One of the biggest concerns in the field of chronic pain management is the use of opioids to treat chronic pain.
As the opioid epidemic continues, healthcare providers are looking for alternative ways to treat chronic pain in the hopes of reducing the number of people with an addiction to opioids.
Some of these alternatives are still being researched and their effectiveness in reducing opioid dependence hasn’t been established.
Nevertheless, it is worth considering these opioid alternatives especially as initial treatment options for pain.
Opioid Pain Relievers In Light Of the Opioid Epidemic
The roots of the opioid epidemic can be traced to the latter half of the 1990s, when pharmaceutical companies were telling doctors that opioids were not addictive.
This led to doctors prescribing opioid medications such as Norco, Vicodin, or OxyContin at greater rates than before.
But opioids are highly addictive, and it is generally believed that the increase in prescription opioids led to the epidemic that is currently ongoing in the United States.
Stats On The Opioid Epidemic
According to the U.S. Health and Human Services (HHS), nearly three-quarters of drug overdoses in 2020 involved opioids.
The HHS estimates that more than 1.5 million people had an opioid use disorder in 2021.
It is also generally believed that the prescription opioid epidemic has led to an increase in heroin use and addiction.
Why Opioids Are Used For Chronic Pain
Chronic pain can be debilitating to a person’s mental health and general quality of life.
Opioids are used to treat chronic pain disorders because they are effective pain relievers. They work by binding to opioid receptors that are distributed widely throughout the body.
These receptors interact with the central and peripheral nervous system as well as endorphins, which have a number of functions in the body, including modulating pain.
It is this broad effect that makes opioids so effective at relieving pain.
A Brief History Of Opioids
Opioids are synthetic drugs that derive from the opium poppy. They are a relatively modern invention, but opium has been used as a pain reliever for centuries, possibly starting with the Sumerians in 3400 B.C.
In the 19th century, morphine became the first opioid synthesized from opium, and this century also saw the invention of the hypodermic needle, which could be used to inject morphine for quick-acting pain relief.
The Dangers Of Opioids
Not coincidentally, the 19th century saw the growth of morphine addiction and the first attempts to treat it.
A German doctor named Eduard Livenstein was the first to postulate that addiction to morphine was physical, not just psychological. He also identified opioid withdrawal symptoms and the cycle of relapse.
Opioids have side effects that can make the experience of taking them unpleasant.
These side effects can include:
- constricted pupils
- respiratory depression
- sleepiness or drowsiness
Opioids can also make people feel very relaxed or “high,” which is partly what makes them so addictive.
Opioids Are Addictive
Modern opioid painkillers create physical dependency with long-term use, and they can also create psychological addiction.
Psychological addiction happens as a result of the reward and reinforcement response that can take place when a person takes an opioid and experiences the relief of pain.
People who experience this reward response to opioid medication can grow to value the pleasurable effect of the drug over the pain relief it brings.
When people use opioids for chronic pain, which necessarily means using opioids over a long period of time, there can be a danger of overdose.
Over time, people can develop a tolerance to opioid pain medicine. This can lead them to take more of the medication in order to get the same relief from the pain that they experienced before.
This trend, especially with powerful opioids like OxyContin or fentanyl, can lead to overdose.
Types Of Chronic Pain
Chronic pain has become a bucket term that can include different types of pain from many different sources.
Chronic pain can include moderate pain in the joints or muscles to severe pain from injuries or cancer.
Sources of chronic pain can include:
- end-of-life stage of cancer or general cancer
- acute pain from unresolved injuries
- neuropathic pain
Chronic pain can come and go, but it is experienced over a span of at least three months.
Alternatives To Opioids For Chronic Pain
Medical professionals have been exploring alternative treatments for chronic pain that involve non-opioid medications or non-pharmacological treatments.
Over-The-Counter Pain Medications
Over-the-counter (OTC) medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) are one option for non-prescription pain relief.
