Opioid Alternatives: Ways To Manage Pain With Less Risk

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Opioids have a list of side effects that make patients think twice before using them, despite being as effective as they are for chronic pain management. Further, their ability to cause addiction always puts them in the “risk vs. benefit” comparison.

There are three approaches that people can go for if they seek alternatives to opioids: medications, interventions, and occupational therapies. The first and most often go-to approach is to find another group of drugs that are less likely to be addictive.

The second approach is by undergoing various interventions to relieve chronic pain. This approach is less common because people usually rely on it when medications fail to alleviate their pain.

The third approach, occupational therapy, is often used along with other pain medication methods or to prevent pain from arising to begin with.

Opioid Alternative Medications

There are four groups of medications that you can use instead of opioids. Those are NSAIDs, corticosteroids, antidepressants, and anticonvulsants.

1. Non-steroidal Anti-inflammatory Drugs

NSAIDs are medications commonly used to relieve moderate to severe acute pain and reduce inflammation. They are also among the most common alternatives to opioids because of their treating pain potency.

Use and Method of Action

These medications work by inhibiting an enzyme known as cyclooxygenase or (COX). This enzyme plays a major role in the production of prostaglandins, which are substances that cause a wide range of pain conditions, including:

  • Headaches
  • Back pain
  • Joint pain
  • Muscle aches
  • Dental pain
  • Postoperative pain
  • Fever
  • Menstrual cramps

NSAIDs often start their action in the human body within 30-60 minutes of being taken. The chronic pain relief effect can last for a few hours before the patient needs a second dose of the medication.

Availability

While NSAIDs can be taken by prescription, some of them are still available as over-the-counter medications. Among the most commonly used OTC NSAIDs include:

  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve)
  • Aspirin

Upon examination, the doctor may prescribe other NSAIDs like:

  • Diclofenac (Voltaren)
  • Indomethacin (Indocin)
  • Celecoxib (Celebrex)

Safety and Side Effects

NSAIDs are generally safe and effective for the majority of people. However, they can still cause some side effects if taken in high doses or for extended periods. These include:

  • Drowsiness or dizziness
  • Heartburn
  • Headache
  • Skin rashes
  • Increased risk of heart problems
  • Diarrhea or constipation
  • Stomach upset

2. Corticosteroids

Corticosteroids are a group of medications that doctors prescribe to treat a variety of conditions like autoimmune diseases, inflammation, and cancer pain.

Use and Method of Action

Corticosteroids work by mimicking the effects of cortisol, which is a hormone that the human body naturally produces to alleviate multiple conditions.

However, the amount secreted by the body may not be enough to handle severe conditions, hence the external administration.

Typically, a doctor would prescribe corticosteroids for the following conditions:

  • Blood disorders
  • Cancer
  • Allergic reactions
  • Autoimmune diseases
  • Skin conditions
  • Digestive disorders
  • Neurological disorders
  • Respiratory disorders
  • Eye disorders
  • Organ transplants

Availability

  • Triamcinolone cream (0.025% or 0.1%)
  • Hydrocortisone cream (1% or less)
  • Betamethasone cream (0.05%)

Meanwhile, prescription corticosteroids include:

  • Inhalers: Beclomethasone, mometasone furoate, and budesonide
  • Eye drops: Dexamethasone and prednisolone acetate
  • Nasal sprays: Budesonide, beclomethasone, and fluticasone propionate
  • Pills: Prednisone, methylprednisolone, and betamethasone
  • Injections: Hydrocortisone, triamcinolone, methylprednisolone, and dexamethasone

Safety and Side Effects

Occasional use of corticosteroids is safe. However, they are notorious for causing side effects if used for extended periods. These include but aren’t limited to:

  • Fluid retention and weight gain
  • Acne
  • Skin thinning
  • Mood swings and difficulty sleeping
  • Decreased bone density
  • Increased blood sugar levels
  • Stomach ulcers
  • Cataracts or glaucoma

3. Antidepressants

Even though they’re not designed for this, antidepressants are among the most common methods to treat chronic pain that doesn’t seem to go away with other medications.

