirms that placebo responses engage endogenous analgesic pathways, motivational circuits, and neuroimmune mediators.²⁴ The flip side, called the nocebo effect, is equally real: if you expect a treatment to cause pain or side effects, your brain can generate those experiences too.

This matters practically because a trusting relationship with your healthcare provider, a clear explanation of how a treatment works, and genuine belief that the treatment will help are not just nice-to-haves. They are active ingredients in pain relief. Conversely, anxiety about a procedure or skepticism about a medication can blunt its effectiveness. This does not mean your pain is imaginary. It means the brain’s pain-processing system is deeply intertwined with expectations and context, and smart pain management takes advantage of that biology rather than ignoring it.

Genetics and Why the Same Drug Works Differently in Different People

One of the most frustrating aspects of pain treatment is that a medication that works beautifully for one person does nothing for someone else with the same condition. Part of the explanation is genetic. Variations in genes that code for drug-metabolizing enzymes, opioid receptors, and drug-transport proteins all influence how you respond to pain medication.²⁵ Someone who metabolizes codeine very rapidly, for example, may experience dangerous side effects from a standard dose, while a slow metabolizer may get no pain relief at all because the drug is never converted to its active form.

A twin study investigating pain sensitivity and opioid response found that genetic factors accounted for anywhere from about 12% to 60% of the variation in how people experienced pain and responded to opioid-based pain relief, depending on the specific measure.²⁶ Age, sex, race, education, and anxiety also played a role. Pharmacogenomic testing, which checks your genetic profile before prescribing, is still far from routine in pain clinics, but it is slowly gaining traction, particularly for surgical patients where getting the dose right the first time makes a meaningful difference in recovery.

Emerging Treatments on the Horizon

Cannabinoids have attracted enormous public interest as pain treatments, but the evidence so far is more modest than the enthusiasm suggests. The strongest data supports their use for neuropathic pain and spasticity associated with multiple sclerosis, while results for fibromyalgia, osteoarthritis, and general musculoskeletal pain remain inconsistent. On average, pain reduction from cannabinoids does not exceed about half a point to one point on a ten-point scale, and those small gains come with side effects including dizziness, dry mouth, and cognitive impairment.²⁷ That does not mean cannabinoids are useless, but for most people with chronic pain, they are unlikely to be a standalone solution.

Psychedelics represent a more speculative frontier. Psilocybin and LSD appear to disrupt entrenched functional connections in brain regions associated with chronic pain, and the neuroplastic effects may allow healthier neural reconnections to form, potentially producing sustained relief. Early evidence is most promising in cancer-related psychological distress and severe headache disorders like cluster headache and migraine, where patients who have self-medicated with psychedelics report both acute and preventive benefits.²⁸ The mechanisms are not fully understood, and the evidence remains limited and low quality, so this is very much a watch-this-space area rather than a treatment you can walk into a clinic and request.

Phantom Limb Pain After Amputation

One of the more dramatic illustrations of how pain lives in the nervous system, not just the body, is phantom limb pain. After an amputation, many people continue to feel pain in the limb that is no longer there. The nerves that once served that limb are still sending signals, and the brain continues to interpret them as coming from the missing body part. Surgical techniques performed during the amputation itself can reduce this risk. One approach, peripheral nerve coaptation combined with nerve wrapping and repositioning, showed striking results: none of the patients who received the technique reported phantom limb pain at two and six months, compared with more than half of those who received standard nerve treatment alone.²⁹ For people already living with phantom limb pain, treatment options include many of the same tools discussed throughout this article: nerve pain medications, mirror therapy (a form of visual feedback that “fools” the brain), and spinal cord stimulation. The condition underscores a broader principle in pain medicine: the injury and the pain are not always in the same place, and treating the nervous system itself is often the real target.