Pain can range from dull to sharp, from mild to intense. No matter how you describe it, you want it to go away—and fast. According to research or other evidence, the following self-care steps may be helpful:
These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full pain article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.
Pain is a sensation that is transmitted from an area of tissue damage or stress along the sensory nerves to the brain. The brain interprets the information as the sensation of pain.
Substances that decrease pain either interfere with the ability of nerves to conduct messages, or alter the brain’s capacity to receive sensations.
Pain may be a symptom of an underlying pathological condition, such as inflammation. It may also be due to other causes, such as bruising, infection, burns, headaches, and sprains and strains. Use caution when treating pain without understanding its cause—this may delay diagnosis of conditions that could continue to worsen without medical attention.
Product ratings for pain
|Science Ratings||Nutritional Supplements||Herbs|
Cayenne (capsaicin; topical use only)
Reliable and relatively consistent scientific data showing a substantial health benefit.
Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.
Symptoms of pain include discomfort that is often worsened by movement or pressure and may be associated with irritability, problems sleeping, and fatigue. People with pain may have uncomfortable sensations described as burning, sharp, stabbing, aching, throbbing, tingling, shooting, dull, heavy, and tight.
Body weight may be related to pain tolerance. One study indicated women who are more than 30% above the ideal weight for their age experience pain more quickly and more intensely than do women of ideal weight.1 No research has investigated the effect of weight loss on pain tolerance.
Exercise increases pain tolerance in some situations,2 3 in part because exercise may raise levels of naturally occurring painkillers (endorphins and enkephalins).4 Many types of chronic pain are helped by exercise,5 6 7 though some types of physical activity may aggravate certain painful conditions.8 People who want to initiate an exercise program for increasing pain tolerance should first consult a qualified health professional.
Some severe painful conditions might require surgical treatments to disrupt the pain signal.
Certain amino acids have been found to raise pain thresholds and increase tolerance to pain. One of these, a synthetic amino acid called D-phenylalanine (DPA), decreases pain by blocking the enzymes that break down endorphins and enkephalins, the body’s natural pain-killing chemicals.9 10 DPA may also produce pain relief by other mechanisms, which are not well understood.11
In animal studies, DPA decreased chronic pain within 15 minutes of administration and the effects lasted up to six days.12 It also decreased responses to acute pain. These findings have been independently verified in at least five other studies.13 14 Clinical studies on humans suggest DPA may inhibit some types of chronic pain, but it has little effect on most types of acute pain.15 16
Most human research has tested the pain-relieving effects of 750 to 1,000 mg per day of DPA taken for several weeks of continuous or intermittent use. The results of this research have been mixed, with some trials reporting efficacy,17 18 19 others reporting no difference from placebo,20 and some reporting equivocal results.21 It appears that DPA may only work for some people, but a trial period of supplementation seems worthwhile for many types of chronic pain until more is known. If DPA is not available, a related product, D,L-phenylalanine (DLPA), may be substituted at amounts of 1,500 to 2,000 mg per day.
As early as 1981, preliminary human research showed that DPA made the pain-inhibiting effects of acupuncture stronger.22 One controlled animal study23 and two controlled trials in humans24 25 showed that DPA taken the day before acupuncture increased the effectiveness of acupuncture in reducing both acute dental and chronic low back pain.
Other amino acids may be beneficial in reducing pain. In the central nervous system, L-tryptophan serves as a precursor to serotonin. Serotonin participates in the regulation of mood and may alter responses to pain. In a preliminary trial, 2,750 mg per day of L-tryptophan decreased pain sensitivity.26 Another preliminary trial found that L-tryptophan (500 mg every four hours) taken the day before a dental procedure significantly decreased the postoperative pain experienced by patients.27 In another preliminary trial, 3 grams of L-tryptophan taken daily for four weeks significantly decreased pain in a group of people with chronic jaw pain.28 No research has been published investigating the pain control potential of 5-hydroxytryptophan (5-HTP), another serotonin precursor that, unlike L-tryptophan, is currently available without a prescription.
Vitamin B12 has exhibited pain-killing properties in animal studies.29 In humans with vertebral pain syndromes, injections of massive amounts of vitamin B12 (5,000 to 10,000 mcg per day) have reportedly provided pain relief.30 Further studies are needed to confirm the efficacy of this treatment.
