Patients rated massage and opioids as their most helpful chronic pain treatments

The most tried chronic pain treatments in a new retrospective review weren't the ones patients rated most helpful. The rankings the 226 patients built for themselves, from inside their own weeks and their own bodies, are worth reading closely.

What the review actually found

A retrospective review published on 17 August in Pain Management pulled intake questionnaires from 226 adults evaluated at Indiana University Health's multidisciplinary pain clinic between January 2023 and March 2024 (Naimi Shirazi et al., 2026). Mean age was 45. About 4 in 5 were women. Each person rated 56 different treatments they had tried, marking each as helpful, unhelpful, or not sure.

The treatments patients had tried most often were not the ones they rated most helpful. Acetaminophen had been tried by 90 percent of the sample, ibuprofen by 83 percent. Fewer than half of the people who had tried either found it useful. Physical therapy had been tried by 88 percent, and 62 percent of those who tried it rated it helpful, a much better return on the same near universal exposure.

The top of the helpfulness list ran a mix that most guidelines would not put in the same paragraph. Massage therapy came first at 77 percent helpful. Oxycodone came second at 74 percent. Psychotherapy came third at 67. Then hydromorphone at 67, physical therapy at 62, aquatic therapy at 62, hydrocodone at 61. Four movement or manual modalities and three opioids, sharing the top of the list.

The co presence of those two groups is what actually matters. The authors are careful in the paper, and I want to be careful here too: this is patient rated helpfulness in a group, not efficacy in a controlled trial, and it does not tell us who inside the group tried what alongside what else. What it does tell us is that a cohort of chronic pain patients ranked both massage and oxycodone highly. That is a group of people telling us nothing in their current toolkit is doing the job alone.

What the headline would miss

A quick read of this paper turns into "patients love massage, not pills." That is not what the numbers show. The same cohort of patients ranked both massage and oxycodone highly, and many were leaning on more than one kind of help to get through a week. What is worth sitting with is not that gentle and manual work rank well. What is worth sitting with is that they rank right next to pharmaceutical management, in the same population, and that patients are the ones drawing the map.

The other quiet thing in the data is the sample itself. This was a multidisciplinary pain clinic; people arrived there having already tried multiple approaches, not one. When patients get to try many things over a long stretch, the ones that keep helping quietly, session after session, without fanfare, are the ones that end up on the helpful list. When they only get access to one or two, the numbers reflect what was available, not what actually fits.

What I see in clients

Almost every person who comes to me as a Guild Certified Feldenkrais Practitioner has already tried a physiotherapist, a chiropractor, a massage therapist, sometimes several of each. Most are on a medication or have been. Nobody arrives at gentle attention based movement first. And that's the honest place gentle work belongs. Not first, not last, somewhere in the middle of a real person's real assembly of tools.

Last month I sat with a woman in her late sixties who has been in pain since 2019, and when I asked her what actually helped in her week, she named a weekly swim, an hour with her physiotherapist, an evening walk with her husband, and a medication she takes on the days her body tips a certain way; nothing on that list was the one thing her plan had put at the top.

When someone comes to me with two or three years of trial and error behind them, having cycled through a medication that helped and then quietly stopped helping, physiotherapy that eased things some months and not others, a massage practice they could only afford twice a month, they aren't asking me to fix the problem. They're asking whether adding one more attentive thing to their week can make the whole assembly a little steadier. It's a fair question, and in my experience gentle movement is often a fair thing to put in.

The Feldenkrais Method® works on how the nervous system organizes movement, so a body that has been guarded around pain can start moving with less bracing. It sits alongside physiotherapy and massage, not in place of them, and it works on a different layer than the manual therapies do. Compared with other movement methods, yoga, Pilates, tai chi, Alexander Technique, it is a different mechanism, each with its own strengths. When a person is already using several modalities, adding a small daily practice of noticing tends to change how the other modalities land. That is what the Feldy online movement program is built to do, at home, on days when nothing else is scheduled.

The practical read

If you're managing chronic pain, one honest thing this paper says is worth carrying: the fact that a treatment is prescribed most doesn't mean it will help you most. Your own record of what has and has not helped is real data. Bring it to your appointments. And the second read: if manual and gentle movement work are already on your helpful list, keep them there; the list is yours. The absence of a movement modality from a treatment plan is not neutral. It may be a missing tool worth asking about.