Non-Opioid Treatments for PainAdmin2019-12-16T14:31:59-05:00
Every year millions of prescriptions are written for pain medications. Many of those prescriptions are for powerful opioids that can cause side effects and lead to addiction. Today, however, there are many non-opioid treatments available for pain management that result in a higher quality of life, including prescription and over-the-counter medications, nondrug remedies, and high-tech treatments.
Millions of Americans are in severe pain. Some suffer from severe headaches or chronic back pain, others are recovering from surgery, sports injuries or accidents. Chronic pain can limit the patient’s quality of life and lead to additional, serious health problems. In an effort to manage pain, every year millions of prescriptions are written for pain medications. Many of those prescriptions are for powerful opioids that have severe side effects and lead to addiction.
At one time, opioids like oxycodone, hydrocodone, and morphine were considered some of the most helpful drugs for managing chronic pain. However, the rates of opioid abuse and overdose deaths have skyrocketed in recent years. But, more importantly, opioids may not be the most effective treatment for pain relief after all!
How Opioids Work
To understand the problem with opioid medications, it is necessary to understand how they work.
Opioid medications are synthetic versions of opium and the drugs derived from opium, such as heroin and morphine. Just like real opium, the opioid medication mimics the natural pain-relieving chemicals (endorphins) normally produced by the brain and nervous system.
Opioids bind to opioid receptors in the brain, spinal cord, and other areas of the body to “turn down the volume” of pain signals. That is, the opioid tells the brain there is no pain sensation. They also mute other nerve cell functions, such as breathing, heart rate, and the level of alertness.
Over time, the body adapts to these medications and the pain relief lessens. This phenomenon, known as tolerance, means more of the same medicine is necessary to achieve the same degree of pain relief. Tolerance is not the same as addiction (the compulsive use of a drug). However, there is a greater risk that opioid dependency will turn into addiction when the drug is taken for a longer period.
Opioids currently cause the most prescription drug-related overdose deaths in the United States. Unfortunately, that rate is increasing every year. Because the risks are so significant, opioids are used at the lowest dose possible, usually for just a few days.
Opioid Side Effects
In addition to a concern for developing a dependency on opioid medication, there are side effects such as:
Nausea and vomiting.
Additionally, opioids can be dangerous, if taken with alcohol, or with certain drugs such as:
Because of the way opioids act on the brain, the patient cannot just stop taking them. Abruptly stopping opioids can cause withdrawal symptoms such as:
Diarrhea, nausea, and vomiting.
A study in the Journal of the American Medical Association suggests that opioid drugs are no more effective than a combination of non-opioid painkillers in treating acute pain. Another study found opioid pain relievers had no advantages over non-opioid medications for treating chronic back pain and arthritis pain. The most noticeable difference was that opioid medications had more side effects.
Now, the CDC and other regulatory agencies are trying to phase out long-term opioid prescriptions for chronic pain. And at Novus Spine & Pain Center, opioids are not the first option for treating chronic pain.
The process of finding an effective treatment for chronic pain is complex and uniquely personal. What works for chronic low back pain may not offer any relief for osteoarthritis. Additionally, each individual’s diagnosis, biology, and personal history all play a role in finding the proper pain management therapy that works best.
Non-Opioid Pain Management Options
There are many non-opioid pain medications available over-the-counter or by prescription. Some patients find that these are all they need. Non-opioid medications include:
Acetaminophen. This is the active ingredient in Tylenol and a common over-the-counter drug for mild to moderate pain. Acetaminophen is often prescribed to help manage osteoarthritis and back pain. It is recommended as a first-line treatment for pain by the American College of Rheumatology. Acetaminophen doesn’t cause stomach or heart problems like NSAIDs, but taking more than the recommended dosage can lead to liver damage.
Anticonvulsants. Traditionally used to treat epilepsy, anticonvulsants can also relieve neuropathic pain by suppressing pain signals from the brain. Some anticonvulsants (gabapentin and pregabalin) can address chronic nerve pain from conditions like diabetes, shingles, herniated discs, and fibromyalgia. They are often the first-line treatment for neuropathic pain due to the drug’s effectiveness. It is unclear how well they work, since some patients find them very helpful while others experience no benefit at all.