Capsaicin is an extract of cayenne pepper that may ease many types of chronic pain when applied regularly to the skin. In animal studies, capsaicin was consistently effective at reducing pain when given by mouth, by injection, or when applied topically.31 32 A controlled trial in humans found that application of a solution of capsaicin (0.075%) decreased sensitivity of skin to all noxious stimuli.33 One review article deemed the research on capsaicin’s pain-relieving properties “inconclusive.”34 However, in several uncontrolled and at least five controlled clinical trials, capsaicin has been consistently shown to decrease the pain of many disorders, including trigeminal neuralgia, shingles, diabetic neuropathy, osteoarthritis, and cluster headaches.35 36 37 38 39 For treatment of chronic pain, capsaicin ointment or cream (standardized to 0.025 to 0.075% capsaicin) is typically applied to the painful area four times per day.40 It is common to experience stinging and burning at the site of application, especially for the first week of treatment; avoid getting it in the eyes, mouth, or open sores.
Preliminary reports from Chinese researchers also note that 75 mg per day of THP (an alkaloid from the plant corydalis) was effective in reducing nerve pain in 78% of of those tested.41
As early as 1763, use of willow bark to decrease pain and inflammation was reported.42 Its constituents are chemically related to aspirin. These constituents may decrease pain by two methods: by interfering with the process of inflammation, and by interfering with pain-producing nerves in the spinal cord.43 No human studies have investigated the pain-relieving potential of willow bark, and questions have been raised as to the actual absorption of willow bark’s pain-relieving constituents.44 The potential pain-reducing action of willow is typically slower than that of aspirin.
In animal research, alcohol/water extracts of plants from the genus phyllanthus (25 to 200 mg per 2.2 pounds body weight) have shown a marked ability to decrease pain.45 This family includes the plants Phyllanthus urinaria, P. caroliniensis, P. amarus, and P. niruri. Like aspirin, phyllanthus extracts appear to reduce pain by decreasing inflammation.46 Although they are six to seven times more potent than aspirin or acetaminophen47 in test tube studies, extracts of these plants also demonstrate liver-protective properties,48 suggesting they may be safer than drugs such as acetaminophen, which has well-documented toxicity to the liver. The usefulness of phyllanthus extracts for treating pain in humans is unknown.
Other herbs that have been historically used to relieve pain (although there are no modern scientific studies yet available) include valerian, passion flower, American scullcap, Piscidia erythrina, and crampbark (Viburnum opulus).
Transcutaneous electrical nerve stimulation (TENS) is a form of electrical physical therapy that has been used in the treatment of pain since the early 1970s. Pads are placed on the skin and a mild electrical current is sent through to block pain sensations. Many TENS units are small, portable, and may be hidden under clothing. A review of the first ten years of research on TENS described success rates in treating chronic pain varying from 12.5% to 92% after one year of treatment.49 Variations in success rates were attributed to differences in the type of pain the TENS was treating. More current research identifies specific conditions that consistently respond well to TENS therapy:50 51 rheumatoid arthritis, osteoarthritis, low back pain, phantom limb pain, and post-herpetic nerve pain (shingles). Pain caused by pinched nerves in the spine responds poorly to TENS therapy. While a small number of controlled trials have reported no benefit,52 53 most evidence suggests TENS is an effective form of therapy for many types of pain.54 55 56
Relaxation exercises may decrease the perception of pain. Pain increases as anxiety increases; using methods to decrease anxiety may help reduce pain.57 In one controlled hospital study, people who were taught mind-body relaxation techniques reported less pain, less difficulty sleeping, and fewer symptoms of depression or anxiety than did people who were not taught the techniques.58
Acupuncture has been shown to decrease pain by acting on the enkephalin-based, pain-killing pathways.59 In 1997, the National Institutes of Health (NIH) stated that acupuncture is useful for muscular, skeletal, and generalized pain, as well as for anesthesia and post-operative pain. The NIH statement was based on a critical review of over 67 controlled trials of acupuncture for pain control.
Practitioners of manipulation report that it often produces immediate pain relief either in the area manipulated or elsewhere.60 Controlled trials have found that people given spinal manipulation may experience reduction in pain sensitivity of the skin in related areas,61 62 a reduction in joint and muscle tenderness in the area manipulated,63 and a decrease in elbow tenderness when the neck was manipulated.64 One study showed no effect of lower spine manipulation on sensitivity to deep pressure over low back muscles and ligaments.65 Some researchers have speculated that joint manipulation affects pain by enhancing the effects of endorphins. However, only one66 of three67 68 controlled studies has shown an effect of manipulation on endorphin levels.