Use and Method of Action

Antidepressants work by changing the levels of particular neurotransmitters in the brain. These “neurotransmitters” are some sort of chemical messengers that help regulate mood, appetite, sleep, and pain relief.

Antidepressants are often used to treat the following conditions:

  • Post-traumatic stress disorder (PTSD)
  • Generalized anxiety disorder (GAD)
  • Persistent depressive disorder (dysthymia)
  • Obsessive-compulsive disorder (OCD)
  • Cases of unexplained chronic pain

Availability

Antidepressants are only sold with a prescription. Some of those are:

  • Serotonin-norepinephrine reuptake inhibitors (SNRIs): Venlafaxine (Effexor XR) and duloxetine (Cymbalta)
  • Selective serotonin reuptake inhibitors (SSRIs): Paroxetine (Paxil) and escitalopram (Lexapro)
  • Tricyclic antidepressants (TCAs): Clomipramine (Anafranil) and protriptyline (Vivactil)
  • Atypical antidepressants: Trazodone (Desyrel) and mirtazapine (Remeron)

Safety and Side Effects

With controlled use, antidepressants are safe to use for most people. Yet, like any other medication, they have their fair share of side effects. These include:

  • Nausea and vomiting
  • Diarrhea
  • Insomnia
  • Headache
  • Sexual dysfunction (uncommon)
  • Dry mouth

4. Anticonvulsants

Anticonvulsants are primarily designed to treat signs of epilepsy, but their nerve-calming effect has made them common for treating chronic pain.

Use and Method of Action

Epileptic seizures occur when there’s a sudden burst of abnormal brain electrical activity. Anticonvulsants work by altering that activity and making it harder for the brain to generate these sudden bursts of electric signals.

The nerve-calming qualities made anticonvulsants available for a lot more conditions than just epilepsy:

  • Cluster headaches
  • Bipolar disorder
  • Neuropathic pain
  • Parkinson’s disease
  • Restless leg syndrome
  • Trigeminal neuralgia
  • Fibromyalgia
  • Traumatic brain injuries
  • Autism spectrum disorder

Availability

Anticonvulsants are medications that are only available as prescription drugs. They’re categorized as sodium channel blockers, calcium channel blockers, and GABAergic drugs.

  • Sodium channel blockers: Phenytoin (Dilantin), Oxcarbazepine (Trileptal), Lamotrigine (Lamictal), Valproate (Depakote), and Carbamazepine (Tegretol)
  • Calcium channel blockers: Gabapentin (Neurontin), Pregabalin (Lyrica), Levetiracetam (Keppra), and Ethosuximide (Zarontin)
  • GABAergic drugs: Diazepam (Valium), Topiramate (Topamax), Lorazepam (Ativan), and Clonazepam (Klonopin)

Safety and Side Effects

As long as the patient is following the instructions and abiding by the exact doses, anticonvulsants can be safe and effective. Yet, they have some side effects that are most common after first-time use:

  • Blurred vision
  • Skin rash
  • Unexpected and sudden mood flips
  • Drowsiness and dizziness
  • Generalized fatigue, even if the patient is well-rested
  • Constipation
  • Headache
  • Nausea and vomiting

Using Interventions as Opioid Alternatives

Sometimes, the pain is chronic enough or too severe that a more focused approach is needed instead of systemic pain medications. That’s when pain-specific interventions come into action.

1. Joint Injections

Joint injections involve injecting the medication directly into the joint instead of taking an oral medicine or an IV analgesic injection. This can make them extremely effective in relieving joint pain and inflammation.

These injections are minimally invasive and don’t involve any form of major or minor surgeries. However, they are often done in a clinic or in a doctor’s office because of the precision they require.

