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Active and Passive Treatments:
How They Work Together

Chronic pain is often managed from several perspectives. A person’s treatment plan may include medication, medical procedures, surgery, hands-on treatment, exercise, psychological support, assistive devices, pacing and other self-management strategies.

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These treatments are sometimes described as active or passive. The categories can be useful, but they are not absolute and a single treatment can have both active and passive components.

What Are Passive Treatments?

Passive treatments are done ‘to’ the person or are primarily directed by a healthcare provider. During the treatment itself, the person usually has a limited role in carrying it out.

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Examples may include:

  • medication;

  • injections or other medical procedures;

  • surgery;

  • provider-delivered modalities using specialized equipment, such as therapeutic ultrasound;

  • massage, passive stretching or other hands-on treatment; and

  • acupuncture.​

​Some passive treatments are used for a limited period, while others may remain important over the long term. Their value depends on the person’s condition, goals, response and broader treatment plan. Whether they are accessible or sustainable may also depend on availability and, unfortunately, cost.

What Are Active Treatments?

Active treatments require the person to participate in, practise or apply part of the treatment independently or with some support. Many can be used outside a clinic or treatment session and adapted to the demands of daily life.

​Examples may include:

  • home exercises, stretching or graded physical activity;

  • relaxation and nervous-system regulation strategies;

  • pacing and activity-management strategies;

  • adapting how a task is performed;

  • using an assistive device as part of a participation plan; and

  • developing routines for managing symptoms and recovery, including the planned use of medication or home TENS and the scheduling of other treatments.

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Active treatment is not limited to exercise. It may involve physical, cognitive, emotional or environmental strategies. It also does not mean that the person must manage alone. Guidance, monitoring and adaptation from healthcare providers may still be needed.

 

Most importantly, describing a treatment as active does not suggest that a person caused their pain or should be able to control it through effort. Pain may be influenced by factors that are not within the person’s control. Active treatment focuses on the areas where some influence may be possible.

The Categories Can Overlap

The same intervention may be active, passive or a combination of both.

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For example, an assistive device may be provided by a clinician, but learning when and how to use it involves active participation. Education may initially be received passively, then become active when the person applies it to decisions in daily life. Hands-on treatment may reduce symptoms while also supporting participation in an active program.​

The categories can overlap, and some people think about it as:

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“What parts of this treatment increase my ability to influence factors impacting my pain?”
Or
“What parts of this treatment are done ‘to me’ by a provider to impact my pain?”

Both Play a Role

Passive treatments may help reduce pain, address particular symptoms or create an opportunity for movement, sleep or participation. Active treatments can help a person develop strategies they can use between appointments and across different activities and environments.

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Neither approach guarantees pain relief, and neither is inherently better. Relying only on passive treatment may leave gaps between appointments or procedures and may leave the person feeling that effective pain management depends on access to a provider. Relying only on active strategies may overlook treatments that may provide pain management benefits or place too much responsibility on the person living with pain.

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Chronic pain often responds best to a coordinated plan that draws from more than one type of treatment. Medication, procedures and hands-on care do not need to compete with pacing, exercise, adaptation or self-management.

 

The purpose is to identify how each treatment contributes, recognize what is within the person’s circle of influence and build a plan that supports both symptom management and meaningful participation.

References

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Canadian Pain Task Force. (2021). An action plan for pain in Canada. Health Canada. https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2021.html

 

International Association for the Study of Pain. (n.d.). Terminology. Retrieved September 19, 2026, from https://www.iasp-pain.org/resources/terminology/

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