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Dealing with Chronic Pain Without Prescription Opioids

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Living with chronic pain is extremely challenging and debilitating. When all you want is relief from intense pain, developing a long-term pain management plan can be especially difficult. One solution people often turn to is opioids, such as Vicodin, OxyContin, and Percocet, which work quickly to alleviate pain. However, for many people, these are not a good long-term solution.

The prescription opioids are federally controlled substances because even though they have a legitimate medical use, they have a high potential for abuse. People who abuse opioids run the risk of developing an addiction, a chronic condition that negatively impacts multiple areas of a person’s life. Whether you’re in recovery or just want to avoid the potential harms of the narcotic painkillers, there are many other ways to manage chronic pain that don’t involve opioids.

The Opioid Epidemic

The national opioid epidemic has its roots in the widespread availability of prescription painkillers. Sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014.1 However, these numbers do not reflect an increase in reported chronic pain among Americans but rather the way doctors are choosing to treat pain.

Approximately 20% of patients who don’t have pain-related diagnoses or cancer pain are prescribed opioid painkillers in office settings.1 From 2007 to 2012, the rate of opioid prescribing among chronic pain specialists increased steadily.1 As the number of opioid prescriptions increased, so did the number of opioid abuse disorders, or addictions. In 2014, nearly 2 million Americans were addicted to, or dependent on, prescription opioids.2

Additionally, prescription opioids were responsible for more than 15,000 overdose deaths in 2015, with overdoses having quadrupled since 1999.3 Because of this, the medical community is now trying to curb its reliance on opioids for the treatment of pain.

Harmful Side Effects

Prescription painkillers can bring relief from severe pain, but they can produce dangerous side effects. Even when you are taking painkillers exactly as directed by your doctor, you can still develop some degree of physical dependence on them as the body becomes accustomed to the presence of the drug.

Anyone taking painkillers for an extended period of time will develop a tolerance, which means higher doses are required to achieve the same pain-relieving effects. Large doses of opioids can be very dangerous, particularly when mixed with other substances, especially sedatives, such as benzodiazepines, since it increases the risk of profound respiratory depression.

Other side effects of prescription painkillers include: 2,4

  • Constipation.
  • Slurred speech.
  • Drowsiness.
  • Impaired judgment.
  • Impaired memory, cognition, and attention.
  • Disassociation with environment (potentially ignoring harmful situations).
  • Slowed breathing.
  • Coma.
  • Overdose (respiratory depression or failure, coma, death).

People misuse prescription drugs by taking them in ways other than directed. It is not uncommon for people to crush pills and snort them. Some people dissolve pills in water and inject them directly into their veins.

Other side effects of opioid misuse include: 2,4

  • Tolerance (needing more drugs to achieve the same effect).
  • Physical dependence.
  • Experiencing withdrawal symptoms when use is stopped or dramatically reduced.
  • Addiction (a progressive condition characterized by compulsive use).
  • Continued use despite major negative consequences at home, work, or school.
  • Failure to meet responsibilities.
  • Increased risk of accidents, due to driving under the influence or incoordination.
  • Consequences of injection use, such as track marks, scars, cellulitis, infections, such as hepatitis, bacterial endocarditis, tuberculosis, and HIV.
  • Effects associated with intranasal use, such as perforated septum or nasal mucosal inflammation and bleeding.
  • Difficulties in sexual functioning.
  • Reproductive disturbances and irregular menses in women.

Alternative Medications

Chronic pain can be debilitating and distressing. It can interfere with every aspect of your life and make it difficult to function. But there are many non-opioid pain relievers available. The one best suited for you will depend on the type of pain you are experiencing and how you respond to it.

Alternative pain relievers include:

  • Non-steroidal anti-inflammatories (NSAIDs):5
    • Treat inflammation, muscle, and joint pain
    • Include ibuprofen, naproxen, and selective cox-2 inhibitors
    • Brand names: Advil, Motrin, Aleve, Celebrex
    • Can also be applied topically to the skin
    • Can cause stomach problems, kidney issues, and headaches
  • Corticosteroids:6
    • Treats severe inflammation, as well as muscle and joint pain
    • Can be taken orally, topically, or via injection
    • Chronic use of oral steroids is associated with several side effects, including high blood pressure, glaucoma, weight gain, and fluid retention
  • Anticonvulsants:7,8
    • Treats neuropathic pain
    • Includes gabapentin, pregabalin, lamotrigine, and topiramate
    • Side effects include difficulty thinking or concentrating, blurred vision, drowsiness, and memory problems
  • Antidepressants:8,9
    • Can treat chronic pain, fibromyalgia, or physical pain caused by mental health issues
    • Includes selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), Wellbutrin, Remeron, and Cymbalta
    • Side effects include weight gain, sleepiness, vomiting, diarrhea, and sexual problems
  • Muscle relaxers:8,10
    • Treats muscle spasms due to back or neck pain and neurological conditions, such as multiple sclerosis
    • Includes baclofen, carisoprodol, cyclobenzaprine, tizanidine, and methocarbamol
    • Side effects include drowsiness, dry mouth, and dizziness
    • Some muscle relaxant medications may have some abuse potential of their own
  • Regional pain relievers:8
    • Treats severe muscular or neuropathic pain
    • Includes nerve blocks and epidural blocks
  • Topical pain relievers:8
    • Treats muscle and neuropathic pain
    • Includes gels, creams, and patches made from NSAIDs, lidocaine, and Capsaicin

