Alternative to Opioids for Chronic Pain

Alternative to Opioids for Chronic Pain

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Chronic pain is often defined as pain that lasts for 3 to 6 months or more. Chronic pain can be caused by certain conditions or past injuries with pain that persists long after injuries have healed. It is not unusual for more than one condition to contribute to high levels of ongoing pain. Examples include low back pain, arthritis, headaches, nerve and muscle pain, and shoulder or neck pain. Research suggests chronic pain is related to changes to the nerves that can grow worse over time.

As the pain persists, it can become harder to function at normal levels and may affect all aspects of a person’s life. Chronic pain may force people to give up activities they once enjoyed, leading to feelings of isolation and depression. It can interfere with work, sleep, mood; contribute to relationship difficulties; and lead to overreliance on alcohol and drugs (prescribed or otherwise).

Opioids are not the first-line or most effective treatment for non-cancer chronic pain.

Managing Chronic Pain

Many people work with their doctors to find medications that offer relief from chronic pain. In some cases, opioids are useful, typically on a short-term or intermittent basis to control flare-ups or breakthrough pain. However, research shows that injured workers who mainly rely on prescribed opioids for long periods tend to lose more ground than they gain.

A variety of non-opioid medications can be used safely and work well in combination with other treatments for ongoing management of long-term chronic pain. Some examples include:

  • Non-opioid pain relievers, such as acetaminophen (Tylenol®) or non-steroidal anti-inflammatories (NSAIDs) like ibuprofen (Advil®).
  • Some antidepressants and anticonvulsants, which work on the nerve pathways contributing to chronic pain.

Goals of Pain Management

Controlling pain is just one of several important goals of pain management. Others include:

  • Regaining the ability to take part in important activities
  • Preventing further loss of functioning or additional limitations
  • Making accommodations to reduce discomfort at work and other activities
  • Learning to cope with stress and the difficulties chronic pain may cause

If opioids are part of your treatment for chronic pain it is important to talk with your doctor about other medications you take and how much alcohol you drink. You and your doctor may agree in advance on a plan to gradually discontinue opioids and a pain management contract that limits the amounts and frequency of their use.

For more information, check out: Chronic Pain Medicines from the American Academy of Family Physicians, which lists risks and benefits of a variety of different medications that are used to treat chronic pain.

Complementary Treatments

Complementary treatments are often combined with medications and other approaches to help manage chronic pain. Your doctor may refer you for:

  • Physical therapy, which could include exercises to improve range of motion and decrease pain.
  • Occupational therapy, which could include adaptative devices or activities to reduce pain levels, such as making adjustments to reduce discomfort at work, learning to pace yourself, and avoiding re-injury.
  • Behavioral or psychosocial therapy, which could include stress reduction and relaxation techniques.

Check out these resources: Information on complementary treatments for chronic pain

Alternative and Other Treatments

Acupuncture, massage, and spinal manipulation are examples of approaches that can help people with chronic pain but may not be a part of what doctors traditionally offers.

There are a variety of alternative treatments people find helpful, and there are some that are not used as often, but some research suggests may help with chronic pain.

  • Stimulation, such as transcutaneous electrical nerve stimulation (TENS), which uses electrical currents to stimulate the skin and superficial tissues, or transcranial magnetic stimulation (TMS), which stimulates parts of the nervous system that are related to chronic pain.
  • Injections, often called “interventional approaches,” such as cortisone or other steroid shots or nerve blocks.
  • Surgical treatments, pain pumps, and spinal cord stimulators. Both the patient and doctor carefully consider the risks versus the benefits involved with these treatments.

Staying Informed

The more informed people are about medications, complementary and alternative options, and new treatments for chronic pain, the more likely they are to find the right combination that works for them.

For more information, check out: Fact sheets from the National Center for Complementary and Integrative Health:

These materials are intended for educational purposes only. The information provided is not intended to diagnose, treat, cure or prevent any disease or condition, nor is it intended to substitute for clinical or medical care. Decisions about treatment of medical and behavioral health conditions and the use of medications are the sole responsibility of the patient, treatment providers, treating physician and other qualified healthcare professionals. Not all treatment options presented are appropriate for all patients or conditions. Talk with your physician about what course of treatment is best for you.

Problem opioid use can be treated. The sooner people ask for help, the better. To locate help in your community for yourself, a co-worker, or a loved one, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website at www.samhsa.gov or call SAMHSA’s free, confidential, 24/7 National Helpline at 1-800-662-HELP (4357).