The procedure is just like any regular injection;  the skin surface is cleaned and sometimes numbed with a local anesthetic cream. This serves to minimize the pain from the needle.

For deeper injections, doctors sometimes mix the local anesthetic with the drug itself. However, that’s not applicable to all medications.

Joint injections are often used to treat a variety of conditions that include:

  • Rheumatoid arthritis
  • Bursitis
  • Tendinitis (sometimes referred to as tendonitis)
  • Tennis elbow
  • Golfer’s elbow
  • Osteoarthritis
  • Gout
  • Plantar fasciitis

On taking joint injections, you should keep a few precautions in mind:

  • Let your doctor know if you have any allergies or if you’re currently taking any medications. This is to prevent instances of drug interactions or allergic reactions.
  • Listen and apply all the instructions that the doctor gives you after the injection.
  • Avoid exerting excessive effort on the injected joint to prevent inflammation and allow the drug to perform its action.

2. Epidural Steroid Injections (ESIs)

Epidural injections are used to deliver steroids into the area around the spinal cord, making them especially effective in treating persistent back pain that doesn’t go away with medications.

This stubborn back pain often comes from nerve damage, which could have been caused because of:

  • Dislocated or herniated discs
  • Degenerative disc disease
  • Spinal stenosis
  • Severe spinal infection
  • Sciatica
  • Facet joint syndrome
  • Spondylosis
  • Radiculopathy
  • Procedural or surgical errors (rare)
  • Traumatic spinal injuries (due to accidents or spinal injury by blunt or sharp weapons)

Because of how critical the injection site is, this procedure must be done in the doctor’s office/clinic under extremely aseptic conditions.

The needle injection in this procedure goes around the spinal cord, and the slightest bacterial contamination can cause unprecedented side effects.

All the precautions mentioned in joint injections should also be applied here. The patient should also avoid carrying anything heavy or exerting any pressure on the spine to avoid complications.

One thing to keep in mind with ESIs is that they’re not permanent solutions. The effects are often temporary, and repeated injections may be needed.

3. Radiofrequency Ablation (RFA)

RFA refers to a minimally invasive procedure that uses heat to destroy nerve tissue. The procedure involves precisely placing a needle into a specific area of the nerve and then sending radio waves to initiate controlled damage to that nerve tissue.

The idea is to prevent pain signals from going back to your brain, which can be helpful with the following conditions:

  • Cancer treatment: Used to treat cancerous tumors;
  • Cardiac arrhythmias: Used to create small, controlled burns on the heart tissue, disrupting the abnormal electrical signals causing the arrhythmia;
  • Liver diseases: Used to treat benign and cancerous liver tumors;
  • Kidney diseases: Used to treat kidney tumors, most commonly renal cell carcinoma
  • Varicose veins: Used to close off malfunctioning veins, which helps redirect blood flow to healthier vessels and reduce the symptoms;
  • Pulmonary conditions: Used to treat lung tumors and lung metastases;
  • Gynecological conditions: Sometimes used to treat certain gynecological conditions like uterine fibrosis and endometriosis.

Oftentimes, the patient undergoing RFA will require some recovery time after the procedure, which is why taking a few days of work is often recommended.

This not only helps the patient recover faster but also allows them to have enough time to focus on any symptoms that may arise and stay in contact with their doctor, which is extremely important after RFAs.

4. Spinal Cord Stimulation

Much like ESIs, spinal cord stimulation aims to relieve pain that’s localized to the spinal cord. This is done through a device called the spinal cord stimulator or (SCS) which provides transcutaneous electrical nerve stimulation.

This implanted device sends low levels of controlled eclectic pulses directly into the spinal cord to help with managing pain. This procedure is most helpful with the following conditions:

  • Chronic leg, back, and neck pain
  • Complex regional pain syndrome
  • Peripheral neuropathy (peripheral nerve pain)
  • Spinal cord injury
  • Failed back surgery syndrome
  • Ischemic Limb Pain
  • Arachnoiditis

The stimulator implant can also be adjusted to deliver different levels of electrical stimulation. This usually involves a few trials and some coordination between the patient and the doctor to find the best settings for pain relief.

