Chronic pain and acute pain are two very different things. Certain stimuli make the body react in such a way that it sends a signal of pain through the cells to the brain. There, we perceive an uncomfortable jolt, an aching feeling, a burning sensation. Pain can be sharp, dull, hot, sudden, or slow – but it’s always a bad sign. Usually, we feel pain when we get hurt. It’s an indication that we need to do something to stop the pain. We learn as early as possible that if you trip, cut yourself, touch something hot or hit your head, it hurts. And you learn to avoid doing it.
Chronic pain is different. It serves no purpose and robs millions of Americans of countless hours spent struggling with pain when they could be living their lives, accomplishing things, contributing to the lives of their families and to society at large. Millions are stuck in a struggle with meaningless pain, caused by a large variety of issues, ranging from a pinched nerve to extensive spinal damage, a recurring injury, or something in their head that just won’t go away.
Since the 1990s, prescription opioids have been the number one way to deal with this growing issue in America. While chronic pain has always existed, we’ve only in recent decades made headway towards innovating pain management and finding ways to help patients identify and manage debilitating symptoms from conditions such as lower back pain and arthritis. Opioids, for a time, seemed like a proper solution.
These drugs have existed for a long time – first as the ancient drug opium, and eventually in more refined forms such as morphine and heroin – but the decisions to ban heroin and heavily restrict morphine are much older than today’s opioid crisis. It’s other opioids, both synthetic and derived directly from opium analogues like morphine, that drove and started this crisis decades ago. And pain management was at the center of it.
Why We’re Moving Away from Opioids
Nowadays, a large portion of opioid-related deaths are caused by fentanyl, often mixed into heroin. But many deaths are still caused by illegally-acquired and sold prescription medication. When big pharmaceutical companies first realized the profits that could be made from opioid prescription medication, they worked with doctors to incentivize, advertise, and maximize the sale of these drugs.
While patients were ordered to stick to a certain dose, they often received (or, more accurately, were asked to purchase) many more pills than they actually needed. This later turned into a flood of prescription medication making it from the family’s medicine cabinet into the hands of curious teens and addicted adults, and eventually, these drugs hit the streets.
Worst of all, some evidence even came to light showing that while opioids are effective at very quickly relieving acute pain, they are not an effective way to deal with chronic pain. Furthermore, opioid medication could backfire and cause a patient to feel pain more strongly or more frequently than before.
Today, the issue of overabundant prescription opioids has been curbed by decades of regulation and restriction, with new laws in place to tackle the issue of prescription opioids in advertisement, as well as limit the way doctors can prescribe opioids. But the damage has definitely been done. Countless medical professionals have also recognized how a change in attitude towards opioids years prior has fueled and started the crisis, and they have made a drastic turn to limit the way opioids are given to patients. But with that comes a new problem. If opioids are a bad way to deal with pain due to how addictive they can be, what’s the right way?
The Potential of Non-Opioid Analgesics
Few drugs are effective against pain. Opioids are most well-known, next to several over-the-counter drugs and drug combinations commonly sold for headaches, aches and swellings, from paracetamol to ibuprofen. NSAIDs are particularly good for pain related to inflammation, such as gout and joint pain, while acetaminophen (paracetamol) works best for headaches, muscle aches, and the like. Some over-the-counter painkillers are sold with caffeine, which speeds up the process of getting the drug into the brain.
Meanwhile, some prescription drugs show promise in the fight against pain. Antidepressants in particular may help patients mentally cope with the struggles of chronic pain, in turn actually reducing the pain itself. Research shows that negative thinking and depression in particular heightens a person’s sensitivity and susceptibility to pain signals.
Other up-and-coming drugs include tanezumab, a drug affecting the nerve growth factor in the brain and body, with studies showing efficacy for the drug in the treatment of osteoarthritis and chronic back pain. The drug was purchased by Pfizer in 2009 and is on its way to being marketed and sold for chronic pain, without the risk of addiction.
Opioids kill pain like nothing else, but they also promote a tolerance to the effect of more opioids, can sometimes cause a condition that heightens pain, and will lead to addiction. For those who can afford to step off opioids, non-opioid alternatives are crucial to continuing the fight against pain. But there’s more to managing pain than pills and medication.
Pain Management Outside of Pharmacology
Managing pain is partially a matter of medication, and largely a matter of taking on a more nuanced, holistic, and multimodal approach. Modern-day pain specialists recognize that to effectively tackle chronic pain, a patient’s life, circumstances, and options have to be identified and considered. More than just medication, modern-day pain management makes use of therapies and medical interventions to help reduce and eliminate pain and help patients without the use of opioids. Options include:
- Heat therapy
- Stretching and exercise
- Meditation and mindfulness
- Nerve blocks
- Epidural injection
- Corticosteroid injection
- And more
It Takes a Village
Chronic pain, sadly, can last for years and decades. As much as pain management can work with a patient to effectively reduce the pain signals going through a person’s brain, there’s more to pain than the mechanics of neural communication.
The psychology of pain matters as well. Pain management professionals recommend therapy, counseling, and most importantly, support from family and friends to help a patient with chronic pain live a fulfilling, meaningful, and satisfying life despite the pain they endure.