Pain Management Without Medication

Body-based strategies for pain management

Body-based strategies focus on how the body responds to pain. They can help relax muscles, improve blood flow, and reduce pain signals. 

Cold or heat therapy 

Cold and heat can help with some types of pain.  

• Cold therapy can help with pain from swelling, injury, or procedures. Applying ice or cold packs is a common way to treat a painful area. 
• Heat therapy can help relieve tight muscles and increase blood flow. Taking a warm bath or putting on warm towels can help. Talk to your care team before using a heating pad. 

When using cold or heat: 

• Always wrap ice or hot packs in a towel or cloth to protect the skin 
• Check the skin every few minutes for irritation or redness 
• Do not use heat on areas that are numb or that have a medicine patch 

Massage 

Massage uses gentle pressure to increase the flow of blood and body fluids, stretch muscles, and relax the body. Massage can help reduce stress, anxiety, and pain and improve sleep and overall well-being. Massage should be done by a trained provider. Ask your care team if massage therapy could help your child. Discuss any precautions that are needed.  

Acupuncture or acupressure (acupoint therapy) 

Acupuncture and acupressure are types of acupoint therapies that may help to relieve pain symptoms.  

• Acupuncture uses very thin needles placed at specific points on the body to affect how nerves work.  
• Acupressure is an alternative that uses touch and pressure without needles.    

Talk to your care team about acupoint therapy. They may recommend a licensed provider who has experience treating children and teens safely. 

Transcutaneous electrical nerve stimulation (TENS) 

A TENS unit is a small device that sends tiny electrical signals through wires placed on the skin near painful areas. These signals travel to nerves to help reduce pain. This may feel like a tingle or a gentle massage. Ask your care team if a TENS unit might help your child.  

Comfort positions 

Comfort positions are ways of holding or positioning your child during painful or stressful moments. Being held by a caregiver can help your child feel safer and reduce pain or fear during procedures. Child life specialists and other care team members can teach comfort positioning techniques based on your child’s age.

Mind-body strategies for pain management

Mind‑body strategies focus on how thoughts, feelings, and attention affect pain and physical responses. These approaches can help your child feel more in control and change how pain feels. 

Mindfulness  

Mindfulness techniques can help your child pay attention to their body, feelings, and their experience with pain. You may notice that your child’s pain changes with stress, mood, or activity level. Mindfulness can help your child notice when the pain is worse and when it goes away. Being aware of the pain can be the first step to managing it. 

Distraction 

Distraction helps take your child’s focus away from pain. The goal is to focus on something else to take their mind off their discomfort. 

• For short procedures, distraction may include counting, listening to music, watching a video, playing a game, or using a fidget toy.  
• For longer procedures or pain episodes, distraction may include doing a favorite activity, such as watching a movie or favorite show, talking with family and friends, or playing video or board games.  

Different activities may help with short versus long-lasting pain.  

Journaling 

Writing or drawing about pain experiences may help your child express feelings, track pain, and notice what helps or makes pain worse.  

A pain journal may include: 

• Date and time of pain 
• Pain level 
• What pain felt like 
• What helped and what made pain worse 
• How your child felt afterward 

Journaling can reduce stress and help give your child a sense of control. Sharing this information with your care team can help guide pain management plans. A pain journal can help your care team know more about your child’s pain and how they can help treat it. 

Relaxation  

Relaxation helps calm the body so that pain signals feel less intense. This approach may include deep breathing, progressive muscle relaxation, guided imagery, meditation, or soothing music or sounds.  

Deep breathing: To practice deep breathing, have your child focus on taking slow, deep breaths from the belly.  

• Imagine that there is a balloon in your belly that you are trying to fill up.  
• When you breathe in, your “balloon” fills up. When you breathe out, it empties.  
• Breathe in and count to 4 slowly. Breathe out and count to 4 slowly.  
• Practice taking 5 deep breaths in a row. 

You can also breathe in through your nose and out through your mouth or close 1 nostril at a time as you breathe in and out.    

Mini-relaxation: Use mini-relaxation to help your child take small breaks during the day. 

• Set a timer.  
• When the timer goes off, take a deep breath, and relax all muscles (like a wet noodle) for about 10 seconds.  
• Repeat throughout the day. 

Progressive muscle relaxation (PMR): In progressive muscle relaxation, your child tenses and releases small groups of muscles, 1 group at a time. This helps your child learn to notice when their muscles are tense or tight and practice relaxing them.  

• Get in a comfortable position.  
• Start with the toes and work up to the head. 
• Tighten 1 muscle group for 5 seconds, then relax it. 
• Do this 1–2 times before moving to the next muscle group.  
• Take your time. This should last at least 8 minutes. 

