PAIN CARE

Treat Your Chronic Pain without Opioids

By Temma Ehrenfeld  @temmaehrenfeld
 | 
January 11, 2024
Treat Your Chronic Pain without Opioids

You might have a better option to treat your pain than a prescription (or illegal) opioid. Here's what you should know and can do about your chronic pain.

There are hundreds of types of pain, making it difficult for pharmaceutical companies to target their products to specific pain. How people experience pain also varies. As with any other health problem, your expectations and emotions play a role, but pain seems especially personal.

“You can’t see it, you can’t feel it, and you can’t touch it,” says Mark Wallace, MD, an anesthesiologist and pain management researcher at the University of California, San Diego.

The end result is that many people don’t get enough relief. Some 52 million adults, more than 20 percent of the U.S. population, live with chronic pain.

 

YOU MIGHT ALSO LIKE: Our Opioid Crisis section

 

Meanwhile, guidelines and public knowledge about the opioid crisis have led doctors to cut the number of opioid prescriptions they write dramatically. People who take opioids over long periods tend to develop addictions, which can lead to drug-seeking behavior during doctor visits, purchasing opioids illegally, and gravitating to drugs like heroin. High-dose and long-term prescriptions are linked to higher suicide rates through overdoses as well.

Opioid overdoses kill more than 96 million Americans every year. Men ages 25 to 65 are at greatest risk.

That said, your personal risk of abusing painkillers — taking them beyond what you need to manage pain — may not be big if you have no history of addiction or suicidal impulses. 

But you may not even need the drug.  

Opioid alternatives

You have options. Ask for a package of solutions both to reduce pain and cope with it. You may have dismissed over-the-counter (OTC) drugs that could help. Neuromodulation, which involves electric stimulation from a device like a pacemaker, can be effective. So can a variety of programs that address your brain’s role in perceiving pain.

Before the 1990s, American doctors prescribed opioids to cancer patients and people in pain after an acute injury like a fracture. Few hospital patients who received opioids for an acute injury became addicted.

Then along came OxyContin, marketed as an alternative to non-steroidal anti-inflammatory drugs, or NSAIDs, which include ibuprofen (Advil) and naproxen (Aleve). Too much of those OTC remedies poses a risk of internal bleeding in your gastrointestinal tract, especially dangerous for older patients, a group that often suffers from chronic back and joint pain.

But the number of deaths from bleeding caused by NSAIDs is now much smaller than deaths from opioids.

You might ask your doctor for NSAIDs in a higher dose than the OTC versions, which can be “remarkably effective,” notes Michael Leong, MD, former clinic chief of the Stanford Pain Management Center. Another option is a celecoxib (Celebrex), a newer type of NSAID that may be easier on your stomach and intestines.

A three-legged approach to pain treatment

Leong sees pain management as a three-legged chair. The first leg is non-addictive painkillers. The second leg, if necessary, would be neuromodulation, in which an embedded device sends electrical pulses that interrupt or mask pain signals that travel to and from your brain.

The third leg requires coaching patients to respond to their pain differently, making it bearable. You might see a cognitive behavioral therapist, work with a biofeedback machine, or explore a kind of therapy called GMI, for graded motor imagery.

Pain is an experience in the brain, and your brain can be retrained. For example, you might put a painful hip inside a mirror box and move your other hip, without pain. In the mirror, you’ll have the illusion that the painful hip is moving but experience no pain. Over time, your brain may stop associating movements of the painful hip with pain.

“Only when these approaches have been exhausted should opioids be considered as a treatment option,” Leong argues.

A home-based treatment applying electrical stimulation to the skull, called transcranial direct current stimulation, may help. It has reduced pain in patients with fibromyalgia, beating a sham version (equivalent to a placebo).

Imagery treatments may work best combined with electric stimulation. In a small study, 81 percent of participants with complex pain syndromes in the experimental group showed a clinically meaningful reduction in pain severity after six weeks, compared to 27 percent in the sham group. The experimental group received standard GMI plus the stimulation for five consecutive days, followed by once-a-week stimulation for four weeks. 

Scrambler therapy, another noninvasive pain treatment, can yield significant relief for up to 90 percent of chronic pain patients, according to a study at Johns Hopkins in Baltimore. You’ll receive electrical stimulation through your skin just above and below where you feel pain, to encourage your nerves to send signals to your brain from the non-painful areas, replacing the pain signals.

When you talk to your doctor, you’ll probably be asked to rate your pain on a scale of one to 10. Instead, consider using a quality-of-life scale, which you can print for reference. In the scale:

  • Zero corresponds to “stayed in bed all day.”
  • 4 means “Do simple chores around the house and minimal activities outside of home two days a week.”
  • And so on, up the scale.

Concrete information about how your pain affects your life may help your doctor see alternatives. 

 

YOU MIGHT ALSO LIKE: Painkiller Overdoses Tax the Healthcare System

Updated:  

January 11, 2024

Reviewed By:  

Janet O’Dell, RN