It’s not difficult to pinpoint the era in which opioid drugs began creeping into American lives. While opium-based syrups and serums have been available since the 1800s, 1996 saw the introduction of the supposedly non-addictive opioid OxyContin. The introduction of OxyContin made healthcare professionals more comfortable routinely prescribing pain medication. Unfortunately, we know now that Purdue Pharma grossly misrepresented the addictive qualities of the drug.
Between 2002 and 2017, the number of opioid-related deaths grew from about 10,000 per year to more than 49,000, according to the National Institute on Drug Abuse. It’s estimated that opioids killed more people in 2018 than vehicle accidents. It’s not just those who linger in back alleys that succumb to this readily-available killer. It’s mothers, high school students, members of the military, and even college-educated senior citizens.
What are Opioids?
Opioids are a class of highly-addictive pain medication. When administered correctly, they can be used to treat pain caused by a number of conditions, including cancer. They belong to a group of medicines that affect the opioid receptors scattered throughout the body. Opioids not only relieve pain, but also create a sense of pleasure, which can lead to addiction, even in people who have never shown a predisposition to drug abuse.
Breaking the chains of addiction is difficult, to say the least. However, there are many alternatives that can help people with chronic pain find relief without the risk of addiction and that can assist in easing those with an addiction off of opiates.
There are many non-addictive pharmaceutical products available to treat pain. Acetaminophen, antidepressants, muscle relaxants, and other over-the-counter (OTC) and prescription drugs may be safely used as part of a non-opioid pain management routine.
Acetaminophen, commonly sold under the brand name Tylenol, is an OTC medication that has proven effective for pain for decades. A non-opioid analgesic, acetaminophen be especially useful for headaches, arthritis, and cancer-related discomfort. However, it may not be well-tolerated in high dosages for chronic pain, and people with hepatitis C or liver problems may be unable to sustain long-term use of it.
Similar to acetaminophen are non-steroidal anti-inflammatory drugs, or NSAIDs. Naproxen, ibuprofen, and aspirin, sold under various name brands, are all NSAIDs. NSAIDs carry an increased risk of clotting abnormalities, ulcers, and gastrointestinal discomfort. The Cleveland Clinic explains that this type of medication works similarly to corticosteroids to reduce inflammation. People with high blood pressure, diabetics, and those who smoke may be at an increased risk of heart attack when using prescription or over-the-counter NSAIDS.
Anticonvulsant/anti-seizure medication is another type of drug that may be effectual in treating chronic pain. The American College of Cardiology explains, however, that it is not fully understood how anticonvulsants actually reduce pain. It is theorized that this medicine prevents the central nervous system from receiving pain signals. Nerve pain seems to be especially receptive to anticonvulsants, which may be sold under the brand names Lyrica, Topamax, or Trileptal.
Muscle relaxants are often prescribed to treat spasms and muscle tension. They are typically not used as a stand-alone treatment for pain, but may amplify the results of acetaminophen, ibuprofen, or other OTC pain treatment.
Antidepressants, and more specifically, tricyclic antidepressants, have been used to treat pain for more than 30 years. One study published on the National Center for Biotechnology Information website explains that many antidepressants have proven useful in the management of neuropathic pain, such as that experienced by diabetics. It is theorized that antidepressants do not treat pain specifically, but instead work to produce norepinephrine and serotonin, both hormones that can reduce the sensation of discomfort. Further, treating underlying depression, which is often a co-occurring diagnosis in those with chronic pain, may allow the sufferer to cope more effectively with their condition. It is important to note that tricyclic antidepressants have largely fallen out of favor to treat depression, since they come with unpleasant side effects, such as constipation and weight changes.
Non-pharmaceutical pain management techniques include herbal remedies, physical therapy, massage, chiropractic support, and cognitive and behavioral techniques.
