How to Benefit From Active and Passive Pain Management

Chronic pain—defined as pain that persists for several months—is very common: An estimated 1 in 5 Americans have chronic pain, and 1 in 12 have pain that limits their daily activities.

For many types of chronic pain, such as low back pain, neuropathic pain (pain related to the nervous system), or arthritis, there is no easy fix.

Doctors once primarily treated chronic pain primarily with passive treatments like medications. It is now known that pain medications are rarely effective on their own and can lead to addiction and other serious side effects.

Today, many pain management specialists emphasize the importance of active treatments in addition to passive treatments like medications and surgery.

During active treatments, such as physical therapy, meditation, and exercise regimens, the patient actively engages in their own therapy, either alone or with a trained healthcare provider. Active treatments can often reduce pain and improve overall quality of life.

This article will explain the benefits and downsides of both active and passive treatments, as well as which type of therapy may be best for certain conditions.

Woman in scrubs spotting a another women holding a light weight in her outstretched hand during physical therapy

Jose Luis Pelaez / Getty Images

What Is Pain Management?

Pain management is a branch of medicine focused on relieving severe or chronic pain. Pain management specialists treat a wide range of pain-causing conditions, such as diabetic neuropathy, fibromyalgia, arthritis, lower back pain, neck pain, and sciatica.

Because chronic pain is difficult to eliminate completely, pain management specialists instead aim to reduce pain while improving social, emotional, and physical functioning and overall quality of life.

Active Treatment

During active treatments, you engage in your treatment, for example, by doing physical therapy at home or practicing mindfulness meditation. Active treatments are especially important for regaining the ability to function at home and at work. For many types of non-cancer-related chronic pain, approaches that emphasize active treatments often work better and have fewer side effects than purely passive approaches.

Passive Treatment

Passive treatments are provided to the person in pain, such as medications, acupuncture, or massage therapy. During these treatments, you are a passive recipient and do not actively work towards your own recovery.

Types of Passive and Active Treatments

Many different active and passive treatments are used to treat chronic pain. The right combination will depend on the reasons for your pain, its intensity and duration, and your personal preferences and goals.

Passive Treatment

Passive treatments for pain include:

  • Over-the-counter (OTC) medications such as NSAIDs (nonsteroidal anti-inflammatory drugs), such as Advil or Motrin (ibuprofen), Aleve (naproxen sodium), and aspirin
  • Prescription synthetic opioids such as ConZip (tramadol hydrochloride extended release) or other opioids (narcotics)
  • Muscle relaxers
  • Certain types of antidepressants, such as tricyclic antidepressants (amitriptyline) and serotonin-norepinephrine reuptake inhibitors (SNRIs), such as Cymbalta (duloxetine) and Effexor (venlafaxine)
  • Surgery
  • Nerve ablation, in which a portion of the nerves sending pain signals to the brain are destroyed
  • Implantable drug delivery devices, which block pain signals by delivering small, timed amounts of pain medications to a specific area
  • Nerve stimulation devices such as TENS (transcutaneous electrical nerve stimulation)
  • Massage therapy
  • Water-based therapy (hydrotherapy)
  • Acupuncture
  • One-on-one physical therapy or occupational therapy
  • Chiropractic manipulation
  • Ultrasound therapy
  • Hot or cold packs

Active Treatment

During active treatments, you engage in activities and exercises that help relieve your pain and improve your physical and emotional functioning and quality of life, either on your own or with the help of someone else, such as a physical therapist or occupational therapist or psychologist.

Active treatments include:

  • Physical therapy performed at home or with a therapist
  • An exercise or movement regimen, such as yoga or tai chi
  • Meditation, especially mindfulness-based stress reduction
  • Cognitive behavioral therapy or other forms of psychotherapy (talk therapy)
  • Biofeedback (learning to control your heart rate, stress, muscle tension, and blood pressure)
  • Attending a support group for people with chronic pain or related conditions

Benefits of Active vs. Passive Therapies

Passive treatments such as opioids and NSAIDs can be highly effective for treating acute, injury-related pain for conditions like broken bones or a recent surgery.

But for many types of chronic pain, such as low back pain, neck pain, and arthritic (joint) pain, a purely passive treatment approach rarely has a significant impact on pain or improving daily functioning. Active treatments often give better long-term outcomes and more improved day-to-day functioning and quality of life.

