Alternatives to Opioids for Pain Management

You’ve probably heard of opioids. They’re powerful medicines that are prescribed to treat pain. However, opioid users should be use extremely cautious. Taking them can cause your body to become addicted to them in a short time. That means your body feels it must have the medicine, even if the pain is gone. More than a million people in the United States are addicted to opioids. It’s a serious problem.

Fortunately, there are many alternatives to opioids for pain management. In some cases, you can take other types of medicine to control your pain. At other times, you can use non-medicine treatments to deal with your pain. You also may be able to use a combination of medicine and non-medicine treatments to help you feel better. Talk with your doctor about which options are best for you.

Types of Pain

There are two general types of pain. Opioid alternatives can be successful for both types.

• Acute pain: This is pain that starts suddenly, such as because of surgery or an injury. While acute pain can be severe, it usually doesn’t last a long time.
• Chronic pain: This is pain that lasts for a long time, sometimes months or even years. It’s often an underlying pain that you feel all the time. There are many types of chronic pain, including nerve pain, back pain, and pain caused by some medical conditions (such as rheumatoid arthritis or fibromyalgia).

Medical Alternatives to Opioids for Pain Management

These medicines can work for mild and moderate pain. They’re usually fast acting, meaning you may feel pain relief within a few hours.

Over-the-counter medicines

You don’t need a doctor’s prescription for these popular treatment options. One choice is a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). These include ibuprofen (one brand name: Advil), naproxen (one brand name: Aleve), and aspirin (one brand name: Bayer). Another option is a group of drugs called analgesics, including acetaminophen (one brand name: Tylenol).

Numbing medicines

These come in many forms, including creams, lotions, and gels. These are available over the counter or by prescription. The medicine used in these is called an anesthetic. When you apply the product to the area that hurts, the medicine makes the area numb. That means you can’t feel it—or the pain. These medicines may work well in instances such as a sore tooth or an insect sting.

Muscle relaxers

These may be good choices if you have pain in your neck or back. They also may work if you have muscle spasms. The medicine relaxes your muscles. They’re given as a prescription by your doctor.

Nerve blocks

With these, pain is treated with an injection (shot). The shot is given by your doctor near the area that’s hurting. The medicine in the shot is numbing. That makes it so you can’t feel any pain.

Injections in joints or tendons

Your doctor my help you decide if an injection of certain medications into a joint or tendon may help relieve some of your pain. Your doctor might be able to perform some of these in their office, but you may need to be referred to another provider for some other injections.

Antidepressant and anti-seizure medicines

These may seem like strange options for treating pain. But your doctor may prescribe one of these medicines, especially if you have nerve pain.

Non-Medicine Alternatives to Opioids for Pain Management

You don’t always have to take medicine to make pain go away. These non-medicine treatment options may work on mild to moderate pain. They’re usually slow acting, meaning it may take a longer time for you to feel pain relief.

Heat, Ice, and Massage Therapy

• At-home care with heat and ice. Many aches and pains can be treated at home. This applies to acute injuries, such as a sprained ankle, or chronic pain, such as mild arthritis. One of the easiest ways to treat this kind of pain is to apply heat and/or ice to the painful area. They reduce swelling and relax your muscles. Ask your doctor which is best for your situation. However, never put heat or ice directly on your skin. Always wrap them in a soft cloth or towel.
• Massage. During a massage, a specialized massage therapist uses hands-on procedures to apply pressure to your body. Those special movements loosen and relax muscles, ligaments, and tendons. That may relieve your pain. There are many types of massage. While your doctor won’t perform the massage, ask them about which type of massage is best for you.

Nerve Stimulation and Chiropractic Care

• Nerve Stimulation. A transcutaneous electrical nerve stimulator (TENS) unit is a portable machine available for purchase. With this device, you can apply a small amount of electric current through electrode patches to an area of pain. This current affects the nerves to help reduce the amount of pain you feel. This works best for pain in one specific location.
• Chiropractic treatments. Chiropractic treatments may relieve back pain or other chronic pain. A chiropractor uses special hands-on techniques to adjust your body. Most of the time, they make small, minor adjustments to your musculoskeletal system. That is your body’s system that provides stability and includes your muscles, bones, tendons, and other body parts.

Physical Therapy and Exercise

• A healthy lifestyle. In some instances, chronic pain can be caused if you weigh more than you should. If that’s the case, getting to—and maintaining—a healthy weight may be helpful. Eat a well-balanced diet and add exercise to your daily routine. While exercise may seem the opposite of what you should do if you’re experiencing pain, it can strengthen your muscles, which may make you feel better. Talk with your doctor about which exercises would be best for you. If you smoke, try quitting. Smoking can contribute to chronic pain because it decreases oxygen delivery to tissues.
• Food diary. Certain kinds of chronic pain can be triggered by certain foods. You may want to keep a food diary of what you eat and see how it relates to your pain. If you find certain foods make your pain worse, discuss that with your doctor. And avoid eating that food in the future.
• Yoga. Yoga is a gentle exercise you can do at home or in a class. Yoga stretches and lengthens your muscles. This repeated stretching may make your pain go away by working the muscles that are causing your pain.
• Physical therapy. During this therapy, a specially trained therapist teaches you exercises to work the painful area. The goal is to help our body do what it used to do. Examples include special stretches to treat a painful shoulder or weightlifting to regain strength in an injured leg. Physical therapy can be painful. However, this short-term pain typically results in less pain down the road. Don’t give up.

Surgical Procedures

In severe cases of chronic pain, some surgical procedures may help. During a spinal cord stimulation, a specially trained doctor puts a small device in your back. You can control this device with a remote control. When you feel pain, you can use the remote to trigger the device to provide another sensation instead of pain, such as a tingling massage. A similar process happens with a pain pump. A small pump is inserted under your skin. Then, when you feel pain, you push a button on a controller that you hold. That makes the pump inside your body send out medicine that can control your pain.

Things to consider

While none of these treatments can become addictive, many of them are known to have side effects. Depending on the treatment, those may include dizziness, blurry vision, constipation, and skin irritation. Taking NSAIDs or analgesics long-term may also lead to other health issues. You may need to use or apply many of these treatments more than once to see results. Talk with your doctor to find the best opioid-free treatment for your needs. They can also explain which side effects you might experience.

Using opioids medicines can put you at risk for developing opioid use disorder (misusing opioids) and lead to opioid addition. Always consult your doctor about safe ways to manage pain. If you both decide opioids are the most appropriate option, follow all dosing instructions carefully.

Questions for your doctor

• What alternatives to opioids for pain management are best for me?
• What side effects could I have?
• Which treatment options can be used together?
• What’s the best way to use ice and heat treatment at home?
• How long is it safe to use NSAIDs or analgesics?

Resources

CDC: Overdose Prevention

Funding support for this material has been provided to the American Academy of Family Physicians by Indivior, Inc.