Physiotherapy vs. Painkillers: Which Is Better for Long-Term Pain Relief?

If you’ve been living with persistent pain, you may have wondered: 

“Should I keep taking painkillers, or should I try physiotherapy?”

The answer isn’t as simple as choosing one over the other. 

Painkillers can be useful for reducing symptoms, particularly during acute episodes. Physiotherapy, meanwhile, can help address movement, strength, physical capacity, and self-management. For some people, the best approach may involve a combination of treatments rather than choosing one exclusively. 

However, when the goal is long-term management of musculoskeletal pain, research increasingly supports active, non-drug approaches such as exercise and rehabilitation. Medication can have an important role, but its benefits and risks depend heavily on the type of medicine, the condition being treated, and how long it is used. 

Let’s look at what the research actually says.

First: What Do We Mean by “Painkillers”?

“Painkillers” covers a wide range of medications, and they are not all the same.

Common categories include:

• Paracetamol (acetaminophen)

• NSAIDs, such as ibuprofen or naproxen

• Opioids, such as codeine, tramadol, or morphine

• Other prescription medicines that may be used for specific types of persistent pain

These medications have different mechanisms, benefits, and risks.

Therefore, it would be misleading to say that “painkillers don’t work.”

Some medications can provide meaningful short-term pain relief.

The more important question is:

How useful are they for managing pain over the long term?

What Can Physiotherapy Do?

Physiotherapy is more than massage or stretching.

Depending on your condition, it may include:

• Strength training

• Aerobic exercise

• Mobility exercises

• Balance training

• Education

• Activity modification

• Graded return to activity

• Manual therapy

• Functional rehabilitation

• Advice about managing symptoms independently

The aim is often not simply to make pain disappear temporarily.

Instead, physiotherapy can help you improve physical capacity and function while developing strategies to manage your condition over time.

For chronic low back pain, for example, the World Health Organisation recommends education, exercise programmes, some physical therapies, and psychological approaches as part of a holistic, person-centred approach. It also recommends against routine use of opioid analgesics because of the potential for serious harms such as dependence and overdose (WHO, 2023).

Physiotherapy vs. Painkillers: Which Provides Better Long-Term Relief?

There isn’t one answer for every condition.

But when we look specifically at long-term musculoskeletal pain, there is an important difference between the two approaches.

Painkillers primarily aim to reduce the sensation of pain.

Physiotherapy aims to help you improve your physical function and manage the factors contributing to disability, often through exercise and education.

That distinction matters.

For example, taking an analgesic might make your knee hurt less today. A strengthening programme may take longer to produce noticeable changes, but it can help improve your ability to walk, climb stairs, exercise, and perform daily activities.

What Does the Research Say About Exercise?

There is substantial evidence supporting exercise for chronic musculoskeletal pain.

A systematic review and meta-analysis of 38 trials found moderate-certainty evidence that exercise therapy can reduce movement-related pain in people with musculoskeletal pain (Geneen et al., 2022).

Exercise can also improve:

• Strength

• Mobility

• Physical capacity

• Confidence with movement

• Function

This doesn’t mean that exercise works equally well for every condition or every person.

But it does mean that active rehabilitation has an important place in long-term pain management.

What About Knee Osteoarthritis?

Knee osteoarthritis is a useful example because researchers have directly compared exercise therapy with medication.

A systematic review and network meta-analysis compared exercise therapy, NSAIDs, and opioids for knee osteoarthritis pain.

Exercise therapy ranked highest, followed by NSAIDs and opioids. However, the researchers emphasised that differences between treatments were small and probably not clinically important, and the overall confidence in the ranking was low (Kong et al., 2022).

So the study shouldn’t be interpreted as:

“Exercise is always better than medication.”

Instead, it suggests that exercise therapy is a credible evidence-based treatment option that can provide pain relief without exposing patients to the medication-related risks associated with analgesics.

What About Anti-Inflammatory Painkillers?

NSAIDs — including medicines such as ibuprofen and naproxen — can be effective for some painful musculoskeletal conditions.

However, their usefulness depends on the condition and the individual.

A systematic review prepared for the American College of Physicians found that NSAIDs provided small benefits for chronic low back pain, while other medications showed varying degrees of effectiveness (Chou et al., 2017).

NSAIDs can also have potential adverse effects, particularly with prolonged or inappropriate use.

This is why medication should be chosen based on your individual circumstances, including other medicines you take and any relevant health conditions.

What About Opioid Painkillers?

This is where the evidence becomes particularly important.

Opioids can provide pain relief, and they may have a role in carefully selected circumstances.

But their long-term use for chronic musculoskeletal pain is controversial because of the potential for:

• Dependence

• Tolerance

• Overdose

• Sedation

• Constipation

• Other adverse effects

A systematic review of long-term opioid therapy found insufficient evidence to determine whether opioids improve long-term pain and function, while observational evidence suggested increased risks of overdose, opioid misuse, fractures, and other harms (Chou et al., 2015).