Because active treatments involve effort and real work on your part, they can boost your sense of personal efficacy and competence while increasing your independence.

Pain management specialists therefore emphasize active treatments, while using passive therapies as an adjunct, as a bridge to more active therapies, or as a last resort.

Active treatments have shown benefits in treating:

The right mix of active and passive therapies depends on the person's specific type of pain, its location, intensity, and duration, and the person's goals.

Choosing an active or passive treatment is rarely an either-or decision. Active and passive treatments typically work best in combination. For example, passive treatments can sometimes pave the way for more active pain management by reducing pain and improving mobility.

The downsides of a purely passive treatment approach include:

  • Feelings of helplessness and loss of independence
  • Reduced physical activity
  • Reliance on medical specialists for pain relief
  • Potential for addiction to opioids
  • Opioid-induced hypersensitivity to pain (hyperalgesia)
  • Side effects from non-opioid medications (such as NSAIDs or SNRIs), injections, or implantable devices.

The benefits of an active approach include:

  • Improved day-to-day emotional and physical functioning
  • Enhanced sense of self-efficacy and independence
  • Fewer side effects
  • Brain remodeling that reduces sensitivity to pain

Emotional and Mental Aspects of Chronic Pain

Chronic pain is not just a physical condition but one that affects a person's overall emotional and mental well-being. As many as 80% of people with chronic pain experience depression or anxiety. They may avoid activities out of fear of exacerbating their pain and feel isolated and hopeless. Such feelings can increase stress and muscle tension, worsen pain, and further impair day-to-day functioning.

Active therapies involving pain-focused psychotherapy or joining a support group in addition to passive therapies like antidepressants can often help alleviate emotional and mental suffering and improve your quality of life.

Finding a Pain Management Care Team

The first step to starting on a treatment plan is finding a care team you can trust. Pain specialists should be medical doctors with special training in pain management. Pain treatment centers are ideal because they employ a team of specialists who can help with different aspects of chronic pain. You may wish to ask your primary care doctor and friends for recommendations.

Cost is a real consideration. Some pain management therapies are very expensive. Be sure to check with your insurance provider to find out whether the care teams and treatments you are considering are covered by your health insurance plan.

If you do not have health insurance, you should still discuss your symptoms with a healthcare provider and ask them for suggestions on finding affordable active or passive therapies.

Once you find the right team, you will need to communicate your needs and follow up with them about any side effects or other concerns you might encounter. It's critical to be upfront and honest and to advocate for yourself and your needs.

Summary

Both active and passive therapies serve their own purpose and can offer benefits to those recovering from an injury or specific condition. For most people, a combination of these therapies can lead to better pain management, although it's best to discuss these treatment options with a healthcare provider to come up with a pain management plan that's tailored to your body and its needs.

A Word From Verywell

Having chronic or recurrent pain is a miserable experience, and one that can make you feel helpless, hopeless, and alone. In the midst of such feelings, finding the motivation for an active treatment program can be challenging. Remember that despite these considerable hurdles, active treatments are often very effective and become easier to perform with time and practice.

To avoid exacerbating your pain and to stay safe, always talk to your pain management team before embarking on a particular treatment or therapy.

Frequently Asked Questions

  • What provides the most relief for pain?

    The most powerful pain relievers are prescription opioid-based medications (also called narcotics). Because opioids can cause dizziness and falls in the elderly and can be habit forming (lead to addiction), these powerful drugs are generally reserved for cancer pain, short-term treatment of acute pain, and when other treatments for chronic pain prove insufficient. NSAIDs, certain antidepressants, and other pain-reducing medications are less powerful than opioids but have fewer serious side effects.

  • What do doctors consider when prescribing pain medication?

    To determine the best treatment plan, your doctor and care team will conduct a thorough physical exam to determine the cause of your pain and your social, emotional, and physical functioning. For most types of chronic pain, your doctor will start with a conservative management plan, one that does not involve opioids but may include a mix of treatments such as physical therapy and non-opioid medications.

  • Can everyone benefit from active pain treatment?

    Active treatments have been shown to benefit a wide variety of pain types, including arthritis, back pain, headaches, and nerve pain. Active treatments require sticking to a treatment plan and being consistent in your efforts. Which active management approaches are the right for you will depend on your specific type of pain, its underlying cause, and whether you have other chronic conditions. Your pain management team will work with you to determine the best mix of passive and active therapies.

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