According to Harvard Health Publishing, therapeutic massage “may relieve pain by way of several mechanisms, including relaxing painful muscles, tendons, and joints; [and] relieving stress and anxiety… .” Massage is a non-invasive and completely drug-free remedy for muscle and joint pain. Similarly, acupuncture, which is an ancient technique that entails placing needles in specific pressure points, may also provide relief.
The use of heat and cold is also effective for temporarily relieving pain. Heat offers a sense of comfort that can help the body relax, which can reduce muscle strain and thereby ease discomfort. Further, heat promotes blood flow, which can help an injured person recover more quickly. Cold, while perhaps not as comfortable as heat, reduces topical inflammation.
Physical therapy (PT) is extremely effective at reducing pain. PT is not a quick fix, but instead, a series of actions meant to re-strengthen the muscles, bones, and tendons that are injured. Contrary to popular belief, physical therapy is not only used to assist in recovery after surgery and the healing of broken bones. The University of Utah Health reports that physical therapy is an ideal solution for individuals who wish to avoid using opioid painkillers. Chiropractic manipulation and support may be used alongside PT to treat issues relating to spinal misalignment.
Cognitive behavioral therapy (CBT) is a type of counseling led by a licensed mental health professional. It is used to help an individual learn to understand the relationship between cognition, or thoughts, and emotions and their behaviors. The VA explains that CBT “would likely be useful in helping any individuals manage chronic pain more effectively.”
Some individuals who suffer from certain types of chronic pain may find that invasive and minimally-invasive medical treatments are effective. This includes steroid injections, nerve blocks, trigger point injections, and radiofrequency ablation. Radiofrequency ablation essentially burns the nerve pathways that send signals of pain to the brain. Mayfield Brain & Spine reports that it is a common procedure that can be quite effective in treating arthritis as well as peripheral nerve pain and sacroiliitis.
Diet, Exercise, and Inflammation
Inflammation is how the body responds to injury. A broken toe that swells or a visible lump on the head that arises after a concussion are examples of acute inflammation. This physiologic response is necessary, and increases blood flow and white blood cell count to the injured area, which begins the healing process. Chronic, systemic inflammation, which is a common disorder in those with pain conditions, is not visible to the eye, but can often be felt as a persistent ache. A few common inflammatory diseases are arthritis, vasculitis, and gout. In addition to pain, chronic inflammation is linked to heart disease and cancer.
Diet plays a significant role in overall health, and some foods are known for reducing systemic inflammation. Whole grains, fruits, vegetables, and healthy fats all contain nutrients that help the body regulate. Even dark chocolate offers benefits in the form of antioxidants and polyphenols. Michigan State University explains the difference between antioxidants, anti-inflammatories, and phytochemicals. The Arthritis Foundation recommends following an anti-inflammatory diet, which is comprised mainly of vegetables, fish, and olive oil.
Relieving internal inflammation is only part of the dietary puzzle. People who are obese will benefit from a reduced-calorie diet and regular exercise routine, as excessive body weight is known to greatly increase pain. In 2015, the Journal of Pain Research published a study explaining that obesity contributes to pain in three ways: inflammation, mechanical loading, and psychological status. Losing weight can lower the perception of pain and reduce the physical factors that cause it.
Obese individuals who experience chronic pain are encouraged to speak with their primary health care provider to determine the best course of action to help manage their weight. They should be encouraged to get regular physical activity and to understand that weight loss and weight management require lifestyle changes, time, and commitment.
Long-term opioid abuse can ravage the body and mind. Fortunately, it is possible to find relief via non-addictive modalities, such as non-opioid analgesics, anti-inflammatory medications, and lifestyle changes. These non-opioid alternatives are safer than addictive drugs, and may be more sustainable and similarly-effective treatment options for chronic pain and inflammatory conditions.
If you or someone you love suffer from chronic pain and opioid addiction, seek help immediately. The longer you wait, the more damage is done. A medical detox followed up by professional drug rehabilitation and ongoing counseling can help get you back where you belong: pain- and drug-free for life.