MSK Medications: Alternatives Part 2

If you missed the first part of 'MSK Medications: Alternative Opportunities' you can catch it here.

When considering what medications to use, individuals need to make informed decisions, balancing the research, the pros and cons (often a long list of side effects) and also examining alternative evidence-based options. Here are some alternative measures that can be used to modify pain.

Analgesic Alternatives

Pain Management Education

Now I must admit that a lot of people just want to pop a pill and part of our responsibility is to explain the obvious, that is, having a longer term plan (with more than one strategy) for a longer term problem. Research has shown that as load/stress (physical or emotional) increases, so do symptoms. As a clinician helping clients better manage their pain, teaching pacing and appropriate goal setting is critical. For further information on pacing strategies and goal setting. See here.

Appropriate Exercise

Tied in with pacing, exercise is known to creates so many positives;

  • Sense of accomplishment through planning and achieving
  • Enhancing mental wellbeing
  • Circuit breaker on brain worry/rumination
  • Counter production of stress hormones
  • Positive effect on muscles, bones, and joints
  • Create degree of physical fatigue and assist with sleeping
  • Helping maintain a healthy body weight, lower BP
  • Keep the GI tract functioning, resist constipation

The key is finding a baseline for our clients, agreeing on an appropriate form(s) of exercise and developing realistic expectations and time frame on progression. 

Mindfulness Awareness/Relaxation Training

Living in the moment seems obvious, but honestly, we can find ourselves dwelling a lot of time in the future (what ifs) or the past (Bruce Springsteen's Glory Days), neither of which we can change. Mindfulness assists in quality of life and pain management through the process of breathing techniques and active relaxation. We all breath, yet in times of pain, anxiety, stress, it is often the first thing we change, going from relaxed deep breathing to shallow, apical and hyperventilation.

Learning how and practicing intentional slow breathing is beneficial in several ways;

  • Activates the vagus nerve, the primary cranial nerve, which is associated with a recuperative state
  • Increases alpha waves in the brain, calming mid-range waves that foster a relaxed yet alert state of mind
  • Slow breathing tends to increase heart-rate variability

I teach techniques like box breathing and diaphragmatic breathing to assist in pain management. Swimming is another form of intentional breathing where you rapid inhale and slow exhale.


NSAIDs Alternatives



We stock and use comfrey cream in the clinic. Good for superficial applications.

Chronic OA knees/TKR

See here

Acute Ankle Sprains

See here


Micro Currents (MC) & Trans Cutaneous Electrical Stimulators (TENS)

Not for everyone, but certainly worth a trial in regards to managing pain and as an alternative to or compliment with medications. We stock the PainMaster (MC) and NeuroTrac (TENS) ranges and provide advice on fitting and settings.

Supportive Aids

There is plenty of research that confirms what we see in the clinic; if you offload a painful structure, day to day activities become more enjoyable and comfortable. We use an extensive range of tape, braces, and orthotics to help modify loading. 


Turmeric. Long used in Ayurveda medicine, the active ingredient is curcumin. A molecule that is difficult to be absorbed by the gut, but better when combined with a lipase = bioavailable curcumin. Research would indicate beneficial properties. See here

Glucosamine + Chondroitin Sulfate. The jury is still mixed research wise, but the supplement is safe to take and seems beneficial for those with moderate+ OA. See here.

Fish Oil. When sourced with caution (heavy metal toxicity), research indicates it to be beneficial. See here.

UC-II and nTHIAA. A new class of supplements, combined they provide demonstrated anti-inflammatory effects and effectiveness in clinical studies of osteoarthritis and rheumatoid arthritis. See here.

What have you found helps?

I am sure you have other ways to assist clients with pain, that don't involve prescriptive medications. Love to hear your thoughts in the comments section below. Thanks for reading and your contribution.