Examples of OTC medications for pain relief include:
- acetaminophen (found in Tylenol products)
- ibuprofen (Advil and Motrin)
- naproxen (Aleve)
- capsaicin, a topical analgesic
OTC medications work well for minor injuries but additional treatment is typically required for chronic pain conditions.
One way to counteract pain is to get patients involved in physical activity using therapeutic exercises to gently work and strengthen the muscle or muscle groups that are causing the pain.
Physical therapy has been shown to help reduce pain as functionality improves. This may not always be the case, but creating movement may be a good place to start for some people.
Transcutaneous Electrical Nerve Stimulation (TENS)
A TENS unit is a device that sends a low-voltage current through adhesive electrodes into an area that is painful.
Recent studies have been inconclusive about the efficacy of TENS in treating pain, but doctors may still recommend it based on their experience with this form of treatment.
Removing opioids from the equation of long-term pain management does not necessarily mean eliminating prescription medication altogether.
The class of medications known as serotonin and norepinephrine reuptake inhibitors (SNRIs) has been used to treat pain that is neuropathic in nature. In particular, duloxetine (Cymbalta) has been shown to be effective.
Studies have found that SNRI antidepressants can be effective at treating nerve pain and have the additional benefits of elevating mood and helping patients establish good sleep patterns.
Another class of drugs that have been prescribed for pain is anticonvulsants, particularly gabapentin and pregabalin. Both medications are prescribed off-label to help with nerve pain.
One study has shown gabapentin to be effective in treating pain, while others have been inconclusive or shown weak evidence in support of the use of this class of drug for pain relief.
Injections For Pain
Another approach to chronic pain is to inject medication directly into the area that is chronically painful.
There are several different types of injection interventions involving different medications that can be used to treat pain.
This type of treatment involves injecting corticosteroids into joints, reducing inflammation. If chronic pain is caused by inflamed joints, then this type of treatment may be effective.
People experiencing arthritis in their hips, knees, or other joints have received temporary relief from this method.
One study has also shown that steroid injections into joints can provide relief for some people with low-back pain.
Another type of injection is called a peripheral nerve block, which can be used to both treat chronic pain and diagnose it.
Examples of these nerve blocks include:
- medial branch nerve blocks
- intercostal nerve blocks
- genicular nerve blocks
- optical nerve blocks
Nerve blocks require more studies to determine their effectiveness in treating pain.
Trigger Point Injections
While nerve blocks deal with the nerve pathways, trigger point injections can be used to treat myofascial (muscular) pain.
Medications used in these injections can include a local anesthetic and steroids for reducing pain and inflammation.
Doctors will often use ultrasound technology to determine where to inject the medication.
Doctors can perform radiofrequency ablations to treat chronic nerve pain. This procedure uses thermocoagulation to form a clot of nerves, reducing pain in the affected area.
This method of pain management has been found to be effective on medial branch nerves, but less so on nerves involving the neck.
Other Alternatives For Chronic Pain Management
There are other opioid alternatives for chronic pain management that are part of what is sometimes called alternative healing or holistic medicine.
These alternatives may include:
- chiropractic care
- topical analgesics or other products made with CBD
More health insurance plans are providing coverage for alternative therapies today.
Reducing The Number Of People Addicted To Opioids
While opioids have been dependable pain relievers, their use comes with the risk of addiction. Because of this, doctors have been turning to other methods of pain treatment.
Many of these methods are still being studied, but doctors who have experience with them may recommend using them as a way of reducing the risk of addiction to or overdose from opioids.
Opioid Addiction Recovery
If you or a loved one are addicted to opioids, treatment options are available. Reach out to AddictionResource.net today to learn about opioid abuse recovery.
Published on February 1, 2023
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- Centers for Disease Control and Prevention
- Centers for Disease Control and Prevention
- Centers for Disease Control and Prevention
- Experimental and Clinical Psychopharmacology
- Jersey’s Best
- National Center for Biotechnology Information