Managing Chronic Pain Without Opioids

The CDC estimates that more than 20% of U.S. adults experience chronic pain. Perhaps more significant is the fact that 8% of have high-impact chronic pain. (1) High-impact chronic pain is characterized as pain which lasts at least 3 months and comes with at least one major activity restriction. In other words, pain that someone lives with and has a significant effect on their life.

Risks of Prolonged Opioid Use

Since the dawn of modern medicine, opioids have been the traditional go-to for any serious pain. The options to relieve pain without opioids were quite limited. Aspirin and acetaminophen have been around since the late 19th century and were effective, but relatively short-acting and not nearly as effective for moderate to severe pain.

Opiate medications are still unsurpassed for effectiveness when it comes to severe short-term pain. But chronic pain patients have a unique predicament because they need solutions that are compatible with their lifestyle. What is effective for short-term pain may not be appropriate or even safe as a daily regimen for years. But until relatively recently, doctors did not have viable alternative non-opioid pain relief options for chronic pain patients. Even today, millions of chronic pain patients find themselves stuck in a vicious cycle.

People can begin to become opiate tolerant after just a week of use. Over longer periods, they not only experience withdrawal if they stop, but the same amount of opioid medication no longer delivers the same relief. Doctors, increasingly aware of opioid abuse are often reluctant to prescribe more medication. The chronic pain patient may find themselves running out of prescribed medications too early for a number of reasons. Then the panic sets in. They are faced with a terrible dilemma. Suffer until their next doctor visit? Or seek opioids in whatever form they can find them on the black market.

Alternatives to Traditional Opioids

To call this an imperfect situation is an understatement. Between opioid side-effects like constipation, withdrawal symptoms and tolerance, it’s a lot to endure. The demand for better solutions for chronic pain patients has been present for decades. Acupuncture, therapeutic massage and chiropractic have been helpful supplementals. But science is finally delivering a diverse array of options for chronic pain patients to relieve pain without opioids. Here are just a few.

  • Long-acting non-steroidal anti-inflammatory drugs (NSAIDS) and COX-2 Inhibitors
  • Select Anticonvulsants (e.g. Pregabalin, carbamazepine)
  • Select Antidepressants (e.g. Tricyclics and SNRIs)
  • Topical Agents (e.g. Lidocaine, Capsaicin, topical NSAIDS)
  • Corticosteroid injections
  • Transcutaneous Electrical Nerve Stimulation (TENS)

We are even beginning to see non-opioid pain relief for post-surgical pain. A new generation of local anesthetics such as Exparel (bupivacaine liposome) has shown a lot of promise in this area. Medical science still hasn’t eliminated the need for opioid medications. There is a good possibility we won’t transcend opiates entirely for decades, if ever. There may also be circumstances under which doctors still feel an opioid medication is the best option for a chronic pain patient. We have now seen many thousands of chronic pain patients successfully relieve pain without opioids. As always, you should follow your doctor’s guidance. But be aware that non-opioid pain management is a reality and more and more professionals are informed about the issue. If you are a chronic pain patient who is tired of being opioid-dependent, give us a call to discuss the options for care.