Treating Pain Without Opioids

Fatal Overdoses Climbed to Record High in 2019

There were 70,980 reported deaths from overdoses in 2019, surpassing the peak of 70,699 deaths in 2017, according to preliminary CDC data. The numbers represent a 4.6 percent increase from the previous year.

The increase was largely driven by synthetic opioids like illicit fentanyl, though deaths involving methamphetamine and cocaine have been increasing.  A substantial portion of those are combination drugs, where fentanyl is being mixed with meth or cocaine.

Ending the addiction and opioid use disorder epidemic requires us to do more to take on this illness at the source. One way to do this is to curb the over-prescribing of opioid-based painkillers. While we have seen a decline over the past few years in the United States in opioid prescriptions, in 2018 doctors wrote over 168,000 prescriptions for opioid pain killers. Taking opioids for as few as five days can increase the risk of long-term use, and users of heroin often start by using prescription opioids. As the National Opioid Commission stated, “We have an enormous problem that is often not beginning on street corners; it is starting in doctor’s offices and hospitals in every state in our nation.”

List of Common Narcotic Pain Meds

This is a list of the most common narcotic pain medications used today. The consequences of their widespread use has been deadly and it’s essential that we continue to find ways to reduce our reliance on these medications to manage pain.

  • Codeine
  • Fentanyl
  • Hydrocodone
  • Vicodin
  • Demerol
  • Morphine
  • Oxycodone
  • Percocet
  • Methadone
  • Hydromorphone

Second, let’s take a look at common non-opioid pain medication used in place of these narcotics to treat pain without opioids.

  • Acetaminophen (Tylenol)
  • Ibuprofen (Advil)
  • Naproxen Sodium (Aleve)
  • Aspirin (Bayer)
  • Gabapentin (Neurontin)
  • Corticosteroids (Prednisone)
  • Tricyclic Antidepressants (Amitriptyline)
  • Topical Agents (Lidocaine)

As you can see, there are many different types of non-narcotic pains meds used for treating pain without opioids.

What is the Strongest Non-Narcotic Pain Killer?

Two of the most powerful non-narcotic pain killers are IV versions of the OTC pain meds acetaminophen and ibuprofen.

Ofirmev

Ofirmec is IV acetaminophen, and is used for managing mild to moderate pain. IV acetaminophen has also been shown to decrease opioid consumption after major surgery by nearly one-third compared with placebo.

Caldolor

Caldolor is IV ibuprofen used for management of mild to moderate pain to eliminate, or reduce, opioid pain medication. Similar to IV acetaminophen, studies have shown IV ibuprofen decreases pain scores and opioid usage.

These powerful non-narcotic pain killers come with their own side effects. The most common side effects are developing kidney or liver problems. They can also cause severe allergic reactions with hives, difficulty breathing, swelling of your face, lips, tongue, or throat.

Why You Should Consider Alternative to Opioids

While there are a time and place for opioids, other pain management techniques are available to help reduce pain without the fear of overdose or addiction. Some of the reasons to consider treating pain without opioids include:

  • It reduces the risk of overdose
  • Opioids do not address the source of the pain
  • Opioids do not increase function
  • Opioids may increase pain and pain sensitivity over time (doctors call this condition enhanced pain sensitivity)
  • Opioids don’t relieve neuropathic (nerve) pain

Non-Narcotic Pain Management Using Physical Therapy and Medication

Acupuncture

Acupuncture is a traditional Chinese medicine that involves inserting small, thin needles into key areas of the body to re-direct energy flow in the body. Several studies suggest that acupuncture works particularly well at addressing chronic back and neck pain, knee pain, and headache. There is also some evidence to suggest that acupuncture may help prevent migraines.

Some people don’t like the idea of acupuncture because they’re afraid of someone sticking and leaving needles in their bodies. However, the needles are very small and thin. They aren’t meant to inflict pain, but instead, they relieve pain by releasing endorphins, the body’s natural pain-killing chemicals, and work to improve an overall sense of well-being.

Exercise

Exercise involves moving, stretching, and engaging in physical activity. Though it may seem counterintuitive, exercise can help some people address chronic pain. Exercise helps maintain a healthy weight, which helps to reduce pain related to conditions like arthritis. Also, exercise helps to relieve stress and anxiety while also releasing chemicals in the brain called endorphins. These are feel-good chemicals that can help reduce pain naturally and increases a sense of well-being.

The Cochrane Database of Systematic Reviews conducted a review of studies about exercise and pain relief.1 They included 21 studies that enrolled more than 35,000 participants. Some of the pain-related conditions they studied included low back pain, rheumatoid arthritis, spinal cord injury, and patellofemoral (knee) pain.

Researchers found that exercise helped to reduce pain severity and improved physical function in people with chronic pain. Those with chronic pain who engaged in exercise also reported an improved quality of life compared to those who did not exercise.

It’s important to understand that some people may have medical conditions that prevent rigorous exercise. It’s always important to talk to your doctor before starting an exercise program if you have concerns about physical ability. Doctors may be able to suggest adaptive exercises or low-impact movements that would work better for you.

