Millions of Americans live with chronic pain caused by medical conditions, injuries, or surgeries, and many are prescribed opioids to help manage their pain. While opioids can provide powerful pain relief, there is a huge risk for addiction or drug abuse. According to the National Institute on Drug Abuse, approximately 21-29% of patients prescribed opioids for chronic pain relief misuse them, and 8-12% of these patients develop an opioid use disorder. While not everyone taking opioids for chronic pain will become addicted or misuse them, the National Institutes of Health (NIH) recommends that medical professionals provide patients with safe, effective, non-addictive strategies to better manage their chronic pain.
Commonly prescribed opioids include Vicodin, Percocet, OxyContin, Hydrocodone, Morphine, Oxycodone, and Codeine. There are plenty of options for pain relief that are not opioids. Here are some non-opioid options for those living with chronic pain to help you better discuss your treatment options with your doctor.
Over-the-counter or prescription medication
Over-the-counter (OTC) pain medications, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce your pain. You can find these medications at most pharmacies, grocery stores, or on Amazon. OTC topical creams such as Voltaren, Biofreeze, Lidocaine, and Icy-Hot patches can help alleviate pain by blocking pain signals from reaching the brain. Voltaren is a topical cream containing NSAIDs and is used mainly for treating arthritis-related pain.
Talk to your doctor about your options for prescription medication that doesn’t include opioids. Anti-epileptic or antidepressant medications can help reduce pain and help prevent chronic migraines. Prescription NSAIDs such as Celebrex tend to be prescribed when OTC NSAIDs fail. Celebrex specifically can reduce pain from general chronic pain or specific conditions such as arthritis or ankylosing spondylitis.
Before seeing your doctor, you can always look up what prescription medication is available for your specific condition or general chronic pain. This can help you stay informed on what’s available, what to expect in the medication’s side effects and benefits, and help you talk to your doctor about what treatment option is best for you.
Physical or occupational therapy
Physical or occupational therapy (PT or OT) can help patients improve their functional mobility, build strength, and decrease their pain. Many physical or occupational therapists use massage therapy, heat or cold therapy, and TENS during their appointments. All of these can be beneficial for patients living with chronic pain. When discussing PT and OT with your doctor, ask about how many visits your insurance company will approve per year, as many health insurance plans have a yearly maximum allowance for therapy visits.
Injections or nerve blocks
Corticosteroid injections or nerve blocks can help relieve chronic pain, muscle spasms, or nerve pain. These are mainly used to prevent and control pain; although, certain injections can be used to assist the diagnostic process. While most nerve block procedures do not require surgery, there are several nerve blocks that are surgical treatments, such as rhizotomy or neurectomy. Nerve blocks are also commonly given with other surgeries and can be added to your normal treatment regimen. Some patients find long-term relief from one injection or nerve block while others will need recurring treatments for pain relief. Many conditions can be treated with nerve blocks or injections of some sort.
Both nerve blocks and injections can be performed on a variety of nerves or joints. The nerves in your upper extremities, face, neck, back, chest, abdominal, and lower extremities are common locations for nonsurgical nerve blocks while injections can be performed on any joint or muscle. Botox injections on your forehead can help prevent severe migraines.
Radiofrequency ablation or neurotomy is a non-surgical, minimally invasive procedure that uses waves to “burn” the nerves causing pain. This procedure uses heat to reduce or stop the transmission of pain signals to the brain. It’s most commonly used for back, neck, or buttock pain and can be helpful for long-term knee or hip joint pain. Radiofrequency ablation is typically performed when other nonsurgical treatment options have failed to provide the necessary pain relief.
TENS uses low voltage electrical currents via electrodes to provide pain relief. TENS units are common in physical and occupational therapy treatment programs, and you can purchase your own unit from Amazon, sporting goods stores, and medical supply stores. This non-invasive treatment option can be used in conjunction with other prescriptions or OTC medications. While TENS provides pain relief for many conditions, talk to your doctor before using TENS therapy. Conditions such as cancer, heart disease, epilepsy, deep vein thrombosis, and bleeding disorders. This form of therapy can worsen those conditions.
Spinal cord stimulator (SCS)
Spinal cord stimulators (SCS) are implantable devices placed under your skin that allow patients to send electrical impulses using a remote control whenever they feel pain. The electrodes of an SCS are placed in the epidural space, which is located between the spinal cord and vertebrae, and the generator is placed under the skin typically near the buttocks or abdomen. Patients have a remote control outside their body that allows them to send electrical impulses through your spinal cord to your brain that change the way your brain perceives the pain. SCS is typically used when other non-surgical pain relief treatments have failed. It can help improve your quality of life, help you sleep better, reduce the need for other pain medications, and can be used in conjunction with other medications and physical or occupational therapy.
Some people may benefit from natural remedies such as acupuncture, chiropractic therapy massages, biofeedback therapy, yoga, and other relaxation techniques. Heat and cold therapies can help alleviate pain. Cognitive-behavioral and pain management therapies can also help you cope with living with chronic pain.
Some people may be forgetful with their prescribed medication, and medication management programs can help ensure patients reap the most benefits from their prescribed medications. These programs are designed to help people manage their medications, so they consistently take them on time and exactly as directed. While this may seem like common sense, some patients may have difficulty taking their medications, especially when they have multiple medications all with different instructions, or have a medical condition that impairs their memory.
Medication management programs can potentially help decrease your overall medical costs, as taking your medications as directed can reduce your symptoms, the number of emergency room or hospital visits, and reduce the risk for an adverse drug event such as an overdose.