Frequently Asked Questions.

Here are some of the most common questions about the Organization for Pain Free Living (OPFL) and our programs.

Please note that the information about pain on this page is provided for educational purposes only and is not medical advice. If you are experiencing severe pain and require medical advice, please see a licensed physician.

If you don’t find the information you need here, or you have general questions about OPFL or pain therapy, please use the Ask an Expert form to send us your questions and we will reply directly to you as quickly as possible.



Is OPFL a nonprofit organization? Is my donation tax-deductible?

Yes, as part of the HPL 501c3 Institute, all of the donations you make to support OPFL are tax-deductible as they are being made to a nonprofit organization. The HPL 501c3 Institute is recognized as tax-exempt under section 501(c)(3) of the Internal Revenue Code.

Will I receive a receipt for my donation?

Yes, for each one-time donation you will receive an official printed acknowledgement/tax receipt via postal mail approximately 1–2 weeks from the date of your gift (for an online donation you will receive both an email confirmation and an official printed acknowledgement/tax receipt).

What percentage of a donation goes to program activities?

OPFL and the HPL Consortium strive to operate efficiently and to minimize administrative costs. Since its inception in 2014, OPFL allocated more than 90% of its expenditures to its program activities. Furthermore, currently all of the staff of OPFL are volunteers and so no salaries are being paid, making OPFL one of the most efficient non-profits that you can invest in. More information about the HPL Consortium can be found here.

How will my donation be used?

Your donation directly supports both chronic pain research and the free courses that we offer to chronic pain patients. Our immediate goal is to get the SET chronic pain treatment that has been so successful in Germany both in a US clinical trial and through the FDA process.

Does OPFL sell, rent or trade donor information?

No! OPFL and the HPL Institute value your support, and we are committed to protecting your privacy. We will not sell or release your data for commercial use, or for any use that is not directly linked to our programs or to the use for which you have submitted the data. You can read more about our privacy policy here.

Managing Pain

How does pain affect my body?

Pain comes in two very different types: acute and chronic.

  • Acute Pain: Acute pain is the body’s way of responding to a wide range of physical dangers. Say you touch a hot stove. When you do this, your pain receptors (nociceptors) will detect a dangerous situation and relay that information to your brain — you pull your hand, before you even think about it. So, you remove your hand before it badly burns. While the pain may hurt, your reaction is an important protective device.
  • Chronic Pain: Chronic pain does not function in the same way as acute pain. When you experience pain for an extended period of time, your nociceptors overload and are more sensitive to pain signals. They fire off at lower levels, making you feel more pain than what actually exists. So, while your body may not be in danger, your pain receptors continue overreacting. The reason for the overreaction is multi-fold. There are structural (neuronal and the cells surrounding the neurons) changes in three different highly complex networks: the periphery, the spinal cord (dorsal root ganglia), and in the brain. Chronic pain is effected by cognitions, emotions, behaviors, the amount of movement or exercise, the personal and environmental rewards structure around you and many other factors. Physically, pain patients fall into heterogeneous subgroups. In many, but not all, pain is both due to and enhanced by stress.  Also the autonomic nervous system, which can be measured by the baroreceptor sensitivity is diminished in chronic pain patients. On the other hand, the pain that you feel is real. FMRI studies show a strong correlation between the pain that you feel and the pain that shows up in brain scans.
What should I do if my pain worsens?

After dealing with chronic pain, worrying about your pain returning if you don’t take opiates is completely understandable. Treatments can dramatically reduce your pain without medication, such as OBT (Operant Behavioral therapy), CBT (cognitive behavioral therapy), physical therapy, electrical stimulation, and stress reduction techniques. In our experience, many of these options can prove very helpful to patients once they detox completely and their body no longer craves narcotics.

Why haven't I been given a diagnosis?

Traditionally, pain was seen as a symptom of a disease or condition, and although chronic pain can be associated with conditions such as arthritis, sciatica or low back pain, in many cases no specific ongoing injury or disease can be found as a cause.

The intensity of chronic pain often reflects a problem with the body’s pain system itself rather than damage in a particular part of the body.

Don't I need more tests, isn't pain a signal of damage to the body?

Not necessarily. The intensity of chronic pain often reflects a problem with the pain system itself rather than damage in a particular part of the body.

Even when there is an underlying painful condition, the level of pain you feel may be out of proportion to any damage or continuing harm to the body. This is what can make living with chronic pain so difficult. It can be a challenge to understand why there is so much ongoing pain and discomfort, which isn’t serving a useful purpose and yet doesn’t seem to be able to be relieved.

What can I do about pain?

Learn what good and bad behaviors are. Focus on good behaviors and healthy relationships. Reduce stress and do moderate exercise. Know that chronic pain patients come in subgroups, what works for one person, will not work for others. Study and implement the suggestions in the pain course on this site. Work hard, take your time, relax, don’t beat yourself up, and keep at it. Rome was not made in a day.