Nerve Blocks

Nerve blocks are a non-opioid pain treatment approach where a doctor injects a local anesthetic into the skin and around nerves that are responsible for the pain. While doctors can’t block all nerves, they can typically block abdominal, knee, back, and shoulder pain. Sometimes, doctors will insert special catheters (small, thin plastic tubes) that can deliver continuous amounts of a local anesthetic to provide longer-lasting pain relief.

Non-Narcotic OTC Medications

Opioid medications like morphine, fentanyl, and hydrocodone aren’t the only medicines that can relieve pain. There are over-the-counter(OTC) medications that provide pain relief. The benefit of these medicines is that they don’t have the addictive potential of opioids. While it is possible to overdose on some OTC medications, the amount you’d have to take is extremely high.

Examples of non-opioid medications used to treat pain include:

  • Ibuprofen (Advil, Motrin)
  • Acetaminophen (Tylenol)
  • Aspririn (Bayer)
  • Naproxen Sodium (Aleve)

These medications often work to relieve inflammation and reduce pain in the body. They’re inexpensive and usually available as generic options. When used in combination with other treatments, like physical therapy, non-opioid medicines can effectively help manage pain.

 

Non-Opiate Prescription Pain Killers

Corticosteroids

Corticosteroids act like hormones you produce naturally in your adrenal glands. Corticosteroids lower inflammation in the body and reduce immune system activity. Both these effects can help with non-narcotic pain management. These drugs are used to treat rheumatoid arthritis, lupus, and Addison’s disease. Corticosteroids are taken in several ways:

  • By mouth
  • By inhaler or nasal spray
  • Topically
  • By injection

Corticosteroids have many potential side effects and need to be monitored closely by your doctor.

 

Tricyclic Antidepressants

Antidepressants have been found to be effective in treating many different types of pain, including:

  • Multiple Sclerosis
  • Diabetes
  • Shingles
  • Arthritis
  • Migraines
  • Fibromyalgia

We don’t know exactly how these non-narcotic drugs control pain, but it is thought that they might reduce pain signals in the nervous system. Tricyclic antidepressants affect two chemicals in your body, serotonin and nor-epinephrine. Serotonin and nor-epinephrine reuptake inhibitors (SNRIs) affect those chemicals. The SNRI duloxitine (Cymbalta) is the approved for treating pain.

 

Gabapentin

Gabapentin (Neurontin) is an anticonvulsant used to control seizures, but it has been found to control some types of pain. It’s also used to treat headaches, diabetic neuropathy, and fibromyalgia. It’s also a sedative used to treat many other conditions. Gabapentin is one of the most prescribed non-narcotic medication because of this versatility.

 

Factors That Can Make Pain Worse

Different people experience pain in different ways. Two people can have the same surgery, with one person experiencing significant pain afterward, while the other quickly recovers. While the person who is still in pain isn’t at fault, this example shows how pain is a complicated issue that affects both the mind and body.

Some of the factors that doctors have found can make pain worse includes:

Anxiety

Sometimes fear and worry about pain can be as crippling as the pain itself.  Treating anxiety has been shown to reduce reliance on pain medications.  Using techniques such as distraction, creating a non-threatening medical environment, and helping patients learn how to deal with feelings of anxiety can be extremely helpful in addressing chronic pain.

Inactivity

While there is a time to rest an acute injury, not moving usually does more harm than good when it comes to chronic pain.  When the body isn’t active, there is a tightening of muscles and tendons that can cause additional stress.  Also, people who don’t engage in regular exercise are more likely to be obese.  Carrying extra weight and not engaging in physical activity can increase pain, especially in the lower back and knees.

Mood Disorders

An estimated 61 percent of patients who take opioids and struggle with chronic pain experience major depression.  The conditions are closely linked, and doctors think depression can cause chronic pain just as chronic pain can cause depression.

If you find you are struggling with depression, it is important to talk to your doctor about your feelings.  Some people end up accidentally self-medicating with opioids as a means to escape feelings of sadness and depression.  Medications and therapies are available to help address feelings of depression.  These strategies can decrease opioid use and address chronic pain more effectively.  This isn’t always true for all people, but it can be worth trying if you struggle with chronic pain and depression.

Stress

Chronic pain and chronic stress are closely related.  In fact, one article published in the journal Chronic Stress described the two conditions as “two sides of the same coin.”  Doctors believe that chronic stress can lead to a dysregulation in the brain.  This means that too much or too little brain activity is experienced in response to stress.  This can aggravate a number of conditions, including chronic pain in the body.

Stress is a common experience for many individuals, but daily and continued stress overwork, social interactions, health conditions, and chronic pain can impact a person’s overall perception of health and well-being.  The results can be an increased pain experience.  People who experience chronic pain should take steps to reduce overall stress levels, which can often lead to a mild to dramatic improvement in overall health and well-being.

Finding Pain Relief Free from Opioids

Narcotic pain meds aren’t the only option when it comes to treating pain. While they may represent a beneficial treatment for some, taking steps to better respond to pain and increasing overall health through movement, diet, and better sleep can also help reduce pain.

If you aren’t quite sure where to start, talk to your doctor about your pain and overall health. You can discuss some of the interventions mentioned in this article and determine what will help you live better with your chronic pain. While you may not get the same immediate results that you might with a pain pill, non-opioid strategies can provide a safer and longer-lasting solution to managing chronic pain.

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2020-08-05T20:14:58+00:00August 7th, 2020|Articles|