Hypnosis has been shown to significantly reduce pain associated with office surgical procedures that are performed while the patient is conscious (i.e., without general anesthesia).69 People undergoing office surgical procedures received standard care, structured attention or self-hypnotic relaxation in one study. Those using self-hypnosis had no increases in pain during the procedures, compared to those in the other groups. Hypnosis also appeared to stabilize bleeding, decrease the requirement for narcotic pain drugs during the procedure, and shorten procedure time.
1. Pradalier A, Willer JC, Dry J. Pain sensitivity in obese individuals. Ann Med Interne (Paris) 1982;133:528–31.
2. Guieu R, Blin O, Pouget J, Serratrice G. Nociceptive threshold and physical activity. Can J Neurol Sci 1992;19:69–71.
3. Fordyce W, McMahon R, Rainwater G, et al. Pain complaint—exercise performance relationship in chronic pain. Pain 1981;10:311–21.
4. Schwarz L, Kindermann W. Changes in beta-endorphin levels in response to aerobic and anaerobic exercise. Sports Med 1992;13:25–36 [review].
5. Ferrell BA, Josephson KR, Pollan AM, et al. A randomized trial of walking versus physical methods for chronic pain management. Aging (Milano) 1997;9:99–105.
6. McCain GA. Nonmedicinal treatments in primary fibromyalgia. Rheum Dis Clin North Am 1989;15:73–90.
7. Kottke TE, Caspersen CJ, Hill CS. Exercise in the management and rehabilitation of selected chronic diseases. Prev Med 1984;13:47–65 [review].
8. Cowan P, Lovasik DA. American Chronic Pain Association: strategies for surviving chronic pain. Orthop Nurs 1990;9:47–9 [review].
9. Ehrenpreis S. Analgesic properties of enkephalinase inhibitors: animal and human studies. Prog Clin Biol Res 1985;192:363–70.
10. Guisti P, Carrara M, Cima L, Borin G. Antinociceptive effect of some carboxypeptidase A inhibitors in comparison with D-phenylalanine. Eur J Pharmacol 1985;116:287–92.
11. Walsh NE, Ramamurthy S, Schoenfeld LS, Hoffman J. D-phenylalanine was not found to exhibit opiod receptor mediated analgesia in monkeys. Pain 1986;26:409–10.
12. Ehrenpreis S, Balagot R, Comaty JE, Myles SB. Naloxonr reversible analgesia in mice produced by D-phenylalanine and hydrocinnamic acid, inhibitors of carboxypeptidase A. In Bonica JJ, et al., eds. Advances in Pain Research and Therapy, Vol. 3. New York: Raven Press, 1979.
13. Ehrenpreis S. Pharmacology of enkephalinase inhibitors: animal and human studies. Acupunct Electrother Res. 1985;10:203–8.
14. Balagot RC, Ehrenpreis S, Kubota K, Greenberg J. Analgesia in mice and humans by D-phenylalanine: relation to inhibition of enkephalin degradation amd enkephalin levels. In Bonica JJ, et al., eds. Advances in Pain Research and Therapy, Vol. 5. New York: Raven Press, 1983
15. Mitchell MJ, Daines GE, Thomas BL. Effect of L-tryptophan and phenylalanine on burning pain threshold. Phys Ther 1987;67:203–5.
16. D’Alessandro R. D-Phenylalanine does not affect nociceptive, flexion reflex thresholds in normal humans. Anesth Analg 1983;62:857–8.
17. Budd K. Use of D-phenylalanine, an enkephalinase inhibitor, in the treatment of intractable pain. In Bonica JJ, et al., eds. Advances in Pain Research and Therapy, Vol. 5. New York: Raven Press, 1983.
18. Donzelle G, Bernard L, Deumier R, et al. Curing trial of complicated oncologic pain by D-phenylalanine. Anesthesie, Analgesie, Reanimation 1981;38:655–8 [in French].
19. Balagot RC, Ehrenpreis S, Kubota K, Greenberg J. Analgesia in mice and humans by D-phenylalanine: relation to inhibition of enkephalin degradation and enkephalin levels. In Bonica JJ, et al., eds. Advances in Pain Research and Therapy, Vol. 5. New York: Raven Press, 1983.
20. Walsh NE, Ramamurthy S, Schoenfeld LS, Hoffman J. Analgesic effectiveness of D-phenylalanine in chronic pain patients. Arch Phys Med Rehabil 1986;67:436–9.
21. Sicuteri F. Enkephalinase inhibition relieves pain syndromes of central dysnociception (migraine and related headache). Cephalalgia 1981;1:229–32.
