Opioid Alternative Treatments

Millions of Americans suffer from chronic headaches or back pain. Others are recovering from surgery, sports injuries, or accidents. Every year, prescription opioids are used to treat moderate-to-severe pain. Because they have several serious side effects, it is important to learn more about the benefits and risks of opioids. Prescription opioids are powerful, can cause serious side effects, and lead to addiction.

CHRONIC PAIN

More than 100 million American adults suffer from chronic pain. Chronic pain is pain that doesn’t go away and lasts three months or longer. Common causes include muscle injuries that don’t heal, fibromyalgia, musculoskeletal pain, and shingles.

Examples of chronic pain include:

• Arthritis in your knees.
• Surgical pain that isn’t treated properly.
• Migraine headaches.
• Back pain.

When pain lasts fewer than three months, it is considered acute pain. It can be pain that starts suddenly in response to an injury like a cut, bruise, burn, a broken bone, or pulled muscle. Acute pain also occurs after surgery. It can be caused by a fever, infection, or labor contractions. Labor pain, postoperative pain, and broken bones are all examples of acute pain, which can be effectively managed for most people with medication, physical therapy, and massage.

Sometimes acute pain can become chronic pain. A sports injury that isn’t diagnosed and treated correctly can lead to long-term damage to joints or muscles. Certain injuries can cause nerve damage. Postoperative pain that isn’t managed appropriately can lead to chronic pain.

OPIOIDS

Opioids (narcotics) are medications prescribed by physicians to treat persistent, acute, or severe pain. They can be part of effective pain management for people recovering from surgery or experiencing severe pain associated with cancer, serious injuries (such as falls or auto accidents), or from severe, chronic conditions like migraine headaches or fibromyalgia. Opioids can lead to addiction and overdose. They can and should only be used under the careful supervision of a physician.

Besides addiction, opioids have serious side effects, including some that are life-threatening. Opioid side effects include sleepiness, constipation, nausea, shallow breathing, slowed heart rate, and loss of consciousness.

In Florida, health care practitioners are required to do the following when prescribing, ordering, or administering Schedule II opioid drugs for the treatment of pain:

1. Inform patients of non-opioid alternatives for the treatment of pain.
2. Discuss the advantages and disadvantages of the use of non-opioid options, including whether the patients are at high risk of or has a history of controlled substance abuse or misuse and the patient’s personal preferences.
3. Provide patients with an educational pamphlet about the use of non-opioid alternatives created by the Florida Department of Health.
4.  Document the non-opioid options considered in the patient’s record.

OPIOID-ALTERNATIVE MEDICATIONS

There are many over-the-counter opioid-alternative medication options, such as Tylenol (acetaminophen) and aspirin, Motrin, and Advil (non-steroidal anti-inflammatory drugs-NSAIDs). Your physician may recommend using Advil/Motrin (ibuprofen) in combination with Tylenol (acetaminophen) depending on the type and cause of your pain. This combination can be as effective as opioids in controlling pain. These medications should only be combined as directed by a physician.

Your physician may also prescribe antidepressants, anti-seizure medications or steroids and suggest a combination of medications to address different aspects of your pain.

OTHER ALTERNATIVES

Medication may not be the only effective option for relieving your pain. Relief can be found with non-drug therapies used alone or in combination with drugs. These non-drug therapies include physical therapy, acupuncture, surgery, injections, and nerve blocks. Many patients also find relief with high-tech treatments using radio waves and electrical signals. Massages and other relaxation techniques, including biofeedback, where you learn to control involuntary functions such as heart rate, can bring pain relief.

ACUPUNCTURE – You may find relief from acupuncture, where thin needles are inserted at different places in your skin to interrupt pain signals.

CHIROPRACTIC CARE – Using manual, mechanical, electrical, natural methods, physical therapy, nutrition and acupuncture, chiropractic physicians treat and rehabilitate pain, diseases, and conditions. Chiropractors use a hands-on, prescription drug-free approach to health care to treat neuromusculoskeletal complaints, including back pain, neck pain, pain in the joints of the arms or legs, and headaches.

ELECTRICAL SIGNALS – Transcutaneous electrical nerve stimulation can provide short-term pain relief, especially for various types of muscle pain. This technique sends low-voltage electrical signals from a small device to the painful area through pads attached to the skin. While researchers aren’t exactly sure why it works, they think it may either interrupt the nerve signals to the brain or stimulate the production of “feel good” endorphins – the body’s natural painkillers.

INJECTIONS OR NERVE BLOCKS – If you have muscle spasms or nerve pain, injections with local anesthetics or other medications can help short-circuit the pain.

NERVE BLOCKS – Using X-ray imaging, pain medicine physicians can inject numbing medication that blocks or dampens pain and might even stop chronic pain from developing. The location of the injection depends on the source and type of pain. For example, pain in the arm or face can be relieved by blocking nerves in the neck. Relief may need a series of injections and repeated treatment.

PAIN PUMPS – Special pumps can be implanted to allow a patient to push a button and deliver pain medications to their spinal cord. This can bring relief without the side effects that often come with taking these drugs by mouth. Patients also get a psychological boost by having direct control over their pain. These spinal drug pumps are used most often by people with cancer pain and by patients with other types of pain who had side effects when orally taking the medication.

PHYSICAL THERAPY – A physical therapist or physician who specializes in physical medicine and rehabilitation can create an exercise program that helps improve your ability to function and decreases your pain. Whirlpools, ultrasound, and deep-muscle massages may also help.

RADIO WAVES – Radiofrequency ablation involves inserting a needle next to the nerve responsible for the pain. The electric current created by radio waves burns the nerve, short-circuiting the pain signal.

SPINAL CORD STIMULATION – When other methods fail, your physician might recommend spinal cord stimulation (SCS), which uses a pacemaker-like device that replaces the pain with a more tolerable sensation (typically a tingling or massage-like feeling.) The device is implanted in the lower back, attached to tiny wires that are in the spinal canal. When patients feel pain, they can use a remote control to send signals to the painful area. This technique can help with back pain as well as nerve damage in the legs that causes numbness and pain (neuropathy), common in people with diabetes. New forms of SCS show promise in relieving pain without the tingling.

SURGERY – When other treatments aren’t effective, surgery can be performed to correct abnormalities in your body that may be responsible for your pain.

If you suffer from chronic pain and would like to discuss non-opioid alternative treatments, contact the specially trained physicians at Florida Orthopaedic Institute.