Managing Chronic Pain Without Opioids

Managing chronic pain without opioids is a goal for many patients, as doctors and patients are realizing the risks of long-term opioid misuse. On one hand, chronic pain conditions (nerve pain, arthritis, low back pain) are affecting a growing segment of America’s population. On the other hand, a full-blown opioid crisis is making headlines due to medication misuse, overdose, and addiction.

Faced with the serious risks associated with opioid use, pain specialists seek a comprehensive treatment for their patients.

At NSPC, we feel it is important to communicate with our patients and offer them the appropriate non-opioid treatments for chronic pain. Our patients have a wide range of treatment choices, in the form of non-opioid medications and minimally-invasive procedures.

Chronic pain

• Chronic pain is different from acute pain, the short-term pain you feel when you sprain your wrist or pull a muscle. Acute pain usually improves within a month. However, chronic pain can last for months or even years.
• It starts after an injury such as a back sprain or an illness such as arthritis. There may be no known trigger.
• There are different forms: inflammation, nerve pain, nociceptive pain (i.e. pain from a wound or a fracture).
• People with chronic pain have higher rates of depression, anxiety, sleep problems, and sexual dysfunctions.
• Changes occur in how a person feels pain. The focus shifts to the brain and spinal cord. Treatments have to act directly on these two organs. Treatments include antidepressants, spinal stimulation, and pain pumps that release medicine directly to the spinal cord.

For more information, click here.

Opioids

• Opioids are strong medications that act in the brain and spinal cord, to prevent you from feeling pain.
• They have moderate to high abuse potential and are listed on various “Substance-Control Schedules” in the United States.
• ften misused by people who don’t suffer from pain. In 2013, between 13 and 20 million people used opiates recreationally (0.3% to 0.4% of the global population between the ages of 15 and 65).
• Legitimate chronic pain patients can become tolerant to prescription opioids. The medication’s effect decreases over time. Addiction is another unintended outcome of chronic opioid use. It is a dysfunction and a disease where a person pursues the opioid agent.
• At high doses, opioids act on the brain to stop a person’s drive to breathe. This may result in death.
• Naloxone is a medication used in emergencies when a person stops breathing after taking opioids. Doctors prescribe this medication for home use to patients who are at risk for overdose.

Risks of opioid treatment

Although opioids are strong painkillers, they are often a poor choice in the long term. There are several reasons why opioids may stop working. Knowing these reasons helps you understand why non-opioid treatments are so important.

• Pain relief can decrease over time as patients become used to opioids and require increasing doses (tolerance).
• Extended opioid use can actually increase pain (hyperalgesia). Hyperalgesia is different from tolerance.
• Opioids are effective for pain after fractures, surgeries, headaches, etc. However, opioids as the sole therapy are poor choices for inflammation and nerve pain.

Managing pain without opioids

Treatments are divided into:

1. Non-opioid medications
2. Injections
3. Minimally-invasive procedures
4. Alternative treatments

Non-opioid medications

These medications work through different mechanisms. Combining different medications increases the overall pain relief and allows a person to take lower doses of each medication. This can reduce side effects. When you take your medications on a schedule, you maintain the right level of medicine in your blood and prevent pain flare-ups.

Common types of medications for pain relief:

• Acetaminophen (Tylenol) – An over the counter pain reliever used for osteoarthritis, lower back pain, and migraine.
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) – Over the counter medicines for inflammation relief, such as Naproxen (Aleve) or aspirin are used for osteoarthritis and minor muscle or tendon aches.
• Prescription anti-inflammatories – Medications such as Celecoxib (Celebrex) are effective for low back pain without sciatica (nerve pain that travels down the leg).
• Anti-seizure medications – Anti-seizure medications such as Pregabalin (Lyrica), Gabapentin (Neurontin) can treat pain. They are used for nerve pain including diabetic foot pain, herpes zoster pain, or fibromyalgia.
• Antidepressants – At low doses, medications such as Amitriptyline (Elavil) or Duloxetine (Cymbalta) can treat nerve pain.
• Topical Agents (creams, sprays, patches) – A great first-line treatment. They are safer because they lack the widespread body effects of medications in pill form. Examples: Lidocaine cream or patches for nerve pain. Capsaicin cream can treat muscle, joint, and nerve pain.

Injections

Your pain specialist performs injections in their office. It often takes less than 10 minutes. You get to go home shortly after. These procedures are offered before you consider more invasive options.

Steroid Injections – Your pain specialist places medicine next to your area of back, joint, or nerve pain. Effects can last days to months. Your pain may stop permanently.

Regenerative injections – Your own cells and platelet growth factors are injected in your area of pain in order to relieve low back pain and treat other joint areas such as knees, shoulders, hips.

For more information, click here.

Minimally-invasive procedures (may require implant of a small device)

• Kyphoplasty – This procedure restores the original height and angle of your backbones by placing filler material in bone areas that need it. It is used to treat fractures in people with osteoporosis.
• Radiofrequency ablation – This treatment uses heat to treat a certain nerve that is causing joint pain. It can stop pain in arthritic or injured joints in the neck, back, pelvis, and knees.
• Pain pumps – Your pain specialist places a small device that delivers medications (opioids, numbing agents) directly to the fluid around the spinal cord. This method of delivering opioids does not cause addiction. The pump is placed under your skin in an area that is concealed, such as the abdomen. Pump implant involves an operating room procedure in a hospital or outpatient center. This device functions for months at a time before you need a medication refill.
• Spinal cord or dorsal root ganglion stimulators – These therapies relieve pain by blocking pain messages before they reach the brain. Instead of feeling pain, patients feel a tingling sensation. They are used for chronic pain in the beck, arms, legs, and other areas. Your pain specialist places a small battery-operated device in your back. It sends electrical pulses to your spinal cord or neighboring structures (such as the dorsal root ganglion) and blocks pain signals.
• Peripheral nerve stimulators – These devices send healing bursts of electricity to treat pain caused by a specific nerve. They are useful for arm, leg, face pain.

Alternative treatments

Take control of your pain and to adopt helpful coping mechanisms, on your own schedule. These treatments improve your general well-being and usually show immediate results.

• Exercise
• Meditation
• Assisted therapies (massage, acupuncture)

Click here to read more about alternative treatments from our past blog postings.