Non-Medicinal Treatment Options

Medication is not the only way to treat pain. There are a number of non-pharmacologic strategies available that can help you reduce your pain and learn how to live a normal life, such as:

  • Cognitive behavioral therapy: This type of therapy can help people build coping strategies to improve pain management.
  • Physical therapy: This involves working one-on-one with a physical therapist who can help you learn to stretch and strengthen your muscles to decrease your overall pain level.
  • Acupuncture: This ancient practice has been used for thousands of years to provide relief from chronic pain. It involves placing needles at distinct points around your body. Research suggests it reduces self-reports of chronic pain.12
  • Yoga: By combining relaxation techniques with stretching routines, yoga can provide both physical and mental relief from chronic pain.13
  • Massage: Professionals use several different techniques that involve pressing and rubbing muscles and soft tissue for pain relief.
  • Chiropractic care: Practitioners use a variety of techniques to perform minor adjustments to the spine and other parts of the body to correct alignment problems and potentially relieve pain.14
  • Nutritional therapy: A diet full of healthy fats, fruits, vegetables, and whole grains can promote overall health. Eating a diet of fish, soy-based foods, walnuts, flaxseed, leafy greens, avocados, beets, and berries is associated with relief from chronic pain caused by inflammation.15
  • Mindfulness meditation: Research suggests that mindfulness meditation can help relieve chronic pain and depression by helping people to live in the moment. Stress contributes to pain, so meditation helps prevent this.16

What To Do If You’re Addicted

If you are addicted to opioids, help is available. You can find ways to manage your chronic pain without them. Most people begin their addiction treatment in an opioid detox program. There are several different types of detox programs available, for example:

  • Inpatient detox: Patients live in a safe environment with 24-hour supervision by medical professionals. Medication is often provided to ease the painful symptoms of withdrawal.
  • Outpatient detox: Outpatient clinics allow you to schedule detox sessions throughout the day while still returning home at night.
  • Hospital: Patients who are at a high risk of medical complications, such as the elderly or chronically ill, may be safer and more comfortable going through withdrawal in a hospital environment.

Detox is a great way to get started with recovery, but it is not an adequate substitution for addiction treatment. Following detox, a comprehensive addiction treatment program is the best way to ensure long-term recovery.

Addiction treatment programs provide both individual counseling and group therapy. During these sessions, people learn new strategies for dealing with drug cravings, pain, and other triggers. They develop new, healthy habits that will help them maintain long-term sobriety. Such programs include:

  • Inpatient treatment: Involves 24-hour medical supervision in a safe, drug-free environment. Offers individual counseling and group therapy, as well as many other services.
  • Intensive outpatient programs (IOPs): Involves structured addiction treatment several days per week while allowing the patient to return home in the evenings.
  • Standard outpatient treatment: Involves attending a clinic for a set number of hours per week to receive addiction counseling.
  • Doctor’s office: Some people find that they can get sober with the help of their current family doctor, therapist, or pain management specialist.

Additionally, many people find 12-step groups like Narcotics Anonymous (NA) extremely helpful along the journey to long-term sobriety. Meetings are free and convenient to attend. They can be used as an adjunct to substance abuse treatment programs or as aftercare/ongoing support.

Sources

  1. Centers for Disease Control and Prevention. (2017). Prescribing Data.
  2. Centers for Disease Control and Prevention. (2016). Prescription Opioids.
  3. Centers for Disease Control and Prevention. (2017). Prescription Opioid Overdose Data.
  4. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). Arlington, VA: American Psychiatric Association Publishing.
  5. American College of Rheumatology. (2017). NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)
  6. Mayo Clinic. (2015). Prednisone and Other Corticosteroids.
  7. Medline Plus. (2017). Carbamazepine.
  8. Belgrade, M. (2012). Non-Narcotic Management of Pain.
  9. Mayo Clinic. (2015). Antidepressants: Selecting One That’s Right for You.
  10. Dean L. (2007). Comparing Muscle Relaxants. Bethesda (MD): National Center for Biotechnology Information (US).
  11. National Institute of Mental Health. (2016). Mental Health Medications.
  12. Vickers, A. J., & Linde, K. (2014). Acupuncture for Chronic Pain. JAMA: The Journal of the American Medical Association, 311(9), 955–956.
  13. National Center for Complimentary and Integrated Health. (2017). Yoga.
  14. National Center for Complimentary and Integrated Health. (2012). Chiropractic: In Depth.
  15. Mayo Clinic. (2016). Nutrition and Pain.
  16. Hilton, L., Hempel, S., Ewing, B.A., et al. (2017). Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis. Annals of Behavioral Medicine, 51(2), 199–213.

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