Antidepressants. Tricyclic antidepressants (like imipramine, nortriptyline, and amitriptyline) have been shown to lessen pain caused by damaged nerves (including back pain, fibromyalgia, and diabetes-related nerve pain). Because chronic pain can cause several problems that can lead to depression, antidepressants may doubly benefit pain and mood symptoms. Anti-depressants can also help patients sleep.
Corticosteroids (also called “steroids”). Useful in treating both acute and chronic pain, steroids decrease inflammation, swelling, and pain by suppressing immune cell activity. They are used to treat patients with arthritis, back injuries, nerve pain, and cancer. Drawbacks to corticosteroids include the potential to accelerate joint destruction. Steroids can also cause side effects like weight gain, high blood pressure, and a weakened immune system. Taking low doses short-term and using injections and creams just at the site of pain (instead of taking pills) can help to reduce these side effects.
COX-2 inhibitors. Developed to reduce common side effects associated with traditional NSAID medications, COX-2 inhibitors are commonly used for arthritis and pain resulting from muscle sprains, strains, back and neck injuries, or menstrual cramps. They are as effective as NSAIDs, and may be the right choice if long-term pain control is required without the risk of stomach damage.
Injections (nerve blocks). Arthritis, injuries, muscle pain, and headaches are among the kinds of pain treatable with an injection. Injected with the guidance of X-ray imaging, the numbing medication blocks or dampens the pain, and may stop chronic pain from developing. The location of the injection depends on the source and type of pain (arm or face pain can be relieved by blocking nerves in the neck). Relief may require a series of injections and repeated treatments.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). More potent than acetaminophen, but also available over-the-counter and with a prescription for a higher dosage. NSAIDs are most effective for mild to moderate pain that’s accompanied by swelling and inflammation. They also help lower fever and reduce inflammation. A downside for older patients is the risk of organ toxicity, kidney or liver failure, and ulcers. Long-term use can lead to gastrointestinal upset and bleeding, and the FDA warns that NSAIDs (other than aspirin) may increase the risk of heart disease and stroke.
Serotonin and Norepinephrine Reuptake Inhibitors (SNRI). A type of anti-depressant appropriate for treating nerve, muscular and skeletal pain. Often recommended for pain management of fibromyalgia, diabetic peripheral neuropathy, and chronic musculoskeletal pain.
Non-Drug Pain Management Options
Some patients find relief with non-drug therapies that can be used alone or in combination with medications. These methods of pain management include:
Acupuncture. A technique involving the insertion of extremely fine needles into the skin at specific points on the body to interrupt pain signals. It is believed this action releases endorphins, the body’s natural pain-killing chemicals. It may also influence serotonin levels, the brain transmitter involved with mood.
Biofeedback. A machine-assisted technique to help patients learn to control their own body responses, including the response to pain.
Chiropractic. Chiropractors try to correct the body’s alignment to relieve pain, improve function, and to help the body heal itself. Chiropractic treatments are often just as effective, if not more, than medication. It is also free of side effects.
Cold and heat. Cold can be useful immediately after an injury to relieve pain, decrease inflammation and muscle spasms, and help speed recovery. The application of heat raises the patient’s pain threshold and helps relax muscles.
Exercise. Research shows staying active is especially important for people with chronic pain. Staying physically active, despite some pain, can play a helpful role for people with some of the more common pain conditions, including low back pain, arthritis, and fibromyalgia. Low-impact exercise helps improve mobility and functionality.
Massage. For some patients, massage is as effective, if not more effective, than medication. Therapeutic massage may help relieve pain by relaxing painful muscles, tendons, and joints, while also reducing stress and anxiety. Massage is safe and free of side effects.
Pain-relieving assistive devices. A range of assistive devices can help support painful joints, relieve the pressure on irritated nerves, and soothe aches and pains. Devices include splints, braces, canes, crutches, walkers, and shoe orthotics (inserts).
Physical therapy (PT) and occupational therapy (OT). PT helps restore or maintain the ability to move and walk. OT helps improve the ability to perform daily activities, such as dressing, bathing, and eating. Both require the patient to attend therapy sessions and do home exercises, which are essential to improving physical healing and relieving pain long term.
Psychotherapy. Specially trained professionals can offer several avenues for pain relief and management that include helping the patient reframe negative thinking patterns about pain. Seeing a mental health professional does not mean the pain is “all in your head.”
