Treating Chronic Pain Without Opioids

Chronic pain is an invisible yet all-encompassing experience that significantly alters one’s way of life and mental health. According to the NIH, 1 in 10 people in the United States suffer from chronic pain. Navigating through daily routines with persistent agony is not only physically daunting but also emotionally draining.

More often than not, chronic pain sufferers are presented with a treatment plan centered around opioids. While these drugs may provide short-term relief for their severe pain, their long-term use carries a high risk of dependency and potentially lethal side effects.

Given the gravity of the ongoing opioid crisis, it’s of paramount importance to discover and discuss non-opioid strategies for managing chronic pain.

Understanding Chronic Pain

What is Chronic Pain?

Chronic pain transcends the normal sensation of pain. It lingers persistently, exceeding 12 weeks despite attempts to mitigate it with medication or treatment. The nature of chronic pain is such that it may persist even after the injury that caused it has healed. 

Unlike acute pain, a direct response to a potential injury, chronic pain lingers and sometimes worsens over time, significantly impacting a person’s quality of life.

Causes of Chronic Pain

Chronic pain can stem from a variety of factors. Physical injuries and accidents might trigger it, but conditions like arthritis, fibromyalgia, nerve damage, and infections can also lead to persistent pain. Moreover, chronic pain can exist even without any identifiable cause. Psychological factors such as stress and anxiety often exacerbate the severity of chronic pain.

Dangers of Opioid Use

Opioids, powerful prescription pain medications, provide effective short-term pain relief. However, their prolonged use can lead to a host of complications. These include physical dependence, the development of tolerance (needing more medication to achieve the same pain relief), and a high risk of overdose.

In fact, as many as 26% of people who receive prescription painkillers from a licensed physician are battling with addiction. As a result, opioids have become a double-edged sword in pain management and pain medicine.

Addiction and Dependency

Opioids work by binding to the opioid receptors in the brain, blocking pain signals and often producing a sense of euphoria.

This interaction can lead to physical dependence, where the body becomes accustomed to the drug’s presence and requires it to function normally. When the drug is reduced or stopped, withdrawal symptoms may occur, an indication of dependency.

Moreover, the euphoric feeling that opioids can create may lead to their misuse, potentially resulting in addiction—a chronic disease characterized by compulsive drug use despite harmful consequences.

Tolerance

Over time, the body can develop a tolerance to opioids. This means that higher doses are required to achieve the same level of pain relief, increasing the risk of overdose and other harmful side effects.

Overdose

An opioid overdose is a life-threatening situation. It occurs when opioids flood the brain too quickly or in excessive amounts, depressing the respiratory system to a point where breathing becomes inadequate or stops altogether. This can lead to a lack of oxygen to the brain, resulting in permanent brain damage or death.

Side Effects

Even when used as directed, opioids can cause several side effects. These may include constipation, nausea, vomiting, dizziness, confusion, and sedation. In the long term, opioid use can also lead to hormonal changes, resulting in lowered libido, fatigue, depression, and osteoporosis.

Opioid-induced Hyperalgesia

Ironically, long-term opioid use can lead to a condition called opioid-induced hyperalgesia, where individuals become more sensitive to pain. This means that the opioids, instead of reducing the experience of pain, may actually exacerbate it over time.

Considering these dangers, it’s crucial that any use of opioids for pain management is carefully monitored by a healthcare provider. Moreover, alternative, non-opioid strategies for managing chronic pain should be explored wherever possible.

The Role of Opioid Drugs in Chronic Pain Management

Traditionally, prescription opioids have been a cornerstone of pain management, especially for severe or post-operative pain for a multitude of health conditions. In 2014, an estimated 5-8 million individuals in the United States took a form of opioids to treat their chronic pain.

However, their effectiveness in treating long-term chronic pain conditions is questionable. With the rising concern over the opioid epidemic, healthcare providers are becoming more cautious about prescribing these drugs in order to reduce the risk of addiction, leading to a shift towards safer, non-opioid alternatives.

Commonly Prescribed Opioids for Chronic Pain:

1. Morphine: Often used in hospital settings, this is a potent opioid for severe pain. Long-acting formulations can be used for chronic pain.
2. Hydrocodone (Vicodin, Norco): a common analgesic usually combined with acetaminophen, it is typically prescribed for moderate to severe pain.
3. Oxycodone (OxyContin, Percocet): Available both in immediate and extended-release forms, this is used for moderate to severe pain.
4. Fentanyl (Duragesic, Actiq): This is a very strong opioid, often used in patch form for severe, ongoing pain, such as in cancer patients for their cancer pain. It can be many times more potent than morphine.
5. Tramadol (Ultram, ConZip): This is a less potent opioid used for moderate to moderately severe pain.
6. Codeine: It’s less potent than other opioids and often combined with other medications like acetaminophen or used in cough suppressants.
7. Hydromorphone (Dilaudid): This is a potent opioid used for severe pain.
8. Methadone: Traditionally used in the treatment of opioid addiction, this can also be used for chronic pain management.

Non-Opioid Pain Relief Techniques and Treatment Options

Physical Therapy

Physical therapy offers a hands-on, non-opioid treatment to alleviate chronic pain. Tailored exercise regimens designed by a physiotherapist help strengthen muscles, enhance flexibility, and improve mobility, thereby reducing many types of pain. Physical therapy may also include techniques like massage and heat or cold therapy, which can provide additional relief.

