Opioid Alternatives for Chronic Pain: Turning Crisis into Choices

Opioid Alternatives for Chronic Pain: Turning Crisis into Choices

Feb 16 2018

With the October 2017 declaration of a public health emergency in the U.S., opioid use has come under intense scrutiny. For those taking opioids for chronic pain, all of this attention may feel like a lot of finger pointing. That’s why it’s important to understand the facts and know about the alternatives when it comes to chronic pain management.

By: Christina Barrington, Vice President of Pharmacy Programs

You don’t have to look far to find opioids in the news; it seems like nearly every day we hear about the four-fold increases in deaths from unintentional drug poisonings driven by increases in prescription drug overdoses. However, this increased attention following the declaration of an opioid crisis should not be about blame, but about solutions and how to best treat chronic pain with the least amount of risk. Chronic pain control is an ongoing, ever-evolving and sometimes frustrating process. And those suffering from chronic pain are not alone. Priority Health is here to help our members with chronic pain understand your unique treatment choices so you can live your healthiest, most pain-free life.

 Let’s look at the facts.

Treating chronic pain with opioids has potential risks. Opioids can increase tolerance, meaning over time you might need higher doses to relieve your pain, putting you at greater risk for overdose. Physical dependence is also a very possible risk of opioid use ─you may experience withdrawal symptoms when the medication is stopped or a dose is missed. The risk of overdose increases if opioids are taken with other medications, such as those that cause drowsiness.

Given the safety concerns, it’s best to use opioids with caution and to carefully consider if the benefits outweigh the risks. Because there isn’t enough evidence that prescription opioids effectively control chronic pain over the long-term, they shouldn’t be considered first-line therapy. There is, however, evidence proving that alternative treatments can be effective with less harm. Both non-drug therapy and non-opioid medication therapy are preferred for chronic pain. Choosing the right combination of therapy may help put you in control of your chronic pain.

Non-drug therapy for pain

Retrain your brain

Your brain controls your perception of pain. There are a variety of methods to teach you how your thoughts contribute to pain, how to modify these thoughts and how to use specific behavioral techniques to lessen pain.

  • Cognitive behavioral therapy
  • Biofeedback
  • Relaxation therapy
  • Psychotherapy/individual/group counseling

Work it out

A tailored exercise program can help you regain motor control, strength and flexibility, resulting in decreased pain and increased function. Other therapies to reduce acute muscle tension may provide relief as well.

  • Physical and occupational therapy
  • Aerobic exercise

Get on your nerves

Nerves are responsible for sending pain messages to the brain. There are a variety of techniques to reduce or alter the transmission of pain signals from your body’s nerves. Some options may also reduce inflammation that can cause pain. Many of these interventions are performed by a pain management specialist.

  • Thermal applications (heat/cold)
  • Transcutaneous electrical nerve stimulation (TENS)
  • Spinal cord stimulation
  • Ultrasonic stimulation
  • Electrical neuromodulation
  • Ablative techniques
  • Nerve blocks
  • Trigger point injections
  • Epidural steroid injections
  • Botulinum toxin injections

Ask your doctor if the above options are right for you. Some extremely painful conditions may require more advanced therapy and your physician can advise if you are a candidate for potential surgery to correct the underlying condition.

Non-opioid medication therapy for pain

There are a variety of non-opioid medications used to treat chronic pain. Some may be more effective than others, depending on the type of chronic pain you’re experiencing. Some types of nerve and musculoskeletal pain are best treated with a combination of medications from different classes. Here are some examples:

Nerve Pain Musculoskeletal Pain
  • Gabapentin (Neurontin®), Lyrica®
  • Topical Lidocaine (IcyHot®-OTC) and Capsaicin (Salonpas®-OTC)
  • Duloxetine (Cymbalta®), Venlafaxine (Effexor®)
  • Acetaminophen (Tylenol®)
  • Amitriptyline (Elavil®), Nortriptyline (Pamelor®), Desipramine (Norpramin®)
  • Naproxen (Naprosyn®, Aleve®), Ibuprofen (Motrin®), Meloxicam (Mobic®), Celecoxib (Celebrex®)
  • Tizanidine (Zanaflex®), Baclofen (Lioresal®)

 One size doesn’t fit all in pain management

When it comes to chronic pain, one size doesn’t fit all. Work with your doctor to help determine what level of pain control you can expect for your condition. Schedule routine appointments and monitor your level of pain to evaluate strategies that work best for you. Ask your pharmacist to watch for unsafe drug combinations or for drugs that aren’t appropriate for your medical conditions. And be sure to check with your health insurance provider to see what resources are available to you. At Priority Health, we offer our members resources such as behavioral health support and care management options for chronic pain.

If you use opioids as part of your chronic pain management strategy, use the lowest effective dose and make sure you and your family have naloxone on-hand and know how to use it in the event of an overdose. Remember—when it comes to chronic pain, every single person is unique and that’s ok. The goal is to work with your care team to find the best approach for your pain management to live a happier and healthier life, pain-free.

About the Author: Christina Barrington is Vice President of Pharmacy Programs at Priority Health. She leads both the pharmacy operations and clinical pharmacy teams. In this role she manages all pharmacy activity and reports to the Chief Medical Officer. Barrington’s areas of expertise include clinical pharmacy, benefit design, and strategic planning.


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