Visualization or guided imagery: This approach teaches your child to think about or imagine a calming place using all their senses (sight, sound, smell, taste, and touch).  

• Sit in a comfortable position. Close your eyes if you feel comfortable doing so. Play calming music if it helps.  
• Begin by taking slow, deep breaths. Let go of any tension in your body.  
• Imagine that you are in a special place. This can be any place that is relaxing and comforting to you, like a warm beach by the ocean or a favorite place that makes you happy.  
• Use your senses to make the special place feel more real.  

Cognitive-behavioral therapy (CBT)  

CBT is a type of therapy that helps people understand the connection between thoughts, feelings, and behaviors. It can include different strategies, such as noticing and challenging negative thoughts, using positive self-talk, practicing relaxation, and building coping skills. CBT can help your child feel more in control of their pain and find pain management strategies that work best for them.  

Biofeedback  

Biofeedback trains the mind to control the way the body responds to stress and pain. A health care provider uses special equipment to detect and monitor body signals such as breathing and heart rate. Your child watches on a screen to see how their body changes to learn how different calming techniques affect their body. In time, your child can manage how their body responds without biofeedback. 

Medical hypnosis 

Medical hypnosis is provided by a trained provider to help your child focus their attention and reduce pain and stress. Your child stays awake and in control of their body during hypnosis.  

Aromatherapy  

Aromatherapy uses scents from essential oils to help the body relax and reduce pain, stress, and other symptoms. Ask your care team what options are available and safe for your child. Do not allow your child to swallow the oil and do not apply on the skin unless directed. Follow instructions on how to use essential oils safely and store them out of the reach of children.    

Modeling and role play 

Modeling is when someone shows helpful ways to cope with pain so that others can learn from watching. For example, your child may see another patient take slow, deep breaths during a needle stick and then try it themselves.   

Medical role play is when children use real or pretend medical items to know what to expect and practice coping skills ahead of time. This can give them a sense of control over painful situations. For example, a child life specialist can guide your child through a pretend procedure using strategies like deep breathing or distraction. This can help your child feel more prepared and confident when the real situation happens. 

Lifestyle and wellness strategies for pain management

Sleep 

Poor sleep can make pain feel worse, and pain can also make it hard to sleep. Getting enough rest can help your child manage pain better. Try to: 

• Keep the same bedtime routine and sleep schedule each day.  
• Keep the room dark at night and bright during the day.  
• Limit bright screens, exciting games, and intense activity before bed.  
• Use calming routines, such as a bath or reading, before going to sleep.  

Talk with your care team for more ideas about how to help your child if they have trouble sleeping or if pain interferes with sleep.  

Hydration 

Not drinking enough fluids can make pain worse. Dehydration may cause muscle cramps, joint pain, back pain, inflammation, headaches, or delayed healing. Ask your care team how much water your child should drink each day. Your child can also suck on ice chips or popsicles if they have trouble drinking. If your child does not like to drink water, add healthy flavoring to water or choose drinks with low sugar and low or no caffeine. 

Nutrition 

Eating healthy foods and getting good nutrition helps your child’s body stay strong and gives the energy needed for healing and recovery. A healthy eating plan—including fruits and vegetables, whole grains, and protein—helps your child get the nutrients they need and may help reduce inflammation. Your care team may recommend specific foods to eat or avoid based on your child’s condition or treatment. 

Physical activity and movement  

Movement can help strengthen muscles, loosen stiff joints, and improve blood flow. Physical activity can also improve mood, lower stress, and support sleep—all of which play a role in pain. A physical therapist or occupational therapist may help with an exercise plan. Start slowly with activities like walking, stretching, or light play, and increase activity gradually. Stop if pain increases suddenly.  

Even when your child has pain, encourage them to keep moving with some activity. But make sure they don’t do too much activity at one time. Doing too little or too much can cause pain flare-ups.  

Pacing 

Pacing means balancing between activity and rest. It helps your child to stay active without making pain worse. A pacing plan may include: 

• Setting activity goals based on your child’s pain levels 
• Breaking activity into smaller parts 
• Planning activity around times when your child feels better or has more energy 
• Resting between activities 
• Gradually increasing activity 

You can work with your care team to make a pacing plan that works for your child. 

Pain management looks different for every child, and your child’s needs may change over time. Talk with your care team about which strategies may work best for your child.

Questions to ask the care team

• How can I help manage my child’s pain without medicine? 
• What are the risks and benefits of using these techniques to manage pain? 
• Which techniques are best for my child’s type of pain? 
• Which pain relief strategies are safe to try at home? 
• Where can I find licensed providers who offer these pain management techniques? 
• Will these techniques interfere with my child’s other treatments and medicines? 
• Are there pain management strategies that are not safe for my child? 
• When should I call you for help? 

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