Over-the-counter Medications for Chronic Pain

Non-prescription, over-the-counter drugs provide a more accessible, cost-effective alternative to prescription medications and can be effective in managing mild to moderate pain symptoms.

Common over-the-counter pain relievers include Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve), which work by reducing inflammation and pain in the body. Acetaminophen (Tylenol) is another commonly used medication for pain, although it’s more suited for relieving pain rather than reducing inflammation.

Topical analgesics, available in creams, gels, patches, or sprays such as lidocaine, can also provide localized pain relief and numbing. They often contain ingredients like menthol, capsaicin, or salicylates.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) provides a mental and emotional framework for dealing with chronic pain. Rather than focusing on the physical aspect of pain, CBT aims to alter the way individuals perceive and respond to their pain. Through this therapy, individuals can learn to replace negative thought patterns with positive ones, thereby reducing stress and potentially decreasing the perception of pain.

Alternative Therapies

Acupuncture

A centuries-old practice rooted in traditional Chinese medicine, acupuncture involves the insertion of thin needles at specific points in the body. Many chronic pain sufferers find relief through acupuncture, which is believed to balance the body’s energy and stimulate healing.

Yoga

Yoga combines physical poses with breathing exercises and meditation. Regular practice can boost strength and flexibility, enhance mindfulness, and promote a sense of well-being—all of which can contribute to chronic pain management. Many people find yoga helpful in reducing pain and disability associated with conditions such as chronic lower back pain and arthritis.

Herbal Medicine

Certain herbs and natural supplements are believed to have anti-inflammatory and pain-relieving properties. For instance, turmeric, ginger, and capsaicin (found in hot peppers) are often used in the management of chronic pain. It’s essential to consult with a healthcare provider before starting any herbal medicine, as some may interact with other medications.

Lifestyle Changes

Healthy Diet

A healthy diet is an unsung hero in managing chronic pain. Consuming anti-inflammatory foods—like leafy greens, berries, fatty fish, and nuts—can help reduce inflammation, which is often a significant contributor to chronic pain. Eliminating processed foods and limiting alcohol and caffeine intake can also help manage pain levels.

Exercise

Regular exercise is crucial in managing chronic pain. It promotes the release of endorphins—the body’s natural painkillers—helping to alleviate chronic pain. While exercise might seem daunting for individuals in pain, gentle exercises like swimming, cycling, or walking can be beneficial. Always consult with a healthcare provider before starting a new exercise regimen.

Mindfulness

Mindfulness practices like meditation and deep breathing exercises have shown promise in managing chronic pain. These techniques can help individuals focus on the present moment, reducing stress and changing their relationship with pain.

Hope for Chronic Pain Relief Without Opioids

Living with chronic pain is challenging, but it doesn’t necessitate dependence on opioids. A range of non-opioid strategies, from physical therapy and cognitive-behavioral therapy to lifestyle changes, can offer substantial relief. 

Remember that managing chronic pain is a journey. What works best will depend on an individual’s unique situation, and what might work for one person may not work for another. It’s vital to seek guidance from healthcare professionals to develop a comprehensive, personalized pain management plan.

If you or a loved one are battling opioid addiction or opioid dependence, get in touch with us at Gallus Detox. We can provide you with a positive, supportive environment to safely detox from opiates.

Chronic Pain FAQs

Can chronic pain ever be fully eradicated without the use of opioids?

Yes, it’s possible for some individuals to manage or even eradicate chronic pain without the use of opioids. It’s important to remember that chronic pain is a complex condition with various contributing factors. Therefore, a multi-modal approach is often the most successful.

This includes physical therapies, cognitive behavioral therapies, lifestyle modifications, and non-opioid medications.

How can I integrate mindfulness techniques into my daily regimen for chronic pain management?

Mindfulness techniques can be easily integrated into your daily routine. Start with short, focused sessions, perhaps in the morning or before bed. This could include a few minutes of deep breathing, yoga, or guided meditation using an app or online resource.

Gradually, you can increase the duration of these sessions. Mindfulness can also be practiced throughout the day, for example, by focusing on your breathing or surroundings during a work break, or while eating a meal.

Are there potential side effects linked with the alternative therapies mentioned above?

As with any treatment, there can be potential side effects. For example, physical therapy can sometimes lead to temporary soreness, and acupuncture can cause minor bruising. Herbal medicines can interact with other medications, causing side effects. 

Could physical activity exacerbate my chronic pain symptoms?

It’s possible that certain types of physical activity could exacerbate chronic pain, particularly if the exercise is intense or the technique is incorrect. However, appropriate and regular low-impact exercises, such as swimming, walking, or gentle yoga, often help decrease pain levels over time. 

What specific foods should I include in an anti-inflammatory diet for chronic pain management?

An anti-inflammatory diet should include foods rich in omega-3 fatty acids (like salmon, flaxseeds, and walnuts), fruits and vegetables high in antioxidants (like berries, spinach, and broccoli), spices with anti-inflammatory properties (like turmeric and ginger), and foods rich in fiber (like whole grains and legumes). Avoid processed foods, as well as those high in sugar and unhealthy fats, as they can promote inflammation.

image credit / licensed via Ba Tik from pexels.com

Steve Carleton

Steve worked in the Department of Veterans Affairs for 10 years. He is a PTSD and substance use disorder expert with over 14 years of experience in and around addiction. Steve is also an Adjunct Professor at the University of Denver’s Graduate School of Social work. He teaches cognitive behavioral therapies, Motivational Interviewing, assessment skills using DSM-5, amongst others.