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.
Painkiller Prescriptions That are not Opioids
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.
Nerve-Blocking Drug Treatments
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:
- Epidural steroid injection: This is an injection that goes directly into the neck or spine to reduce inflammation in a painful area. These injections are intended to help pain in the neck, back, hand, arm, or legs. By reducing inflammation, the muscles in the area can also relax, which helps reduce pain overall
- Facet joint injection: The facet joints assist with movement in the neck and spine, and injections in these areas, always conducted under X-ray guidance, can relieve pain in these areas. These injections are not appropriate for other kinds of pain
- Lumbar sympathetic block: This is an injection into the lower back directed at treating pain in the leg caused by complex regional pain syndrome type I (or CRPS I)
- Celiac plexus block: This type of block relieves pain in people who have pancreatic cancer or other conditions that may cause chronic abdominal pain
- Stellate ganglion block: After a diagnosis of complex regional pain syndrome in the arm or hand, this type of numbing injection reduces pain and improves blood flow to the area.
Home-Based Treatments to Ease Pain
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.
- Exercise: Many people who struggle with chronic pain have difficulty moving, and people who have pain from an injury or surgery must be careful of their movements while they heal. That said, finding a low-impact type of exercise can release endorphins, improve muscle tone, and manage mood. Improving overall physical health helps to manage how the brain responds to pain in several ways, so adding exercise to other pain management approaches will keep pain at bay on a long-term basis. Certain types of exercise have been found effective in managing pain.
- Tai chi
- Short walks
- Weight loss: Some chronic pain conditions get worse when you carry extra pounds, so eating healthy foods and developing an exercise routine specifically to shed excess weight, without adding mental stress sometimes associated with dieting, will help manage these conditions. Before embarking on weight loss, consult with your doctor, a physical therapist, and/or a nutritionist to create a sustainable long-term plan
- Cold and/or heat: Using ice packs reduces inflammation, and applying a heating pad can relax muscles. These non-medication approaches to relaxation ease tension and soreness in the body
- Pain-relieving devices: Sometimes, chronic pain or injury-related pain requires additional support, so canes, orthopedic shoes, splints, braces, or crutches can ease pain in a specific area of the body by removing body weight and providing support.
- Mindfulness and related techniques: Meditation, breathing exercises, progressive relaxation, and other mindfulness techniques can lead to relaxation of the body, which helps to alleviate stress and immediate pain. When immediate pain is relieved, and mental stress is managed, long-term pain can cause less harm.
Complementary and Alternative Approaches
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:
- Chiropractic adjustment
- Relaxation, spiritual traditions, or religious practice
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.
Many Approaches to Pain
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.