Passive therapies

Transcutaneous electrical nerve stimulation (TENS) uses electrodes that are attached to a small battery-powered device and are placed on your skin, usually on either side of the location of the pain. Through the electrodes, electrical signals are transmitted into specific nerves. It is believed that this process may help by activating pain-reducing receptors. TENS is sometimes used to treat acute and persistent pain, for example lower back pain. It may be used with pain-relieving medications.

A physiotherapist will help you set up the TENS to find the most effective placement and level of electric current. The treatment time depends on the type of pain and your tolerance to the electrical stimulation. Any pain relief is short-term, however, lasting only while the TENS is applied, or up to an hour after it has been removed.

TENS is most likely to be useful by helping you feel well enough to exercise. Like other passive therapies, it should not be used as a standalone treatment. If TENS does work for you, it is something that you are able to do at home. Though TENS machines can be expensive, with a doctor’s referral, they may be covered by your extended health insurance. TENS machines can also be rented.

What's the evidence?
There is limited evidence for the effectiveness of TENS for treating chronic pain.

Ultrasound therapy uses high-frequency sound waves (they cannot be heard by the human ear). These sound waves are applied to a painful area of the body using a small metal ultrasound treatment head. A gel is also applied to the skin to help with the treatment.

A physiotherapist applies the ultrasound therapy for short periods of time, usually between 10 and 20 minutes, depending on the size of area being treated. During this treatment you would feel the movement of the ultrasound head on your skin on the ultrasound gel but will not otherwise feel the ultrasound waves.

What's the evidence?

Although ultrasound therapy is used to treat acute pain in adults, there currently is no evidence that it benefits youth and young adults with persistent pain. Ultrasound is also not recommended for young teens if their bones are still growing, since ultrasound can cause problems when used over open growth plates in bones. Pregnant women cannot receive ultrasound over the abdomen, pelvis or back. In addition, ultrasound cannot be used over an area that has an infection.

Acupuncture is an ancient Chinese treatment now performed throughout many other parts of the world. It involves inserting very tiny needles into the body at specific points and has been used to treat many medical conditions, including pain.

Traditional acupuncture is based on the theory that energy flows through invisible channels within the body. Regulating the flow of this energy by inserting and manipulating tiny needles at over 400 specific acupuncture points is believed to restore the balance and flow of this energy, relieving pain. Modern acupuncture is based on direct needling of trigger points along with traditional acupuncture points.

Acupuncture may work by stimulating the release of endorphins. It should only be provided by a practitioner with specialized training and certification.

What's the evidence?

Acupuncture has been shown to be effective in treating fibromyalgia, musculoskeletal pain, post-operative pain and nausea. There are early reports that acupuncture can be effective in treating other painful conditions, but more studies are needed to confirm this. Some people feel some immediate pain relief, but most people, especially those with persistent pain, need multiple sessions to get some relief. For others, acupuncture may not work at all.

Laser therapy is the application of focused light over a painful body part to treat musculoskeletal injuries or problems. The laser is applied by a physiotherapist or occupational therapist with a small hand-held application wand. It is applied in a grid pattern through the skin in brief application periods. For example, the physiotherapist would hold the wand to your skin for 10 seconds, then move the wand to the next spot on the grid for 10 seconds until the entire area requiring treatment has been covered. The length of treatment depends on the size of the area being treated. During the treatment you feel the gentle touch of the application wand but otherwise would not feel the laser. You and the physiotherapist applying the laser must wear sunglasses during the treatment.

What's the evidence?

Although laser therapy has been shown to some benefit in localized pain conditions in adults (such as elbow pain, neck pain, osteoarthritis), there is currently not enough evidence to show that it works for persistent pain in young people.

Thermal modalities are treatments that use heat or cold. Applying superficial heat to the skin can increase blood flow, while applying superficial cold can decrease blood flow. They can be used to prepare your body for more active therapies, such as exercise, and also help your body to recover after exercise.

What's the evidence?

There is some evidence that applying heat or cold packs can provide some pain relief for a short time. Depending on your preference, you may find one type of pack – cold or hot – more soothing than another.

Massage therapy is a hands-on treatment that involves rubbing and kneading muscles and joints to relieve tension or pain. Massages for people with persistent pain should always be done by a registered massage therapist (RMT). Your RMT may also be able to teach you some self-massage techniques that you can use at home. For example, they may show you how to safely use a massage roller device to knead your muscles. It is also important to remember that, similar to other passive therapies, massage is most useful for helping people to relax their muscles so they can engage in gentle exercises and movement activities.

What's the evidence?

There is some research evidence to support the use of massage in young people with headaches, juvenile idiopathic arthritis and persistent pain. There is no evidence to show that massage provided by anyone other than a registered massage therapist can help with pain.

Joint mobilizations are passive stretches to your joints that your healthcare provider may do for you. This is a hands-on treatment where the healthcare provider will move your joints in patterns to increase your mobility. Joint manipulation is a similar technique, where your healthcare provider uses small manual thrusts on your joints to help increase your flexibility and reduce pain.

What's the evidence?

There is some evidence that joint mobilization or manipulation may help adults with persistent neck pain, low back pain, migraines, headaches and pain in their extremities (fingers and toes). Right now, there is not enough evidence to know whether these therapies are safe or effective in treating persistent pain in young people. In particular, manipulation of the neck (called “cervical manipulation”) can be very dangerous and has been associated with risk of stroke and even death in adults. There have not been any safety studies in adolescents and only limited studies in young adults. Given these risks, the decision to use cervical manipulations should be very carefully considered if you are a young adult (aged 18 and older). You should avoid cervical manipulation completely if you are an adolescent (17 and younger).