Substance guides

Chronic pain treatment without opioids: Alternatives that work

Published February 10, 2025 · 8 min read · Updated April 2026

Reviewed for accuracy by licensed clinical professionals.

Chronic pain can be managed effectively without opioids. Multiple evidence-based alternatives exist, often producing better long-term outcomes than opioid-only approaches.

Medications

NSAIDs (ibuprofen, naproxen) for inflammatory pain. Duloxetine (Cymbalta) for neuropathic pain and fibromyalgia. Gabapentin/pregabalin for nerve pain. Topical treatments (lidocaine patches, capsaicin cream). Acetaminophen for mild-moderate pain.

Procedures

Nerve blocks and epidural injections. Radiofrequency ablation. Spinal cord stimulation. Trigger point injections. Physical therapy.

Behavioral approaches

CBT for chronic pain (changes relationship to pain). Mindfulness-based stress reduction. Biofeedback. Acceptance and Commitment Therapy. These do not eliminate pain but significantly improve function and quality of life.

Physical approaches

Physical therapy and exercise (strongest evidence). Massage therapy. Acupuncture. Yoga and tai chi. Chiropractic care.

Authoritative sources

This article references guidelines from: NIDA · SAMHSA · CDC

Frequently asked questions

Can chronic pain be managed without opioids?

Yes. Multiple evidence-based alternatives often produce better long-term outcomes than opioid-only approaches.

What is the best non-opioid pain medication?

Depends on pain type. NSAIDs for inflammatory, duloxetine for neuropathic, gabapentin for nerve pain.

Does physical therapy help chronic pain?

Physical therapy has the strongest evidence of any non-pharmacological approach for most chronic pain conditions.

Disclaimer: Informational only. Not medical advice. SAMHSA: 1-800-662-4357.