Chronic pain is a common health issue. In the quest to help patients manage this health condition, many physicians prescribe opiates.
According to Mayo Clinic, chronic pain does not just have physical symptoms. Some people become depressed, anxious, or have difficulty sleeping after dealing with chronic pain for some time. This can make it hard for people to go about their daily lives, take care of tasks at work, and keep up with friends and relatives.
To top it off, it can be difficult to find a treatment that works for an individual. One medication may help a patient’s arthritis, for example, but will not do anything to help another person who has back pain because of an injury. This is because pain is subjective, and each person experiences it differently.
Tolerance levels increase with regular use of opiates. Over time, the original dose of an opiate may not be effective at managing the pain. This may lead to increased dosages, which raises the chances of dependence on the drug. This can quickly lead to continued abuse and eventual addiction.
As a result, people often want alternative means to manage their pain. There are pain management options available that do not involve opiates.
According to Vox, opioids are not always the best thing to prescribe to a patient with chronic pain. A study by Dr. Erin Krebs made headlines around the world when it uncovered that opioids are not ideal for helping patients deal with chronic pain.
Some reasons for this are:
NPR also reports that some doctors advise patients that they may need to live with some amount of pain in their lives. Dr. Krebs says that opiates should not be the first thing a patient receives when dealing with chronic pain. Other means of pain management should be attempted first.
Per Harvard Medical School, there are many methods patients can use to deal with chronic pain that do not require the use of opiates. These approaches can be used while patients cut back on using opioid-based medication, or they can be used along with their current plan for chronic pain management.
Often, chronic pain affects nearly every aspect of everyday life, making it difficult to move around and complete daily tasks. Physical therapy is ideal for people who need to improve their movement. Occupational therapy helps with daily tasks, such as getting dressed and eating. This therapy can be vital to reducing pain, thereby making life more manageable.
This form of electrical stimulation, called iontophoresis, gets medicine into your body through your skin. It is used to reduce pain and inflammation, decrease scar tissue, and address calcium deposits.
People with neck pain, tendinitis (inflammation in the muscle tissue), and joint pain have very specific needs when it comes to dealing with chronic pain. TENS is a form of electroshock therapy that sends light wavelengths of electricity to prevent pain signals from traveling throughout the body. This makes it easier to use joints or muscles that are usually in pain.
Many pain clinics use relaxation techniques to help patients deal with pain. These techniques may include hypnosis, breathing exercises, mindfulness practices, meditation, and progressive muscle relaxation.
According to the Mayo Clinic, relaxation techniques can help patients become aware of their own physical responses to stress and pain. With awareness, they often can reduce their experience of stress and pain.
These ancient practices incorporate movement, breathing, and stretching. They also help to strengthen muscles. These exercise regimes can be particularly helpful to people who experience chronic pain because of fibromyalgia, arthritis, headaches, and back pain.
Small needles are introduced to parts of the body. This is said to release endorphins, which are the body’s natural way of dealing with pain. According to a study published in the Journal of the American Medical Association, acupuncture can help people who have chronic headaches and back pain.
Injectable medication can help people who are in pain because of sciatica, arthritis, and other health issues. Harvard Medical School says doctors should first try less aggressive methods before steroid injections. Doctors may first encourage patients to rest and take over-the-counter (OTC) medications to reduce inflammation.
Eight out of 10 Americans will face pain at one point in their lives. Massages can help people who deal with chronic back pain brought about by run-of-the-mill wear and tear. Massages can also alleviate the stress associated with chronic pain.
People with back pain may find it useful to seek help from a chiropractor. These professionals specialize in aligning the spine to promote pain relief. The UC Berkeley School of Public Health says that this method could help with pain that has been present for six weeks or less.
The American Psychological Association says therapy may help change a patient’s relationship with chronic pain. This is because therapy helps people better understand the emotional toll chronic pain is taking on them while teaching valuable coping skills.
Not all prescription pain medicines are based on opioids. Some medications can assist with migraines (triptan), and others can help with nerve pain, per the U.S. Centers for Disease Control and Prevention (CDC). Antidepressants and injections are other non-opioid options for managing chronic pain.
This type of medication is applied to the part of the skin where you are experiencing pain. Per the Postgraduate Medical Journal, topical ointments are helpful for people who deal with soft-tissue pain and pain related to knee problems. Topical treatments are also recommended for people who are older because they do not cause gastrointestinal issues as many oral medications do.
Many tools are available to help patients deal with painful joints, muscles, and parts of the body that are in pain, such as canes, braces, orthopedic shoes, splints, crutches, walkers, and others. For example, such devices help people with arthritis regain balance as pain in their joints and bones has made it difficult to walk.
Some OTC medications, such as acetaminophen, naproxen, ibuprofen, and aspirin, can reduce pain sufficiently. In some instances, they can be just as good as opioids when it comes to dealing with chronic pain, per the National Safety Council. As with opioids, patients should ask their doctors how to use OTC medications properly because they can still be misused and abused.
A machine is used to help patients deal with responses to things happening in their bodies, including pain. A study published in the International Journal of Behavioral Medicine found that biofeedback reduces pain, depression, and muscle tension. Biofeedback can be used alone or along with other therapies.
There are no guidelines that explicitly tell doctors they must use alternative chronic pain management strategies when a patient stops using prescription pain medication, but most doctors work with their patients to find alternative means to manage their chronic pain.
According to Science Daily, some programs in Canada, such as the Transitional Pain Program, already do this. The goal is that patients will not depend on opioids to manage pain but rather use them only as absolutely needed. The program involves:
Suddenly stopping or reducing opioid use is not safe. Instead, doctors can help patients create a plan using the CDC’s guidelines.
