Alternatives to Opioids for Pain

According to the Journal of Neuroscience, around 100 million Americans suffer from chronic pain, half of them experiencing significant or severe pain. In some of these cases, opioids are the best and sometimes, the only choice for pain relief, but for many people, opioid alternatives have the potential to effectively treat pain without the high risks associated with opioid painkillers. Despite an ever-growing list of effective opioid alternatives for pain management, opioid pain medications continue to be over-prescribed, fueling the opioid crisis, which costs 115 lives each day due to overdose. Here, we look at the risks opioids pose and the alternatives to opioids that are increasingly being used to manage even severe pain.

The Scope of Opioid Painkiller Use in America

The United States accounts for 4.6 percent of the world’s population, but we consume 80 percent of the world’s opioid pain medications. Although the prescribing rate for opioids dropped 19 percent between 2010 and 2015, the length of opioid prescriptions increased from an average of 13 days in 2006 to 18 days in 2015, according to a 2017 study by the Centers for Disease Control.¹ This extends the length of exposure and increases the risk of diversion and abuse. Despite the recent dip in the prescribing rate, doctors are still prescribing three times more opioids than they did in 1999, even though Americans’ perception of pain hasn’t changed in that time. A University of Michigan study found that after laparoscopic gallbladder surgery, physicians prescribed anywhere from 15 to 120 pills.² Remarkably, participants used, on average, a total of six pills to manage their pain after surgery. As a result of this type of over-prescribing, around 3.3 billion pills end up unused each year, and a large number of these find their way onto the street or into the hands of someone who will abuse them. The current opioid crisis has claimed nearly as many American lives as the Vietnam War.

Opioid Abuse, Addiction and Dependence

Opioid abuse isn’t the same thing as addiction or dependence. Abuse is characterized by using opioids in a way other than as prescribed, such as taking higher doses, taking someone else’s medication or taking opioids for non-medical reasons. According to the 2012 National Health Interview Survey, two-thirds of people who abused opioids that year did so to reduce their pain. Only 10 percent of participants said they abused opioids to get high.³Whatever the reasons for abusing opioids, abuse can quickly transition to addiction and dependence.

Addiction

Addiction is the result of complex changes in the brain’s chemical functions and physical structures caused by heavy substance abuse. It’s characterized by compulsive drug use despite the negative consequences it causes. It affects thought and behavior patterns.

Dependence

Dependence typically co-occurs with addiction, but not always. Opioid dependence is purely physical, characterized by withdrawal symptoms that set in when you suddenly stop using opioids. Physical withdrawal symptoms include:

Nausea
Vomiting
Abdominal cramps
Diarrhea
Other flu-like symptoms

Because of the high risk of abuse, addiction and dependence associated with opioids, it’s always best to choose opioid alternatives to pain management whenever possible.

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A Stepped-Care Approach to Pain Management

Everyone experiences pain differently. Pain is measured by a person’s unique perception of the pain, which is indelibly influenced by emotions. For example, someone who is anxious or depressed may experience pain more severely than someone who isn’t. There is no one-size-fits-all approach to treating pain. An effective pain management plan will be highly individualized and address both the physical and emotional aspects of pain. A holistic approach to pain management is highly effective for many conditions and types of pain, and for some, it may be even more effective than opioids. Holistic pain management involves a variety of treatments, therapies and techniques that reduce pain without the negative side effects and risks associated with opioid medications. Pain management experts recommend a stepped-care approach to pain management. The stepped-care model involves starting with a variety of non-opioid pain management techniques and moving to opioids only when all other avenues have failed. According to the American Journal of Public Health, fewer than 200,000 people participate in a stepped-care, holistic pain management program.⁴ This is largely due to the low number of multi-disciplinary pain management programs available and the fact that most health insurance policies don’t cover many of the treatments and therapies they utilize. But when it’s possible, choosing a holistic approach is the safest and most effective way to manage pain, especially chronic pain.

Managing Pain Without Opioids

With the end to the opioid crisis not yet in sight, researchers in many fields are focusing on identifying and developing opioid alternatives for acute and chronic pain. Research continues to show that a combination of treatment therapies offers the best chances for successful, long-term pain management. Research-based therapies commonly used as part of a holistic approach to treating and managing pain include: Non-Opioid Medications Over-the-counter pain medications like acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen work well for many people with a variety of types of pain. Adjuvant medications, which aren’t designed to treat pain but have been found to help manage it nonetheless, include certain antidepressants, anti-seizure medications and sedatives. Steroid Injections Pain related to the joints, tendons and bursae often respond well to steroid injections. Cortisone injected directly into the area of pain works well to manage pain, but injections are a short-term solution and typically part of a broader pain management plan. Exercise Exercise can reduce the severity of some types of chronic pain. An exercise program specific to your pain needs will help boost core strength and improve flexibility, range of motion and balance. Pain Skills Workshops Pain skills workshops teach specific skills, strategies and techniques to reduce pain and help to cope with it. These include techniques for reducing stress and utilizing distractions; optimal self-care skills; good sleep hygiene; and self-massage. Chiropractic Care Chiropractic care is effective for treating back and neck pain, migraines, whiplash pain and pain related to neuromuscular disorders like multiple sclerosis. Chiropractic care includes spinal manipulation, posture education, ergonomic training and ultrasound and laser therapies. Cognitive-Behavioral Therapy Cognitive-behavioral therapy focuses on changing dysfunctional or unhelpful thought and behavior patterns to help change your perception of pain. It helps with development of self-confidence for managing pain, and improves mood. Stress Reduction Stress can cause physical pain and worsen existing pain. Lowering stress and reducing the body’s stress response, including muscle tension, elevated heart rate and body temperature, is central to pain management for many people. Effective stress reduction techniques include meditation, guided visualization, progressive relaxation and deep breathing exercises. Physical Therapy A physical therapist will create an exercise regimen that improves functioning and decreases pain. Physical therapy may also include heat therapy, deep-muscle massage and other interventions. Transcutaneous Electrical Nerve Stimulation Therapy This therapy provides short-term pain relief-especially for muscle pain-by sending low-voltage electrical signals to the area of pain. Researchers believe this interrupts the nerve signals to the brain and stimulates the body’s natural painkillers. Acupuncture Acupuncture involves long, thin needles that are inserted into specific points on the body. This practice is believed to improve energy flow through the body, stimulate the immune system and reduce pain. A review of studies published in the Archives of Internal Medicine involved 18,000 pain patients and found that acupuncture relieved pain by about 50 percent. ⁵ Therapeutic Massage Therapeutic massage therapy has been shown to relieve chronic pain by relaxing painful muscles, joints and tendons; reducing stress and anxiety; and, according to Harvard Medical School, possibly stimulating competing nerves and interrupting pain messages to and from the brain.⁶ Opting for opioid alternatives to manage your pain is safer than using opioids, and it often works as well as-or better than-opioid medications. The right combination of non-opioid treatment therapies can reduce your pain and help you better cope with it. A holistic approach to treating your chronic pain will help reduce pain and improve your overall quality of life and sense of wellbeing for the long haul.