For decades, opioid painkillers were the go-to option for physicians treating pain, but now many pain experts are pointing to lifestyle changes to reduce chronic pain. According to a report broadcast by National Public Radio, lifestyle changes such as increased exercise and yoga may be equally effective in some patients, if not more effective, when compared to opioid medications for pain relief.

Approximately one-third of Americans are currently living with chronic pain, with many using opioids as a means of relief.

However, chronic pain patients have been expressing greater distress after state and federal governments began cracking down on opioid prescriptions. One patient, Ken Adams, says he canceled two surgeries in 2017 after hospital staff refused to give him an IV of hydromorphone after a hip replacement surgery.

For better or worse, his story is typical of pain patients with legitimate needs for painkillers.

While studies have yet to be done on the effectiveness of opioids versus other pain treatment methods directly after surgery, pain specialists say that lifestyle changes may be a more effective way to treat long-term chronic pain.

“It’s important to remember that the main treatments that are recommended for these pain conditions are not medication treatments,” said Dr. Erin Krebs, a primary care physician at the Minneapolis VA Health Care Systems.

Krebs recently published a study analyzing the effects of opioids versus non-opioid pain medications on those suffering from chronic back pain and arthritis.

Krebs found that opioids may actually be less effective at treating chronic pain because patients gradually develop a tolerance to opioid medications, but not non-opioids. It’s this tolerance, as well as developed substance use disorder, that drives patients to opiates such as heroin. In fact, four out of every five new heroin users first began misusing their prescription painkillers.

The gold standard for chronic pain treatment, Krebs said, is a combination of treatments such as exercise, yoga, cognitive behavioral therapy, and rehabilitation therapy. However, prior to the CDC’s crackdown on opioids, many doctors had been prescribing opioids liberally.

Kim Brown was one patient prescribed with opioid medications for a slipped disc in her back. Eventually, Brown says, she was taking up to four different medications including morphine, Percocet, Vicodin, and Dilaudid because she was still in pain.

Brown had been on the medications since 2010 before she met Dr. Dennis McManus, a neurologist specializing in pain management. In the U.S., there are approximately 19 million healthcare workers. For Brown, it took around half a dozen health care workers at McManus’ clinic in Illinois to help her learn how to cope and prevent pain.

In 12 weeks, Brown was treated with occupational physical therapy, nutrition counseling, and massage. Up to 92% of massage patients agree that massage is effective in reducing pain. Those in McManus’ program also participate in cognitive behavioral therapy to help them treat their fears over getting off of their opioid medications.

A multidisciplinary approach to pain management was originally the go-treatment for chronic pain until the 1980s when reimbursement rates went down.

Opioid treatment soon became the predominant pain treatment strategy, especially after the publication of a study by Dr. Hershel Jick wrongfully claimed opioid addiction was rare.

Unfortunately, pain treatment programs like the one Brown went through can cost thousands of dollars because they’re not often covered by insurance.

Steven Kamper, a public health researcher at the University of Sydney, says the high price is still worth it compared to the costs of opioid medications over time. The opioid epidemic is costing the U.S. alone more than $500 billion a year.

“If you compare a fairly intensive multidisciplinary program to surgery and to drugs,” said Kamper, “the cost is not high.”