Chronic pain affects millions of Americans, and about 8 percent of American adults struggle with severe high-impact chronic pain. In many of these cases, over-the-counter pain medication does little take the edge off, and for these patients, few drugs are seemingly as effective or well-tolerated as opioids. But while opioids have been prescribed for decades as more effective and powerful analgesics, many concerns surround their use in chronic pain cases.
First, opioid medication has limited usefulness in different kinds of chronic pain, and there is evidence to suggest that its limitations become especially obvious when treating long-term chronic conditions. Second, following the onset of the opioid crisis in the late 1990s and the rapid rise of opioid-related overdose deaths in the last few years (the third wave), many medical professionals are concerned about the prescribing risks and are encouraged to explore non-opioid analgesics.
Why Explore Non-Opioid Analgesics?
Opioids are powerful analgesic drugs derived directly or synthetically from the opium poppy plant. While opium was cultivated, traded, and used for thousands of years, both medicinally and recreationally, it was not until the early 19th-century when opium-produced opioids were born – starting with morphine and later heroin.
Alternative opioid analgesics followed, including codeine, hydrocodone, and oxycodone, the latter of which began the opioid crisis following a period of over-prescription and aggressive marketing, followed by a second wave of the United States opioid deaths in the 2010s because of a growing illegal heroin market, and a third wave when the trend of mixing the opioid fentanyl into other recreational drugs began.
With concerns regarding the addictive potential of any opioid, as well as continued overdose deaths, many pain specialists recommend non-opioid analgesics as a safer alternative, including off-label analgesics such as antidepressants and ketamine infusion therapy, as well as non-opioid analgesics such as nerve blocks and radiofrequency ablation, and controversial options such as CBD and MDMA are still under review.
Comprehensive Patient-Centered Pain Management
More than just a brain signal, pain is a sensory experience influenced in no small part by environmental factors, as well as highly subjective internal factors. Informing patients of other possibilities to address discomforts at home, such as frequent warm soaking, improved sleep hygiene, and topical remedies such as camphor and menthol, can also help.
A patient’s history is critical for ideally assessing their pain management options. Patients with a history of addiction would be further ill-suited for opioid medication or maybe more at risk of developing a dependence even in stages where opioid medication is still commonly used, such as post-operative pain.
The Pharmacological Challenges of Chronic Pain
Some forms of chronic pain can be mitigated through over-the-counter medication. Yet, many patients find these options lacking and need a more potent analgesic to regain quality of life. While finding effective non-opioid analgesics can be complex, a comprehensive approach to treating pain symptoms might be improved. Experimental and off-label prescription analgesics exist, but none are currently used. Specific alternatives need to be explored and considered on a per-patient basis in coordination with non-opioid analgesics.
Other Pain Management Options Explored
Besides medication, modern pain management includes various alternative non-opioid analgesics ranging from mild nerve stimulation to minimally invasive surgery. Other non-surgical interventions include:
Nerve Blocks
These involve the use of certain medications or neurolytic agents to induce temporary relief and eliminate pain. The drug is injected near a specifically targeted nerve to relieve inflammation around the nerve, or damage it, thereby eliminating pain signals until the damaged fiber regrows properly.
Transcutaneous Electrical Nerve Stimulation
This procedure utilizes electrodes to send a current through into a targeted area to interfere with pain signals.
Spinal Cord Stimulation (SCS)
This therapy involves minimally invasive surgery and utilizes a small device implanted near the spine to use electricity to stimulate an area of the spinal cord and its surrounding nerve roots.
Radiofrequency Ablation (RFA)
Much like a nerve block, radiofrequency ablation relies on heatwaves to burn a damaged nerve and regrow it to restore normal function.
Surgical Options
In some cases, neuropathic pain is caused by damage to the surrounding area, such as a fractured or crushed vertebra or a chronically inflamed spinal disc. Careful surgical options may involve removing portions of bone or tissue to reduce pressure on an affected nerve or utilize specialized hardware to restore stability to the spine.
Physical and Mental Therapies
Pain management goes beyond the mechanical element of shutting down nociceptors (pain receptors) and delves deeper into managing and reducing the psychological impact of chronic pain, its effects on:
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- Social life and isolation
- The physical impact of pain
- Personal feelings as a result of pain’s impact on the day-to-day
- Feelings of shame and guilt due to diminished capacity or function
- The lack of mobility and activity further feeds into worsened symptoms of chronic pain over time
Comprehensive and compassionate dialogue with patients is important for better understanding their needs and how they may be met outside of addressing the pain directly, such as helping them:
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- Explore appropriate levels of physical therapy and activity
- Seek support at home and within the community through other patients
- Address co-occurring mental health challenges such as depression and substance use
Physical and mental therapies that address and improve pain symptoms can include:
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- Talk therapy
- Acupuncture
- Aquatic therapy
- Outdoor activity
- Animal-assisted therapy
- Cognitive-behavioral therapy (CBT)
- General physical exercise (appropriate to the patient’s strength and pain)
Nutrition and Home Remedies
Nutrition can significantly impact a patient’s pain sensitivity and overall pain levels and help keep down physical markers that influence pain in certain conditions, including inflammation. Other helpful remedies include:
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- Hot and cold therapies
- Massages and Epsom salt soaks
- Topical analgesics like capsaicin and camphor
- Sleeping aids in improving sleep and rest quality
- Herbal remedies such as turmeric and cloves (which contain a natural numbing agent)
Home remedies are not always going to be effective, and whether they help improve symptoms can depend on various factors. For example, a healthier diet may not in itself provide enough relief but can improve quality of life alongside other elements of a comprehensive pain management plan.
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