Topical pain relievers. These are medication-containing creams, ointments, and patches that are applied to the skin. They may be used in place of, or in addition to, other pain treatments for osteoarthritis and musculoskeletal pain.
Weight loss. Many painful health conditions are worsened by excess weight. It makes sense, then, that losing weight can help relieve some types of pain.
Yoga and tai chi. These mind-body exercises incorporate breath control, meditation, and movements to stretch and strengthen muscles. They may help with chronic pain conditions such as fibromyalgia, low back pain, arthritis, and headaches.
High-Tech Pain Management Options
Not all patients with chronic pain find relief with medications or non-drug treatments like physical therapy. For these patients, there are several “high-tech” treatments that may relieve their pain and, in some cases, keep it from coming back. These methods for relieving chronic pain include:
Cold laser therapy. This procedure, also called low-level laser therapy, is FDA-approved to treat pain conditions. The cold laser emits pure light of a single wavelength that is absorbed into an injured area and may reduce inflammation and stimulate tissue repair.
Iontophoresis. This form of electrical stimulation is used to drive medications into areas of pain and reduce inflammation.
Neurostimulators. A treatment using implanted electrodes to interrupt nerve signals. This does not cure what is causing the pain, but stops the pain signals before they reach the brain. It can be used for back, neck, arm, or leg pain. Trials are currently underway to test their effectiveness on headaches.
Pain pumps. Special pumps can be implanted to allow a patient to push a button and deliver pain medications to their spinal cord, bringing relief without the side effects that often come with taking these drugs by mouth. Patients can also get a psychological boost by having direct control over their pain. Spinal drug pumps are used most often by people with cancer pain, but also by patients with other types of pain who experience side effects with oral medications.
Radio waves. Radiofrequency ablation involves inserting a needle next to the nerve causing the pain, and burning it using an electric current created by radio waves. This short-circuits the pain signal. Because nerves grow back, the procedure must be repeated; however, pain relief can last up to one year.
Spinal cord stimulation (SCS). Also called neurostimulation, a pacemaker-like device implanted in the lower back replaces pain with a more tolerable sensation, typically a tingling or massage-like feeling from tiny wires placed in the spinal canal. The patient uses a remote control to send signals to the painful area. This technique can help with back pain as well as neuropathy common with diabetes. Newer forms of SCS show promise in relieving pain without the tingling.
Stem Cell Therapy. This is one of the most promising research areas involves harvesting stem cells from a patient’s bone marrow and injecting them into an area that has become painful because of tissue deterioration. The stem cells help build new, healthy tissue and offer a more permanent pain-relief solution.
Transcutaneous electrical nerve stimulation (TENS). This technique employs a very mild electrical current to block pain signals from reaching the brain. Unlike SCS, the stimulator attaches to the skin with small sticky pads attached via wires to a battery-operated device. TENS deals more with nerves than the spine.
Ultrasound. This therapy directs sound waves into tissue. It is sometimes used to improve blood circulation, decrease inflammation, and promote healing.
Among the millions of chronic pain sufferers in the nation, no two cases are the same. Everyone has unique needs. When other treatments are not effective, surgery may be an option to correct abnormalities that may be responsible for the pain.
While there isn’t a cure for chronic pain, many effective pain treatments are available to help you effectively function. Taking a prescription opioid is not always the best option.
Work with a medical professional to find the best solution for you. Keep your medication risks to a minimum to improve your odds of many good days, for many years to come.
Should You Need Help
Drug addiction is a serious illness that affects people from all walks of life. More than 2.3 million individuals sought treatment for drug or alcohol addiction at specialty treatment facilities in 2016.
There is help available for an opiate dependency or addiction. Drug abuse hotlines are an excellent resource for people with questions about treatment options. Here are some resources for anyone seeking help.
If you are facing an immediate crisis, please call emergency services at 911.
To find a treatment facility near you, contact:
Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline
800-487-4889 (TDD) for hearing impaired
SAMHSA offers free and confidential information for individuals and family members facing substance abuse and mental health issues. Phones answered 24 hours a day, 7 days a week with help available in English and Spanish.
People living with addiction can recover and remain drug-free.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and treats patients with chronic pain with numerous therapies including non-opioid pain treatment options. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.