Alternatives to Opioids for Pain

The following article was written by Guarav Jain, MD, of the Pain Diagnosis and Treatment Center at BMC and appeared in the Berkshire Eagle on March 20, 2017

Opioid epidemic drives move toward safe alternatives

By Gaurav Jain, MD, FIPP

Behind all of the grim headlines about the burgeoning epidemic of opioid addiction and its tragic death toll – claiming some 78 lives each day or nearly 30,000 lives annually in the U.S. alone – efforts are gaining ground to manage both acute and chronic pain through highly effective alternatives to prescription opioids. Those alternatives include safer biological options such as non-opioid pharmaceuticals, physical interventions such as acupuncture and movement therapies and proven psycho-social methods such as cognitive behavioral therapy and biofeedback training.

Nearly 40 million adults in the U.S. suffer from severe or chronic pain, according to the National Institute of Health. In a well-meaning effort to alleviate that pain, doctors at the turn of the 21^st century began to significantly increase the rate at which they prescribed opioids for their patients. That practice quickly and seriously got out of hand. Opioid prescriptions have quadrupled since 1999, leading to a parallel, alarming, four-fold increase in deaths from prescription opioid overdose, as well as heroin overdose. On an average day in the U.S., more than 650,000 opioid prescriptions are dispensed, 3,900 people initiate illegal, non-medical use of prescription opioids and another 580 people initiate heroin use.

Recognizing the urgency of the situation, physicians and health systems throughout the country are focusing on ways to eliminate or reduce the use of opioids, while still managing the reality of chronic pain.  The alternatives themselves are highly effective and readily available; the big challenge that remains is to wean the U.S. health care system (and its patients) from the heavy reliance on opioids and push those alternatives into the everyday mainstream of effective pain management.

Separately and together, the triple effect of these biological, physical modalities and behavioral therapy alternatives to pain management is beginning to gain traction in the war on opioid addiction. Patients suffering from chronic pain should seriously look beyond passive expectations concerning treatment and be talking to their doctors about avoiding prescription painkillers and moving to these safe alternatives.

Biological Alternatives: Many non-opiate drugs developed for a wide range of uses, including anti-inflammatories, nerve pain medications like antiepileptics, muscle relaxers, several antidepressants, can become useful options in overall chronic pain management. The anti-inflammatories include both over-the-counter and prescription-strength versions of common drugs such as acetaminophen, Naprosyn and ibuprofen. Certain types of injections to treat arthritis, nerve pain, muscle pain, and headaches also can be considered. New therapy with the use of spinal cord stimulator could be a viable option in some cases. The effectiveness of these alternatives can vary, and while they are not addictive in the same way as opioids, they may have other side effects. Still, given the high long-term risks associated with opioids, any viable pharmaceutical alternatives should be seriously discussed by patients and their prescribing physicians, even if it’s in conjunction with limited, highly controlled use of opioids.

Physical modalities and Alternatives medicine: A growing body of clinical evidence has shown that a variety of physical interventions such as acupuncture, massage, traditional physical therapy, osteopathic manipulative treatments, chiropractic manipulation, transcutaneous electrical nerve stimulation (TENS), aquatic therapy and regular exercise can ease pain and improve functionality and mobility in people with many kinds of chronic pain. In addition, gentle physical movement therapies such as tai chi and yoga have been shown to improve chronic back and joint pain, arthritis, fibromyalgia, and other conditions.

Behavioral Alternatives: The mind-body-spirit benefits of traditional psychotherapy, relaxation therapy, hypnosis, guided imagery, music therapy, cognitive and /or behavioral therapy, resilience training and biofeedback techniques (through which patients learn to control muscle tension, blood pressure and heart rate) are increasingly evident in chronic pain management. On their own and in conjunction with non-opiate pharmaceuticals and physical therapies, these psycho-social practices can be part of a highly effective strategy for easing pain, improving inactivity and social withdrawal and steering clear of addiction.

Gaurav Jain, MD, FIPP is a specialist in pain medicine, internal medicine and psychiatry with Berkshire Health Systems