More recent research has reached similar conclusions about the limitations of long-term evidence. A 2026 systematic review and meta-analysis found that opioids may provide meaningful pain relief over short periods, but found little or no benefit beyond placebo over longer periods in the studies included (Busse et al., 2026).

This is one reason major guidelines have moved away from routinely recommending opioids for chronic musculoskeletal pain.

What Does the World Health Organisation Recommend?

The World Health Organisation’s 2023 guideline for chronic primary low back pain recommends a holistic and person-centred approach.

Recommended interventions include:

• Education

• Exercise programmes

• Some physical therapies

• Psychological therapies

• Certain medicines, including NSAIDs when appropriate

The guideline specifically recommends against routine use of opioid analgesics for chronic primary low back pain because potential harms can outweigh benefits (WHO, 2023).

The WHO also emphasises that people with persistent low back pain may need a combination of interventions, rather than relying on a single treatment in isolation.

Does Physiotherapy Work Immediately?

This is one area where medication may have an advantage.

Some painkillers can reduce pain relatively quickly.

Physiotherapy often requires more patience.

For example, you might not notice major improvements in strength after one exercise session.

Instead, rehabilitation often works through progressive adaptation:

Exercise → recovery → adaptation → increased capacity → greater activity

Over weeks and months, this can translate into improvements in function and symptoms.

This is why physiotherapy shouldn’t necessarily be judged after one appointment.

But Pain Relief Isn’t the Only Goal

Imagine two people with knee pain.

Person A

Takes medication and experiences temporary pain relief but remains weak and avoids stairs.

Person B

Uses appropriate medication when necessary while following a progressive strengthening programme, gradually increasing walking and improving confidence with movement.

Both may experience pain relief.

But Person B is also working on physical capacity and function.

This illustrates why long-term pain management often needs to look beyond the pain score itself.

A successful rehabilitation programme may aim to help you:

• Walk further

• Lift more

• Sleep better

• Return to work

• Exercise

• Play sport

• Manage stairs

• Perform daily activities

• Feel more confident moving

Does Physiotherapy Mean You Should Stop Taking Painkillers?

No.

This is an important distinction.

You should not suddenly stop prescribed medication without speaking to the healthcare professional who prescribed it.

Physiotherapy and medication aren’t necessarily competing treatments.

In some situations, medication may help control symptoms sufficiently for you to participate in rehabilitation.

For example, someone with significant pain may find it easier to exercise when symptoms are appropriately managed.

The goal is to use each treatment for what it can offer while regularly reviewing whether it is still necessary.

Can Painkillers Help You Do Physiotherapy?

Sometimes.

If pain is preventing you from moving or exercising, appropriate symptom management may allow you to participate more comfortably in rehabilitation.

However, medication shouldn’t necessarily be used to mask symptoms so you can repeatedly overload an injured area.

Your physiotherapist can help you understand how to modify activity and progress exercise safely.

What About “Pushing Through the Pain”?

Physiotherapy doesn’t mean:

“No pain, no gain.”

In fact, rehabilitation should be individualised.

A 2025 systematic review comparing painful and non-painful exercise in adults with chronic musculoskeletal pain found no clear difference in pain or disability outcomes between the approaches. However, the researchers rated the certainty of evidence as low to very low (Tran et al., 2025).

The message isn’t that you should deliberately exercise through severe pain.

Instead:

Some discomfort during rehabilitation doesn’t automatically mean you’re causing damage.

But significant or persistent worsening should be discussed with your physiotherapist or healthcare professional.

The Biggest Difference: Passive vs. Active Care

One way to think about the difference is:

Painkillers

Primarily provide symptom relief.

Physiotherapy

Can help develop physical capacity, movement, function, and self-management skills.

Neither description means one treatment is automatically better for everyone.

However, for many chronic musculoskeletal conditions, guidelines increasingly emphasise active rehabilitation rather than relying solely on passive symptom control.

The American College of Physicians, for example, recommends non-drug treatments such as exercise as initial options for chronic low back pain and recommends considering medication when non-pharmacological treatment has not provided an adequate response (Qaseem et al., 2017).

What About Chronic Low Back Pain?

Low back pain is one of the clearest examples of where active rehabilitation can play an important role.

The WHO recommends exercise programmes and education as part of care for chronic primary low back pain and recommends avoiding routine opioid use.

This doesn’t mean every person with back pain needs physiotherapy.

Some people improve with self-management and physical activity.

Others may benefit from professional guidance, particularly if pain is persistent, function is significantly affected, or they are unsure how to exercise safely.

What Should You Choose?

Instead of asking:

“Physiotherapy or painkillers?”

consider asking:

“What combination of treatments is appropriate for my condition?”

Your treatment plan may include:

Education + Exercise + Physiotherapy + Activity Modification + Appropriate Medication

For some people, medication may be unnecessary.

