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One in five adults suffers from chronic pain, and if you’re 65 or older, you may be even more likely to experience ongoing pain lasting three months or longer. Not only does chronic pain significantly impact quality of life, it is linked to depression, anxiety, and post-traumatic stress disorder.

Many older adults chalk up chronic pain from conditions like arthritis, low back problems, and nerve or joint deterioration as an inevitable part of aging. And while some pain may become more frequent as we age, it doesn’t mean we have to accept it as unavoidable or rely only on medications to help. About 15% of adults 65 and older regularly use pain relievers; however, these drugs can cause serious side effects, interact with other medications, or create dependency. Both the National Center for Complementary and Integrative Health (NCCIH) and the American College of Physicians (ACP) recommend noninvasive, non-drug approaches like acupuncture, massage, meditation, and tai chi as the first step in treating many painful conditions.

But do these options really work? Clinical evidence varies, depending on the intervention and the condition. Not every approach works for every person, although many find they no longer need pain medication, and others are able to cut back on the quantity of pain relievers.

“My own mother has struggled with low back pain for many years,” says Dr. Christine Goertz, a chiropractor who researches low back pain at Duke University. After regular visits to the YMCA for swimming, “everything changed for her,” Goertz says. The back pain was entirely manageable with ice, heat, and exercise—and no drugs.

Classes or group activities provide another benefit: They reduce social isolation among older people. Chronic pain can lead to isolation, which may then lead to more chronic pain. This ends up being a real cycle that is important to interrupt, according to Goertz.

Treatment alternatives for chronic pain sufferers

There are many different alternative and complementary therapies that may help you manage chronic pain. The National Institute on Aging says some of the well-researched, evidence-based options include:

Acupuncture uses hair-thin needles to stimulate specific points on the body to relieve pain. It’s been found helpful for lower back and neck pain as well as osteoarthritis, and may be helpful for cancer pain. It can also relieve joint pain from certain breast cancer treatments.

Biofeedback helps you learn to control your heart rate, blood pressure, muscle tension, and other body functions. This may help reduce your pain and stress level.

Cognitive behavioral therapy, or CBT, may help reduce reaction to pain. CBT helps a person adjust negative emotions, like stress and anxiety; modify thinking patterns and behaviors; and reduce muscle tension and nervous system sensitivity. This leads to coping better with pain, say experts from the University of California, San Francisco.

Electrical nerve stimulation, sometimes called TENS, uses low-voltage electrical impulses to relieve pain. A battery-powered device delivers brief electrical bursts through electrodes placed near pain “trigger points” on your skin. Researchers think TENS may stimulate nerve cells that block pain transmission, or increase endorphins, the body’s natural painkiller, which reduces the feeling of pain.

Guided imagery uses directed thoughts to create mental pictures that may help you relax, manage anxiety, sleep better, and have less pain. It can help people with arthritis, cancer, Parkinson’s disease, and pain from fractures, as well as reduce stress, improve overall functioning, and decrease the need for anti-inflammatory drugs.

Hypnosis uses focused attention, relaxation, imagery, and suggestion to help manage pain. Research shows it can help reduce chronic pain, although results vary from person to person.

Massage therapy can release tension in tight muscles. It has a temporary beneficial effect for many conditions, including low back pain, neck pain, cancer-related pain, according to the National Institutes of Health.

Mind-body stress reduction combines mindfulness meditation, body awareness, and yoga to increase relaxation and reduce pain. These approaches can help improve activity and reduce pain, according to the NCCIH.

Physical therapy uses a variety of techniques to help manage everyday activities with less pain and teaches you ways to improve flexibility and strength. It can help with many different conditions, including low back and neck pain and osteoarthritis.

Spinal manipulation practitioners, usually chiropractors, use their hands or a device to apply a controlled thrust to a joint of your spine. The technique moves the joint more than it would on its own, according to the NCCIH. It can be moderately effective for neck pain; some evidence points to this as a remedy for lower back pain.

Tai Chi is a low-impact, slow-motion exercise that originated in China as a martial art. The practice includes deep, natural breathing and focusing attention on your body’s sensations. It can benefit those with lower back pain as well as pain from knee or hip osteoarthritis.

Tai chi is one of the hundreds of forms of qigong (“chi gong”) exercises that help optimize energy within the body, mind, and spirit to improve and maintain well-being. Qigong can be helpful for some people with fibromyalgia, Parkinson’s disease, chronic heart disease, and high blood pressure. It may also help improve depression, balance, and ability to do daily activities.

Yoga is an ancient Indian practice that can help promote mental and physical wellness. In the U.S. yoga generally incorporates physical movements, breathing techniques, and meditation. There are various types of yoga practices, but generally it’s beneficial for certain types of low back pain, osteoarthritis, and rheumatoid arthritis.

Low back pain is a major problem for many

About 80% of adults experience low back pain in their lifetime, says Goertz. Those 50 and older are at greater risk of lower back pain from ongoing wear and tear of discs, joints, and other structures in the spine, as well as muscle strain. It’s one of the major disabling health conditions among older adults over 60.

Often people with low back pain are afraid to move, but this can lead to more pain and less improvement, Goertz says. Exercise will help: “You’re not going to make yourself worse.” However, if you’re considering an exercise or other complementary program, you should speak with your health provider first, to make sure there’s no underlying issue.”

Many insurers, including Medicare, now cover alternative therapies on a limited basis, and certain Medicare supplemental plans may even pay for gym memberships. There are also many free or low-cost options available online, or at local senior centers or the local Y.

Chronic pain doesn’t have to be an inescapable part of aging. When done correctly and under supervision of an experienced practitioner, many of these complementary, noninvasive options may work wonders to make you feel better. Before trying any therapy, exercise, or practice, experts recommend consulting your health care provider.