The CDC-provided guidelines invite doctors to seek additional help for patients who are tapering off opiates. This implies that a doctor, patient, or another expert can incorporate additional strategies to help a patient as they reduce the dosages of opiates they are taking.
The CDC also says that doctors can choose to taper patients off opioids if:
Physicians should consider a patient’s individual needs and tailor their plan accordingly. No two people will react the same to any tapering plan.
Once a patient has been taking the smallest possible dose, they can safely stop using opioids.
Opioid withdrawal should always be supervised by a medical professional. If any form of opioid abuse has been taking place, comprehensive addiction treatment is needed.
Chronic Pain: Medication Decisions. Mayo Clinic. Retrieved December 2018 from https://www.mayoclinic.org/chronic-pain-medication-decisions/art-20360371
(October 2008) Opioids and the Treatment of Chronic Pain: Controversies, Current Status, and Future Directions. Experimental and Clinical Psychopharmacology. Retrieved December 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2711509/
(2016) Treating Chronic Pain without Opioids Applying CDC's Guideline for Prescribing Opioids. Centers for Disease Control and Prevention. Retrieved December 2018 from https://www.cdc.gov/drugoverdose/training/nonopioid/508c/index.html
(February 2018) Chronic Pain Management. New South Wales Government. Retrieved December 2018 from https://www.health.nsw.gov.au/pharmaceutical/doctors/Pages/chronic-pain-medical-practitioners.aspx
(September 2016) Non-opioid options for managing chronic pain. Harvard Medical School. Retrieved December 2018 from https://www.health.harvard.edu/staying-healthy/non-opioid-options-for-managing-chronic-pain
(March 2018) Opioids Don't Beat Other Medications for Chronic Pain. NPR. Retrieved December from https://www.npr.org/sections/health-shots/2018/03/06/590837914/opioids-dont-beat-other-medications-for-chronic-pain
(November 2018) 5 Things to Know Before Signing a Pain Management Contract. Verywell Mind. Retrieved December 2018 from https://www.verywellmind.com/what-to-know-before-signing-a-pain-management-contract-4149991
(March 2018) Finally, proof: opioids are no better than other medications for some chronic pain. Vox. Retrieved December 2018 from https://www.vox.com/science-and-health/2018/3/6/17082590/opioids-tylenol-chronic-pain-study
(February 2018) Guidance on opioid tapering in the context of chronic pain: Evidence, practical advice and frequently asked questions. Canadian Pharmacists Journal. Retrieved December 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843113/
Pocket Guide: Tapering off Opioids for Chronic Pain. Centers for Disease Control and Prevention. Retrieved December 2018 from https://www.cdc.gov/drugoverdose/pdf/clinical_pocket_guide_tapering-a.pdf
(August 2018) Helping surgical patients taper off opioids safely and successfully. Science Daily. Retrieved December 2018 from https://www.sciencedaily.com/releases/2018/08/180820104218.htm
(April 2014) Knowing When to Say When: Transitioning Patients from Opioid Therapy. National Institute on Drug Abuse (NIDA). Retrieved December 2018 from https://www.drugabuse.gov/sites/default/files/knowing_when_to_say_when_3-31-14_ln_sd_508.pdf
(September 2018) Iontophoresis in Physical Therapy. Verywell Health. Retrieved December 2018 from https://www.verywellhealth.com/iontophoresis-in-physical-therapy-2696534
(March 2014) Acupuncture for chronic pain. Journal of the American Medical Association. Retrieved December 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4036643/
(September 2015) Transcutaneous Electrical Nerve Stimulation (TENS). Cleveland Clinic. Retrieved December 2018 from https://my.clevelandclinic.org/health/treatments/15840-transcutaneous-electrical-nerve-stimulation-tens
(April 2017) Relaxation techniques: Try these steps to reduce stress. Mayo Clinic. Retrieved December 2018 from https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/relaxation-technique/art-20045368
(Written 2014, updated November 2018) Back pain: What you can expect from steroid injections. Harvard Medical School. Retrieved December 2018 from https://www.health.harvard.edu/pain/back-pain-what-you-can-expect-from-steroid-injections
(July 2011) Aching Back? Try Massage for Chronic Pain. TIME Magazine. Retrieved December 2018 from http://healthland.time.com/2011/07/06/aching-back-try-massage-for-chronic-pain/
(December 2017) Back Pain: Can a Chiropractor Help? UC Berkeley School of Public Health. Retrieved December 2018 from https://www.healthandwellnessalerts.berkeley.edu/alerts/back_pain_osteoporosis/Back-Pain-Can-Chiropractor-Help_7867-1.html
(July 2013) Topical therapies in the management of chronic pain. Postgraduate Medical Journal. Retrieved December 2018 from https://www.ncbi.nlm.nih.gov/pubmed/24547601
(July 2017) Mobility Aids - What People With Arthritis Need to Know. Verywell Health. Retrieved December 2018 from https://www.verywellhealth.com/mobility-aids-what-you-need-to-know-189387
Evidence for the efficacy of pain medications. National Safety Council. Retrieved December 2018 from https://www.nsc.org/Portals/0/Documents/RxDrugOverdoseDocuments/Evidence-Efficacy-Pain-Medications.pdf
(February 2017) Efficacy of Biofeedback in Chronic back Pain: A Meta-Analysis. International Journal of Behavioral Medicine. Retrieved December 2018 from https://www.ncbi.nlm.nih.gov/pubmed/27307013