For others, it may be useful as part of a broader treatment plan.

The answer depends on:

• The cause of your pain

• How long you’ve had it

• Severity

• Your medical history

• Other medications

• Your goals

• Your response to treatment

When Should You See a Physiotherapist?

Physiotherapy may be worth considering if pain is:

• Limiting your movement

• Preventing exercise

• Affecting work

• Affecting sleep

• Returning repeatedly

• Making everyday activities difficult

• Affecting your confidence with movement

• Persisting despite self-management

A physiotherapist can assess your movement and physical capacity and develop an appropriate rehabilitation plan.

When Should You Speak to Your Doctor About Medication?

Medication decisions should be individualised.

Speak to a doctor or pharmacist if you’re unsure:

• Which painkiller is appropriate

• How long you should take it

• Whether it interacts with another medicine

• Whether you have health conditions that affect its safety

• Whether you should continue a prescribed medication

If you’re taking opioids or another prescription medicine regularly, don’t stop suddenly without professional advice.

The Best Long-Term Strategy May Not Be One Treatment

Persistent pain is often complicated.

It may involve physical, psychological, behavioural, and social factors.

That’s why a single treatment isn’t always enough.

The WHO specifically recommends a holistic, person-centred approach to chronic primary low back pain and notes that a combination of interventions may be necessary (WHO, 2023).

For one person, that might mean:

Physiotherapy + exercise + education

For another:

Exercise + medication + psychological support

And for someone else:

Self-management + gradual activity progression

The treatment should fit the person — not the other way around.

So, Which Is Better for Long-Term Pain Relief?

Physiotherapy may be particularly useful when you want to:

• Improve strength

• Increase mobility

• Restore function

• Return to activity

• Build physical capacity

• Learn how to manage your condition

• Reduce fear of movement

• Develop long-term self-management strategies

Painkillers may be useful when you need:

• Short-term symptom relief

• Help managing an acute painful episode

• Medication as part of a broader treatment plan

For chronic pain:

Evidence generally supports active, non-pharmacological approaches as an important foundation of management, while long-term opioid use has limited evidence of benefit and potentially significant risks (WHO, 2023; Chou et al., 2015).

Final Thoughts

The question isn’t necessarily:

“Physiotherapy or painkillers — which one wins?”

A better question is:

“What will help me manage my pain and improve my life over the long term?”

Painkillers can have an important role, particularly for short-term symptom control. But for many chronic musculoskeletal conditions, medication alone doesn’t address the physical limitations, reduced strength, movement difficulties, or loss of confidence that can accompany persistent pain.

Physiotherapy and exercise can help address these areas.

Research suggests that exercise can reduce pain and improve function, while evidence for long-term opioid treatment is much less certain and comes with important safety considerations (Geneen et al., 2022; Chou et al., 2015).

Ultimately, the best treatment isn’t necessarily the one that makes your pain disappear fastest — it’s the approach that helps you safely regain function and manage your condition sustainably.

And in many cases, that means combining appropriate medical treatment with movement, rehabilitation, education, and self-management.

References:

Busse, J. W., et al. (2026). Impact of treatment duration on the effectiveness of opioid analgesia: A systematic review and meta-analysis. [Journal details pending publication indexing].

Chou, R., Turner, J. A., Devine, E. B., Hansen, R. N., Sullivan, S. D., Blazina, I., Dana, T., Bougatsos, C., & Deyo, R. A. (2015). The effectiveness and risks of long-term opioid therapy for chronic pain: A systematic review for a National Institutes of Health Pathways to Prevention Workshop. Annals of Internal Medicine, 162(4), 276–286. https://doi.org/10.7326/M14-2559

Access Options.

Chou, R., Hartung, D., Turner, J., Blazina, I., Chan, B., Fu, R., & Gordon, D. (2017). Opioid treatments for chronic pain. Comparative Effectiveness Review №229. Agency for Healthcare Research and Quality.

Geneen, L. J., Moore, R. A., Clarke, C., Martin, D., Colvin, L. A., & Smith, B. H. (2022). It hurts to move! Intervention effects and assessment methods for movement-evoked pain in patients with musculoskeletal pain: A systematic review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 52(6), 345–374.

Kong, L. J., et al. (2022). Similar effects of exercise therapy, nonsteroidal anti-inflammatory drugs, and opioids for knee osteoarthritis pain: A systematic review with network meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 52(4), 207–216. https://doi.org/10.2519/jospt.2022.10490

Download PDF.

Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166(7), 514–530.

Tran, I., Gibbs, M. T., Yu, N., Powell, J. K., Smith, B. E., & Jones, M. D. (2025). Effectiveness of painful versus nonpainful exercise on pain intensity, disability, and other patient-reported outcomes in adults with chronic musculoskeletal pain: An updated systematic review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 55(8), 1–11. https://doi.org/10.2519/jospt.2025.13253

Download PDF.

World Health Organization. (2023). WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. World Health Organisation.