Opioids have a long and complex history in medicine, from the discovery of opium in ancient times to the advent of modern-day chemistry, and brand-new isolated alkaloids like morphine, heroin, and codeine. However, for as long as people have used opium and its many derivatives, it’s always had the same two major flaws: it’s incredibly addictive, and it does not deal well with certain kinds of pain.
While powerful, the analgesic applications of opioids are limited in scope, and even in cases where their pain management is highly valued, it greatly diminishes over time and becomes much less useful in cases of chronic pain.
However, that doesn’t mean opioids aren’t both incredibly powerful, and very useful. Even in the context of the opioid crisis and numerous policy changes which aim to help refocus pain management towards non-opioid solutions, there is no denying the importance of opioids in medicine, especially for terminal and intractable pain.
The interest in finding and developing alternatives to opioids is high. While there aren’t many currently available medications that supplant opioids as an effective analgesic for very strong acute pain, alternatives are being researched and worked on. There are many other options in the repertoire of a pain management specialist.
Why Opioids Aren’t Always the Best Choice
There are several reasons why opioids are not always the best choice for pain management. Firstly, it’s important to identify why opioids have been the primary means of care and pain management for so long. Because of that, it’s taking this long to change it.
- They’re easy: the healthcare system being what it is, many doctors and patients face the same problem. Having their time and resources being short in supply. Pain pills often help doctors address their patients’ problems and work much faster. An alternative to opioids would be more expensive, like physical therapy, or something potentially ineffective like acupuncture.
- They’re profitable: the 90s saw a surge in painkiller prescriptions and painkiller ads, and opioids were selling much faster than ever before. However, this profitability also fed a cycle that fueled the rise of the worst opioid crisis in history and led the US to be the world’s largest consumer of opioids.
- They’re effective: opioids are a critical medical tool, and will continue to be important, especially in cancer pain. They would not have become so widespread if not for their usefulness. But the big question is, is it worth the risk? And are the alternatives good enough to replace it?
- They’re well-tolerated: there are few side effects to opioid use and very few people resist opioids. While the risk of addiction and subsequent overdose is not to be understated, opioids do not face very many contraindications that might greatly restrict their use otherwise. Still, side effects exist, as do allergic reactions.
Other Problems With Opioids
However, the ultimate issue with opioid medication is the fact that it is addictive. There are also other problems to consider.
- It’s not effective against neuropathic pain.
- It loses effectiveness over time.
- Could lead to hyperalgesia.
- It could be ineffective due to your genes.
Today, we understand that the best way to treat pain is to approach it from all relevant angles. There’s a lot that factors into how we perceive pain. Like from our mental well being, to our physical constitution, underlying conditions, dietary changes, sleep, hydration, exposure to heat or cold, and inflammation. By exploring a breadth of factors outside of the limited scope of opioid medication, modern-day pain management aims to find better alternatives to opioids.
OTC and Prescription Alternatives
There are other kinds of prescription medication that may help alleviate certain kinds of pain. One particularly effective type of drug is a tricyclic antidepressant. It acts both as an antidepressant, thus improving mood regulation, as well as an analgesic for nerve pain. Other prescription drugs have specific kinds of pain. It include a certain class of antiseizure drugs known as gabapentinoids, which can calm overactive nerves.
Over-the-counter pain medication is available in the form of NSAIDs (non-steroidal anti-inflammatory drugs) and acetaminophen, also known as paracetamol, and often sold under brand names like Tylenol and Panadol. Acetaminophen is an analgesic that combines excellently with anti-inflammatory drugs like ibuprofen. In select cases, these OTC medications are just as effective as opioids.
More invasive treatments exist as well. Targeted injections of certain steroids and medicines can numb the nerves, or even block pain entirely for some time. This can be especially helpful with chronic pain caused by damaged or overly sensitive nerves, or an injury that didn’t heal right.
Non-Medicinal Pain Treatments
In coordination with certain medication, less pain can happen through non-medicinal treatments and appropriate lifestyle changes. It’s important to mention research shows that a healthier and more active lifestyle helps reduce pain from inflammation and arthritis and improves post-injury recovery. Even cases of chronic pain can benefit from appropriate amounts of exercise and a healthier diet.
Aside from lifestyle changes, targeted treatments such as massage therapy and physical therapy, as well as unorthodox methods like pet therapy and acupuncture have shown to help improve quality of life and reduce pain.
Experimental and Future Treatments
There’s a lot that to do to find alternatives to opioids. Many researchers, however, are hard at work finding even better alternatives to opioids.
While no approved alternatives exist, some treatments to look out for include cannabidiol (CBD) oil for pain (a cannabinoid similar to THC, but without any of its psychoactive effects), experimental analgesics like AT-121 which doubles as a potential medication for opioid addiction, and other opioid alternatives still being tested.
Pain Is a Complex Problem
It’s inherently very hard to treat pain. First of all, pain is not really a condition. It’s a sense, and a critical one at that. Chronic pain sets itself apart here, as it can be debilitating and hindering to one’s health and healing. Unlike acute pain, does not act as a warning to prevent further damage, or as a survival mechanism.
Secondly, pain is completely subjective. Some people are far less likely to report their pain. They could be potentially hiding a problem that could have been treated in early stages. Others feel pain more severely than their peers, due to different factors from mental health to genetics. Sometimes pain is the direct result of an underlying cause. At other times, it’s the nerves malfunctioning or struggling with damage.
The Bottom Line
All of these issues make it difficult to identify why a person is experiencing pain, and how best to treat it. Some people respond better to certain treatments than others, even when both share the same condition and receive the same treatment.
However, by coordinating with a pain management specialist, you give yourself the best odds at a better outcome and improved quality of life. Which allows you make the most of the low-pain or pain-free days, and make them more frequent over time.