22. Kitade T, Minamikawa M, Nawata T, et al. An experimantal study on the enhancing effects of phenylalanine on acupuncture analgesia. Am J Chin Med 1981;9:243–8.
23. Takeshige C, Mera H, Hisamitsu T, et al. Inhibition of the analgesia inhibitory system by D-phenylalanine and proglumide. Brain Res Bull 1991;26:385–91.
24. Kitade T, Odahara Y, Shinohara S, et al. Studies on the enhanced effect of acupuncture analgesia and acupuncture anesthesia by D-phenylalanine (first report)—effect on pain threshold and inhibition by naloxone. Acupunct Electrother Res 1988;13:87–97.
25. Kitade T, Odahara Y, Shinohara S, et al. Studies on the enhanced effect of acupuncture analgesia and acupuncture anesthesia bu D-phenylalanine (2nd report)—schedule of administration and clinical effects in low back pain and tooth extraction. Acupunct Electrother Res 1990;15:121–35.
26. Leiberman HR, Corkin S, Spring RJ, et al. Mood, performance and pain sensitivity: changes induced by food constituents. J Psychiatr Res 1982;17:135–45.
27. Shpeen SE, Morse DR, Furst ML. The effect of tryptophan on post-operative endodontic pain. Oral Surg Oral Med Oral Pathol 1984;58: 446–9.
28. Seltzer S, Dewart D, Pollack RL, Jackson E. The effects of dietary tryptophan on chronic maxillofacial pain and experimental pain tolerance. J Psychiatr Res 1982–83;17(2):185–6.
29. Hanck A, Weiser H. Analgesic and anti-inflammatory properties of vitamins. Int J Vitam Nutr Res Suppl 1985;27:189–206.
30. Hieber H. Treatment of vertebragenous pain and sensitivity disorders using high doses of hydroxocobalamin. Med Monatsschr 1974;28:545–8 [in German].
31. Santos AR, Calixto JB. Ruthenium red and capsazepine antinociceptive effect in formalin and capsaicin models of pain in mice. Neurosci Lett. 1997;235:73–6.
32. Otsuki T, Nakahama H, Niizuma H, Suzuki J. Evaluation of the analgesic effects of capsaicin using a new rat model for tonic pain. Brain Res 1986;365:235–40.
33. Nolano M, Simone DA, Wendelschafer-Crabb G, et al. Topical capsaicin in humans: parallel loss of epidermal nerve fibers and pain sensation. Pain 1999;81:135–45.
34. Kingery WS. A critical review of controlled clinical trials for peripheral neuropathic pain and complex regional pain syndromes. Pain 1997;73:123–39 [review].
35. Hautkappe M, Roizen MF, Toledano A, et al. Review of the effectiveness of capsaicin for painful cutaneous disorders and neural dysfunction. Clin J Pain 1998;14:97–106 [review].
36. Fusco BM, Giacovazzo M. Peppers and pain. The promise of capsaicin. Drugs 1997;53:909–14 [review].
37. Robbins WR, Staats PS, Levine J, et al. Treatment of intractable pain with topical large-dose capsaicin: preliminary report. Anesth Analg 1998;86:579–83.
38. Zhang WY, Li Wan Po A. The effectiveness of topically applied capsaicin. A meta-analysis. Eur J Clin Pharmacol 1994;46:517–22 [review].
39. Ellison N, Loprinzi CL, Kugler J, et al. Phase III placebo-controlled trial of capsaicin cream in the management of surgical neuropathic pain in cancer patients. J Clin Oncol 1997;15:2974–80.
40. Rains C, Bryson HM. Topical capsaicin. A review of its pharmacological properties and therapeutic potential in post-herpetic neuralgia, diabetic neuropathy and osteoarthritis. Drugs Aging 1995;7:317–28 [review].
41. Lin DZ, Fang YS. Modern Study and Application of Materia Medica. Hong Kong: China Ocean Press, 1990, 323–5.
42. Hedner T, Everts B. The early clinical history of salicylates in rheumatology and pain. Clin Rheumatol 1998;17:17–25.
43. Cherng CH, Wong CS, Ho ST. Spinal actions of non-steroidal anti-inflammatory drugs. Acta Anaesthesiol Sin 1996;34:81–8.
44. Robbers JE, Tyler VE. Tyler’s Herbs of Choice: The Therapeutic Use of Phytomedicinals. New York: Haworth Press, 1999, 200–4.
45. Santos AR, Filho VC, Yunes RA, et al. Analysis of the mechanisms underlying the antinociceptive effects of extracts of plants from the genus Phyllanthus. Gen Pharmacol 1995;26:1499–506.