There are a number of healthcare professionals who can provide help and support, but like any long-term complex condition, chronic pain requires self-management. Learning the proper behaviors skills and incorporating them into your daily life is important.

It is unlikely that any pain relievers will be able to completely stop the pain, a multimodal or multidisciplinary approach has been shown to be more effective for chronic pain than medicine, although depending upon your condition medication may have a role in your treatment.

How do I talk to my doctor?

For many people with chronic pain, having a sense of collaboration and trust with their healthcare providers is important. An open dialogue can create the basis for common understanding of treatment goals and challenges. On the other hand visits to many doctors or constant visits to one doctor may be a pain behavior and increase your pain.

The more you tell your healthcare providers about your personal situation and what strategies you have tried to manage pain, the better. This can help them tailor a plan with you to suit your individual needs.**

Who can help me deal with my pain?

There are a number of healthcare professionals who can provide help and support. Chronic pain management needs to cover a number of different aspects of life and these can be covered in a multimodal or multidisciplinary plan. Talk to your healthcare provider about developing a multidisciplinary plan that suits your needs.

However, like any long-term condition, chronic pain requires self-management. Learning good behaviors and incorporating them into your daily life is important. People who are actively engaged in self-management techniques report lower levels of pain-related disability, improvements in mood, better general health and reduced use of health services and medicine.

What is a biopsychosocial approach?

Because there are many factors that affect chronic pain, management needs to cover a number of different aspects of life too. This is called multimodal or multidisciplinary pain management and it looks at:

  • Biological aspects – such as your physical fitness, activity, heart rate, blood pressure, baroreceptor sensitivity and muscle tension.
  • Psychological aspects – including your understanding of pain and how you think about it, as well as mood and emotional factors which may be related to stress, anxiety or depression. Medication use and attitude are also important components.
  • Social or environmental aspects – such as work, social activities, relationships, partner, and family issues. Are you being rewarded for bad pain behaviors?

There is a lot of research evidence to show that people with chronic pain who are actively involved in this type of approach have less disability than those who rely on more passive therapies, such as taking medication or surgery.**

Why has a psychologist been recommended to help me manage my pain?

Your doctor may refer you to a psychologist to try techniques such as operant behavioral therapy, cognitive behavior therapy, electrical stimulation, or other therapies to help retrain your brain.

It is thought that in people experiencing chronic pain the messaging system in the nerves, spinal cord and brain becomes overly sensitive. This magnifies the messages from the nerves even when there is no active damaging stimulus. When these nerve messages reach the brain it thinks there is harm and reacts by feeling pain – even when there is no injury. These thoughts are enhanced by fear (Oh now here comes my migraine), partner solicitous behavior, stress, pain behaviors such as limping or sitting differently, avoiding movement, catastrophizing or similar behaviors.

The brain, body, and the mind are integrally connected. You cannot change one without changing the other two. The brain is a physical organ made up of billions of nerves. The brain has billions of connections in very complex networks that control your whole body. Most of the processes are automatic and can’t be controlled by direct thought. However, what you think and feel can have a big influence on all this complex activity without you even being aware of it.

It can be hard to have control over our feelings and emotions. You can’t just decide you are not going to let pain make you angry or depressed. However, psychological techniques can be used to help train you to counter unhelpful thoughts and change your behaviors. This can have a positive influence on the pain we feel and how we are able to function.

Will my pain get worse if I am very active?

When you have constant pain it seems natural to avoid doing things like walking, bending and moving around as they can make the feeling of pain worse. However, our bodies are designed to move. When we decrease activity, we lose muscle strength – over time this means that even simple daily activities can become more difficult. Many people with pain fear exercise as they think it will cause more problems. However, regular stretching and exercise can actually decrease pain and increase your ability to function physically.

It is important to remember that chronic pain is not necessarily associated with ongoing damage to your body. This means that hurt doesn’t necessarily equal harm, and if no ongoing cause for the pain is found, you can slowly increase your physical activity despite a certain level of pain. This gradual approach to activity is called pacing.

On the other hand, if you find yourself running marathons to avoid pain, the activity itself can be a pain behavior and maybe relaxation is a better approach.

Should I wait for my pain to go away before I go back to activities I used to do?

Starting to exercise and learning new coping skills are important strategies to help improve your ability to function and reduce the impact of the pain. It is important not to wait for the pain to be completely gone before starting normal activities, including work.

Can chronic pain be treated without medicine?

While people with chronic pain often take some kind of medication, typically it provides limited relief. Chronic pain is a complex condition and different things are needed.

