Opioid medications have an important use in treating chronic or acute pain, but after prescribing practices were loosened in the mid-1990s, an epidemic of opioid addiction and overdose swept the United States. According to the U.S. Centers for Disease Control and Prevention (CDC), between 1999 and 2016, around 630,000 people died from drug overdoses, and 66 percent of those were caused by an opioid drug.
Increasingly, opioid addiction and overdose involve dangerous and potent substances like heroin and fentanyl. As of 2016, 115 people in the U.S. die every day from an opioid overdose, but the problem began with prescription narcotics and widespread abuse of drugs like oxycodone and hydrocodone.
An estimated 100 million Americans have long-term pain of some kind. It is important for doctors and their patients to discuss prescription opioid painkillers, including their benefits and risks. Because of the opioid addiction and overdose epidemic, many people are working to find ways to treat chronic pain without taking opioid drugs. Several potential avenues of treatment can help reduce pain while you heal after an injury or surgery, or they can help reduce your reliance on painkillers if you struggle with chronic pain.
In response to the opioid addiction epidemic, the National Institutes of Health (NIH) released a comprehensive report called the National Pain Strategy in 2016. This report aimed to decrease the prevalence of pain across the whole continuum of medical patients, from severe acute pain to high-impact chronic pain, while also reducing reliance on opioid medications. The focus is to unburden pain sufferers and their families, limit disability, and lower rates of addiction and overdose.
Although opioid medications can be one effective method for treating pain, wider prescribing practices have shown that this method alone is not effective treatment for most people. Instead, using different medications and focusing on non-pharmaceutical long-term treatments can better manage pain, promote healing, and reduce physical disability.
One surprisingly effective way to manage pain is to prescribe other medications that are not opioids. Several drugs work well to treat pain of all kinds.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
This class of painkillers is typically associated with over-the-counter drugs like ibuprofen, but there are also prescription doses of these drugs that can be very effective in managing pain. NSAIDs are often used in conjunction with opioid painkillers, especially for chronic pain, but they can be an effective treatment on their own as well. There are complications associated with taking NSAIDs, especially in large doses over time, such as liver toxicity, kidney failure, and ulcers.
This is an anti-inflammatory medication that is considered the first line of treatment by the American College of Rheumatology because the drug is very effective at managing pain associated with inflammatory conditions. This drug is also found frequently in over-the-counter (OTC) medications like Tylenol and several cold and flu treatments. Due to its prevalence, increases in accidental acetaminophen overdoses have been reported. It is important to avoid taking more than 4,000 mg (4 grams) because this is the level that causes acute liver failure. Most doctors recommend taking 325 mg at most per day.
Selective serotonin reuptake inhibitors (SSRIs) and norepinephrine reuptake inhibitors (SNRIs)
This specific group of antidepressants has been found effective in treating some pain conditions, especially nerve pain from conditions like diabetic neuropathy or musculoskeletal pain. SSRIs are the most commonly prescribed antidepressants in the U.S. right now because they have a low abuse threshold and few side effects compared to other, older classes of antidepressants. Medications like Cymbalta have been found to be effective in treating chronic pain problems like fibromyalgia, potentially because managing the long-term flow of serotonin in the brain can alleviate pain as it also manages mood.
For severe inflammatory conditions, corticosteroids are an effective approach to treatment. Medications like prednisone inhibit injured nerves. While corticosteroids are not addictive, they are potent medications and have been correlated to serious problems like gastrointestinal damage, psychiatric problems, immune system suppression, interference in the body’s response to stress, and even increased joint destruction.
Some drugs used to treat seizure disorders like epilepsy have been found to soothe neuropathic pain because, like opioids, they can suppress the pain signals moving into the brain. Side effects are not considered severe, although some anecdotal evidence suggests that some people have suffered serious problems trying to quit these medications.
For people in severe pain in a hospital setting or who may struggle with pain for some time after an injury or medical procedure, some interventions directly block pain responses from the body to the brain. Among them are:
Whether you use prescription medications or other medical interventions, or you have decided to focus on alternative means of pain management, some home remedies can improve your health and reduce pain or soreness without medical intervention.
The alternative medicine industry is booming in the U.S., and some of these techniques can be important additions to a medical routine to manage long-term or chronic pain. Medical research is just beginning to understand how these approaches ease pain and stress, but a lot of anecdotal evidence suggests they can be useful in combination with ongoing medical treatment. Complementary approaches to medical treatments include the following:
Other approaches to treatment that are not considered alternative, complementary, or integrative are physical therapy, occupational therapy, and talk or behavioral therapy. People who have a mental illness are more likely to suffer chronic pain; the two conditions are intertwined, as one increases the symptoms of the other. Physical therapy can improve movement in areas affected by pain from injury and illness, and occupational therapy improves daily functioning after suffering a serious trauma, including injury or relapse in chronic pain symptoms. Improving physical and mental health reduces pain overall.
Although opioids can be an important part of treatment, medical professionals are trying to rely less on these drugs and coordinate care overall with several professionals, including pain management specialists, integrative medical experts, mental health care specialists, and others. Treating the entire patient, rather than just stopping pain, improves overall health.
(August 30, 2017). Opioid Overdose: Understanding the Epidemic. U.S. Centers for Disease Control and Prevention (CDC). Retrieved October 2018 from https://www.cdc.gov/drugoverdose/epidemic/index.html
(January 2018). Prescription Opioids and Heroin. National Institute on Drug Abuse (NIDA). Retrieved October 2018 from https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-abuse-heroin-use/introduction
(March 14, 2018). Beyond Opioids: The Future of Pain Management. WebMD.com. Retrieved October 2018 from https://www.webmd.com/special-reports/opioids-pain/20180314/opioid-alternatives
National Pain Strategy: A Comprehensive Population Health-Level Strategy for Pain. National Institutes of Health (NIH). Retrieved October 2018 from https://iprcc.nih.gov/National-Pain-Strategy/Overview
(August 29, 2012). Opioid-Free Ways to Live Well With Chronic Pain. Everyday Health.com. Retrieved October 2018 from https://www.everydayhealth.com/pain-management/opioid-free-ways-to-live-well-with-chronic-pain.aspx
Treatment Options for Chronic Pain. American Society of Regional Anesthesia and Pain Medicine (ASRA). Retrieved October 2018 from https://www.asra.com/page/46/treatment-options-for-chronic-pain
(September 2016). Non-opioid options for managing chronic pain. Harvard Health Publishing, Harvard Medical School. Retrieved October 2018 from https://www.health.harvard.edu/staying-healthy/non-opioid-options-for-managing-chronic-pain
(November 22, 2013). How Can Alternative Medicine Help Pain? Everyday Health.com. Retrieved October 2018 from https://www.everydayhealth.com/pain-management/photos/8-alternative-treatments-for-pain-management.aspx