Opioids Alternatives for Pain

What to do when the pain is too much

Photo: Woman meditating in yoga class

Pain can arise from a wide range of causes. It can be the result of an injury from playing sports, a car accident, or other activities. Pain can be triggered by inflammation, damage to a nerve, cancer, or other conditions. It can be short-term (acute) or a long-term (chronic) problem that lasts weeks, months, or even years.

In recent years, opioids have become a commonly prescribed treatment for a variety of types of pain. They are quick-acting and easy to use. However, many problems with the drugs have also occurred. In some cases, they have been overused or patients have not been properly screened, leading to adverse events like substance abuse disorders, overdoses, and death. It is now understood that opioids should be reserved for carefully selected and monitored patients, with proper ongoing screening.

According to the American Academy for Pain Medicine, opioids should not be the first option for chronic pain management, and if used, they need to be part of a comprehensive pain management plan. Caution should be used if making the decision to use them long-term. With the U.S. now in the midst of an opioid crisis, more attention is being given to the careful prescription of opioids for acute pain, limiting their use for chronic pain, and expanding pain management to include non-opioid therapies.

Generally, various types of pain can be managed with a combination of analgesics, including non-opioids, active therapy, mind-body techniques, and behavioral medicine interventions. What is needed for individuals varies and needs to be guided by a doctor. Here are some possible alternatives for helping manage pain.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These are medications that can play a role in decreasing pain that is related to inflammation or trauma. While many NSAIDs are sold over the counter at local pharmacies, there are also more powerful ones available only by prescription. NSAIDs are often used for arthritis and for pain resulting from muscle sprains, strains, back and neck injuries, and menstrual cramps. However, long-term use or using too large a dose can lead to complications such as stomach bleeding, ulcers, cardiac damage, and kidney damage. NSAIDs can also interact with other medications. Always consult your doctor before taking any over the counter NSAIDs.

  • Antidepressants. While commonly used for treating depression and anxiety, some antidepressants can be used for their analgesic or pain-reducing effects. The most common antidepressants used for chronic pain include tricyclic antidepressants and serotonin and norepinephrine reuptake inhibitors. These antidepressants impact pain signals transmitted within the central nervous system, decreasing pain signaling at the spinal cord and brain. Common side effects may include drowsiness, dry mouth, blurred vision, constipation, insomnia, blood pressure changes, confusion, and dizziness. Antidepressants are not usually recommended for individuals with heart disease. If you experience any of these side effects follow up with a healthcare professional.

  • Anti-seizure medications. In some cases, anti-seizure medications may help relieve nerve-related pain that results from nerve damage. It is believed that they work by acting on damaged or sensitized nerves to slow or prevent uncontrolled pain signals. These medications include gabapentin (Gralise, Neurontin) and pregabalin (Lyrica). Side effects can include dizziness, drowsiness, nausea, short-term memory problems, weight gain, and problems with balance. If you experience any of these side effects follow up with a healthcare professional.

  • Physical or occupational therapy. Physical therapy includes active and passive approaches. Active approaches include strengthening exercises and stretching. Passive approaches include ultrasound, soft tissue massage, and heat and ice. Occupational therapy focuses on assessing function and instructing patients on better ways to pace activities and do them in a more sound, ergonomic fashion. More specialized occupational therapy may be focused on hand injuries, upper limb rehabilitation after surgery, bracing, and other strategies to protect limbs or joints from injury.

  • Behavioral health interventions and mind-body techniques. Behavioral health interventions include counseling, cognitive behavioral therapy, relaxation training, and mindfulness-based stress reduction. Mind-body techniques include yoga and tai chi. Cognitive behavioral therapy focuses on identifying thoughts and beliefs about pain, managing underlying depression and anxiety, and learning techniques to better cope with pain. Mindfulness-based stress reduction focuses on helping patients to be in the present, while also being more aware of their surroundings and separating the physical aspects of pain from the emotional ones. These techniques have been shown to be effective for various chronic pain conditions.