To help with self-management, it can be useful to develop your own pain management plan with your doctor or other pain professional. This plan could include setting step-by-step achievable goals to give you something to aim for.

  • Goals should cover different aspects of your life:
    • Behavioral goals
    • Physical goals – based on duration and difficulty of a set of exercises.
    • Functional/task goals – focused on the achievement of everyday tasks such as housework, hobbies or work.
    • Social and emotional goals – covering relationships, family life and work.
  • Examples of topics that could be covered in your personal plan:
    • Exercise
    • Activity management (e.g, doing tasks at a steady manageable pace)
    • Cognitive therapy to help you think more positively about what you can do
    • Behavioral management (e.g, relaxation techniques, good and bad behaviors)
    • Medicine management
    • Partner behavior
What if my medicines aren't working?

It is unlikely that any pain relievers will take away chronic pain.  A multidisciplinary approach has been shown to be more effective for chronic pain management than relying on analgesic medications alone.

Why do opiates (narcotics) make Chronic Pain worse?

When you first begin taking opiates, they provide pain relief, energy, a sense of well-being and even euphoria. They achieve these results by attaching to your brain’s endorphin receptors. Unfortunately, after you take narcotics for an extended time, your brain reduces the amount of endorphins it produces and increases the amount of receptors, thus decreasing your body’s natural painkillers.

Without natural endorphins, you have to take the opiate painkillers just to avoid withdrawal and feel normal. You need higher doses or stronger medication to feel the same effect.

To make matters worse, the opiates confuse your brain’s pathways. So, you have a reduced ability to decipher which pain needs attention to protect you and which you can ignore. Ultimately, the same medicine you take to avoid withdrawal symptoms steadily makes your pain worse — creating a cyclical relationship.

How will stopping opiate use improve my pain?

When you stop taking opiates, your brain and body can return to a normal state. Your body will begin producing its own endorphins again, and you can expect:

  • Less intense pain
  • Less frequent pain
  • No more opiate side effects
  • No more withdrawal symptoms

This process can take months to complete, but our patients almost always report that they have less pain within a few weeks of completing their detox. It is very helpful if you combine this with a reduction in pain behaviors and reduce stress.

What is the best way to detox from opiates?

We believe an outpatient Accelerated Opiate Detoxification (AOD) method is the safest, most convenient way to detox from opiates. Rather than spending several months tapering your dosages — and experiencing uncomfortable withdrawal symptoms the whole time — AOD helps you comfortably detox in as little as three days. With this approach, we have a 98% detox completion rate.

Why use Naltrexone or other opiate receptor antagonists?

Naltrexone is a non-addictive medication that binds to your brain’s opiate receptors, reducing any cravings you may experience after detox. From our experience, patients who use Naltrexone or similar medication recover more easily and permanently from their opiate dependency and chronic pain.

Will opioids help my chronic pain?

Opioid analgesics (eg, codeine, endone, morphine) are commonly used to treat severe acute pain or cancer pain. However they are often not very effective in chronic pain that is not cancer related.

There is growing evidence for the harms associated with long-term opioid use.**

If your and your doctor decide a trial of opioids is appropriate, you may be asked to agree an opioid treatment plan (contract). It is important that understand that treatment with opioids may not be helpful and may be stopped.**

Why is my doctor suggesting an opioid contract?

If opioids are being considered as an option to help with the management of your chronic pain, an initial short-term trial of opioid medication will be needed to determine whether it will benefit you. To plan and undertake such a trial, you will need to work in partnership with your doctor to set clear functional goals, and assess whether over time you reach these goals. This will help determine whether the benefits of the medication outweigh the risks.

There is a recognized risk of abuse and misuse of opioids as they are addictive and can lead to dependence and addiction. For these reasons, people are often concerned about discussing opioid treatment with their doctors. In fact, doctors are aware that opioids don’t work for everyone, and there are a number of serious risks such as sedation and worsening pain, in addition to addiction and overdose. It is important that you have a clear understanding of these risks to protect yourself from harm.

Both you and your doctor are subject to strict regulations when an opioid medicine is prescribed. Your doctor will usually need to get special approval from your state Department of Health to continue prescribing an opioid medicine to you after a trial period. Your doctor will ask you to sign an opioid contract to ensure that you understand what is expected from you while you take this type of medicine, and that you consent to the requirements described in the contract.


Please note that the information about pain on this page is provided for educational purposes only and is not medical advice. If you are experiencing severe pain and require medical advice, please see a licensed physician.

Have a Question? Ask an Expert!

If you can’t find the answer to your question in the FAQs above, or you have a question about OPFL or pain therapy, please use this form to ask one of our experts and we’ll get back to you as quickly as possible.

If this is a medical emergency, please contact a local doctor.

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Organization for Pain Free Living
Organization for Pain Free Living

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