46. Cechinel Filho V, Santos AR, De Campos RO, et al. Chemical and pharmacological studies of Phyllanthus caroliniensis in mice. J Pharm Pharmacol 1996;48:1231–6.
47. Miguel OG, Calixto JB, Santos Ar, et al. Chemical and preliminary analgesic evaluation of geraniin and furosin isolated from Phyllanthus sellowianus, Planta Med 1996;62:146–9.
48. Syamasundar KV, Singh B, Thakur RS, et al. Antihepatotoxic principles of Phyllanthus niruri herbs. J Ethnopharmacol 1985;14:41–4.
49. Tapio D, Hymes AC. New Frontiers in TENS. Minnetonka, MN: LecTec Corporation, 1987, 63–9.
50. Nicholas JJ. Physical modalities in rheumatologic rehabilitation. Arch Phys Med Rehabil 1994;75:994–9.
51. Gersh, MR. Transcutaneous electrical nerve stimulation (TENS) for management of pain and sensory pathology. In Electrotherapy in Rehabilitation. Philadelphia: F.A. Davis Company, 1992.
52. Long DM. Fifteen years of of transutaneous electrical stimulation for pain control. Stereotact Funct Neurosurg 1991;56:2–19.
53. Carroll D, Tramer M, McQuay H, et al. Randomization is important in studies with pain outcomes: systemic review of transcutaneous electrical nerve stimulation in acute postoperative patients. Br J Anaesth 1996;77:798–803.
54. Oliveri AC, Clelland JA, Jackson J, Knowles C. Effects of auricular transcutaneous electrical nerve stimulation on experimental pain threshold. Phys Ther 1986;66:12–6.
55. Lander J, Fowler-Kerry S. TENS for children’s procedural pain. Pain 1993;52:209–16.
56. Long DM. Current status of electrical stimulation on the nervous system for the relief of chronic pain. Surg Neurol 1998;49:142–4.
57. Robin O, Vinard H, Vernet-Maury E, Saumet JL. Influence of sex and anxiety on pain threshold and tolerance. Funct Neurol 1987;2:173–9.
58. Rybarczyk B, DeMarco G, DeLaCruz M, Lapidos S. Comparing mind-body wellness interventions for older adults with chronic illness: classroom versus home instruction. Behav Med 1999;24:181–90.
59. U.S. Department of Health and Human Services. Public Health Service. Acupuncture. NIH Consensus Statement 1997;15:1–34.
60. Vernon H. Qualitative review of studies of manipulation-induced hypoalgesia. J Manipulative Physiol Ther 2000;23:134–8.
61. Glover JR, Morris JG, Khosla T. Back pain: a randomized clinical trial of rotational manipulation of the trunk. Br J Indust Med 1974;31:59–64.
62. Terrett ACJ, Vernon HT. Manipulation and pain tolerance: a controlled study of the effect of spinal manipulation on paraspinal cutaneous pain tolerance levels. Am J Phys Med 1984;63:217–25.
63. Vernon HT, Aker P, Burns S, et al. Pressure pain threshold evaluation of the effect of spinal manipulation in the treatment of chronic neck pain: a pilot study. J Manipulative Physiol Ther 1990;13:13–6.
64. Vicenzino B, Collins D, Benson H, Wright A. The initial effects of a cervical spine manipulative physiotherapy treatment on the pain and dysfunction of lateral epicondylagia. Pain 1996;68:69–74.
65. Cote P, Mior SA. The short-term effect of a spinal manipulation on pain/pressure threshold in patients with chronic mechanical low back pain. J Manipulative Physiol Ther 1994;17:36–48.
66. Vernon HT, Dhami MS, Howley, TP, et al. Spinal manipulation and B-endorphin: a controlled study of the effect of a spinal manipulation on plasma B-endorphin levels in normal males. J Manipulative Physiol Ther 1986;9:115–23.
67. Christian GF, Stanton GJ, Sissons D, et. al. Immunoreactive ACTH, B-endorphin and cortisol levels in plasma following spinal manipulative therapy. Spine 1988;13:141–7.
68. Sanders GE, Reinnert O, Pepe R, et al. Chiropractic adjustive manipulation on subjects with acute low back pain: visual analogue scores and plasma b-endorphin levels. J Manipulative Physiol Ther 1990;13:391–5.
69. Lang EV, Benotsch EG, Fick LJ, et al. Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. Lancet 2000;355:1486–90.
Copyright © 2007 Healthnotes, Inc. All rights reserved. www.healthnotes.com
The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires September 2008.