How to Take a Multi-Modal Approach to Managing Pain

What is a Multi-Modal Pain-Relief Strategy?

A “multimodal pain” strategy uses a combination of treatments to manage pain. For people taking a self-care approach to pain, this could mean something as simple as combining and over-the-counter pain-relieving medication with a cold compress, relaxation, or other psychological approaches to pain.

By targeting pain in different ways, these strategies can help to reduce pain more effectively while reducing the reliance on high doses of a single medication, the risk of side effects and dependency. Combining methods can help with both short and longer-term pain. Multimodal pain management is increasingly recommended, as it may provide a more holistic and tailored care for people with pain.

Medicinal approaches to pain management

Medicines that might be used to treat different types of pain include non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, local anaesthetics, opioids, anticonvulsants, and muscle relaxants. These medicines should not be taken together and consult a doctor for advice on managing your pain.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Ibuprofen is a type of anti-inflammatory drug. Ibuprofen helps to reduce pain and swelling in the body by reducing the chemical messengers which are involved in pain signalling.

You can take ibuprofen in capsule or tablet form or you could also try using it in a form that is applied to the skin, such as Nurofen Joint & Muscular Pain Relief Medicated Plaster which can bring you up to 24 hours of pain relief. It is simply applied to the skin, helping to relieve pain at the site of injury.

Paracetamol

Paracetamol is another painkiller especially for people who are unable to use NSAIDs.

Local anaesthetics, opioids & anticonvulsants

For more severe pain your doctor may prescribe local anaesthetics, opioids or anticonvulsants.

Non-Medicinal approaches to pain management

Non-medicinal treatments can involve physical therapy, psychological support, cognitive-behavioural therapy (CBT), acupuncture, mindfulness, and lifestyle modifications like exercise and diet changes.

Physical therapies:

Physical therapies are treatments that use things like electricity, heat, cold, or pressure to help manage pain. These methods can affect different parts of the body’s pain pathway.

• Transcutaneous Electrical Stimulation (TENS) uses a device to send a gentle electric current to your nerves or muscles. This may help treat pain by reducing the pain signals. It may also stimulate the production of endorphins which are natural body painkillers. In a multimodal approach, it may work better when used alongside medications, psychological treatments, physical therapy, or other complementary methods.
• Heat and Cold (thermal therapies) use temperature to relieve pain. Heat therapy involves applying things like hot packs or infrared heat to warm up the tissue. Combining heat or cold therapy with painkillers like NSAIDs may enhance pain relief for some types of pain. When used with exercise and physical therapy, it may help with chronic muscle and joint pain, better than using either treatment alone.
• Massage. There is some evidence that massage – either used alone or in combination with other treatment approaches such as analgesic medications – may be an effective method for managing chronic pain.

Psychotherapies

Psychological interventions can be used to manage pain by using mental and emotional strategies that may help change how the brain processes pain signals. These techniques could reduce pain by potentially altering activity in brain areas related to perception, emotion and behaviour.

• Cognitive-behavioural therapy (CBT), is a type of psychotherapy that aims to help manage chronic pain by altering negative thoughts and behaviours. It challenges negative perceptions, addresses emotional responses like anxiety and depression, and encourages healthy habits, such as improved sleep, diet, exercise, and social support. When combined with exercise, massage, and chiropractic care, CBT can help with showing greater pain control for conditions like long-term low back pain and osteoarthritis. CBT can address various aspects that contribute to pain, such as perception, thought processes, and emotional responses.
• Hypnosis could be used to support medical, physical and mental health treatments, when integrated with other therapy such as massage and chiropractic care. It may reduce negative feelings like fear and anxiety and increase positive feelings like relaxation and confidence in coping with pain.
• Acupuncture involves inserting fine needles into the skin, sometimes with small electrical currents, pressure and heat, to treat various health issues. Originating from traditional Chinese medicine, acupuncture has become popular worldwide. Research shows it may help with different types of pain, including back, neck and knee pain.
• Meditation and mindfulness are often used to manage pain. Some types of meditation focus on a specific activity or sensation, like breathing, sounds, or repeating a word. Mindfulness meditation involves focusing on the present moment without judgment. Programs like mindfulness-based stress reduction teach these techniques to help manage stress and pain. When combined with physical therapy, massage, or other therapies, mindfulness can help relieve chronic low-back pain more effectively than these therapies alone. When combined with acceptance commitment therapy, it may also help with arthritis pain, while mindfulness and CBT combined can provide migraine relief, and improve quality of life compared with either therapy alone.
• Music therapy involves activities like listening to music, playing instruments, and songwriting. Music therapy may help reduce pain intensity, emotional distress, and reliance on pain medication. When combined with physical therapy, it can help to improve pain, movement, and quality of life for conditions like osteoarthritis and long-term neck pain. Paired with Cognitive Behavioural Therapy (CBT), it can also help with coping with pain and reduce disability in chronic widespread pain, compared to the treatments on their own.
• Biofeedback is a technique that uses sensors to monitor things like heart rate, muscle tension, and brain activity, and gives real-time feedback. By becoming aware of these bodily signals it may help people to learn how to control them. When used with other therapies, biofeedback can help relieve chronic pain by potentially changing how the body functions and affecting the brain’s pain-related areas.

Physical and psychotherapies combined (mind-body practices):

Movement and manual therapy

• Manual therapy involves hands-on techniques, like joint mobilization and soft tissue manipulation, to help restore movement and function. Movement therapy uses specific exercises and physical training to improve symptoms. Both methods work on the nervous system to help reduce chronic pain.
• Tai Chi involves a combination of physical postures, focused attention and controlled breathing. Research on tai chi has mixed results but it may help reduce pain and stiffness while improving physical function, balance, and psychological health. Tai chi, alone or with physical therapy, may also help to reduce pain and improve daily activities for people with low back pain.
• Yoga has been recommended as a non-medicinal treatment, for managing conditions such as low-back pain. Yoga may also help to reduce neck pain, disability related to neck pain, and may help with tension headaches by lowering their frequency, duration, and intensity.

Talk to a healthcare professional about multi-modal pain approaches?

Talk to a healthcare professional for advice before embarking on complementary or multi-modal approaches, to ensure which approaches are suitable for your type of pain. Don't use complementary approaches to delay seeing a doctor. Get advice from your doctor first, before starting or stopping any treatment.