Spinal cord stimulation is often used after medications fail to relieve pain and before considering surgery. While it reduces the need for analgesics, it’s still usually used along with other pain management procedures (more about that soon).

There’s a newer spinal treatment modality called Dorsal Root Ganglion (DRG) and Peripheral Nerve Stimulation (PNS). DRG and PNS work quite similarly to spinal cord stimulation.

However, this is a new treatment modality that allows for a more targeted stimulation of the nerve roots.

Using Complementary and Rehabilitation Therapies

It’s unrealistic to consider complementary and rehabilitation therapies as alternatives to opioids or even non-opioid medications. Otherwise, medications would have been rendered obsolete.

Instead, these therapies are often used in concomitance with other medications that are less effective (and less addictive) than opioids to achieve similar effects.

Here are some of the complementary and rehabilitation therapies that can be used to control the pain:

1. Acupuncture

This technique is a traditional Chinese medicine (TCM) practice that utilizes thin needle insertion into specific points of the body.

According to the Chinese, these points are connected to energy pathways that flow throughout the body. Inserting the needles into these points is believed to rebalance the flow of energy.

Many opinions exist regarding acupuncture as it’s not fully understood how it works. However, it’s been used to treat pain for centuries, which is why it’s still a considerable option.

Acupuncture has proved to be useful for the following conditions:

  • Back and neck chronic pain
  • Headache and migraine
  • Carpal tunnel syndrome
  • Arthritis
  • Immune system issues
  • Infertility

Because acupuncture doesn’t involve injecting any medication or placing any device into the body, the risks associated are often down to the minimum. The only common side effect is the infection that may arise from using non-sterile needles in the procedure.

2. Chiropractic Treatment

Chiropractic treatment is one of the alternative medicine types that focuses on chronic musculoskeletal pain. It involves massage therapy, muscle stimulation, soft tissue therapy, stretches, and the iconic adjusting or “popping” of the spine and other bones.

Much like acupuncture, it’s unclear how chiropractic treatment works to alleviate pain, especially since patients need to constantly come back to the chiropractor to prevent the pain from coming back.

Several studies have been conducted to verify the efficiency of chiropractic treatment. However, one thing is for sure: many patients seem to provide positive feedback about the treatment, especially if it involves spinal and back pain.

Nevertheless, chiropractic treatment has helped patients with:

  • Back pain, neck pain, and frequent headaches
  • Joint pain
  • Whiplash
  • Sports injuries
  • Tennis and golfer’s elbow
  • Arthritis
  • Muscle pain

While the treatment is somewhat questionable, regular chiropractic care is a reliable way to prevent injuries from happening.

3. Massage Therapy

While chiropractic adjustment is more focused on bones, massage physical therapy is primarily focused on manipulating soft tissues of the body. This includes muscles, tendons, and ligaments.

Massage therapy has been proven to be an effective way to handle a variety of conditions, including:

  • Joint pain
  • Sports injuries
  • Insomnia
  • Stress
  • Soft tissue injuries
  • High blood pressure

In addition to handling these conditions, massage therapy can also provide various benefits, making massage useful even if there’s no underlying condition to treat. These include:

  • Reducing stress hormones
  • Lymphatic system stimulation
  • Reduced depression and anxiety
  • Less muscle tension
  • Reduced stress hormones
  • Better joint mobility and flexibility

Wrapping Up

Opioid alternatives can sometimes be as effective if used correctly and according to the doctor’s instructions. There are also many options to choose from, depending on the condition that needs treatment.

Despite not being addictive, these opioid alternatives still have their risks and side effects like any other medical approach. So it’s best to be well-informed before taking a step.

If you or someone you know is suffering from opioid addiction or simply looking for better alternatives, feel free to book an appointment with us, and we’ll handle the rest.

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