Managing Chronic pain without addiction – A guide to Pain Management without Opioids

Pain is defined as a feeling or sensation that is not pleasant or comfortable. Pain can be mild, moderate or severe.  It can bearable or unbearable. It may or may not disrupt one’s daily life or functional level. But the truth is, no one wants to live in pain. In addition, no one should put their health at risk in an effort to be pain-free.   I will focus on some very effective and non-pharmacological pain management techniques in this post.

Pain Management

Since 1999, Americans have increasingly been prescribed opioids. This includes painkillers (like Vicodin, OxyContin, Opana, and methadone), and combination drugs (like Percocet). In some situations, prescription opioids are an appropriate part of medical treatment. However, opioid risks include depression, overdose, and addiction, plus withdrawal symptoms when stopping use. As a result, people addicted to prescription opioids are 40 times more likely to become addicted to heroin.

The Centers for Disease Control and Prevention (CDC) is urging health care providers to reduce the use of opioids in favor of safe alternatives like physical therapy. This article concentrates on few non-pharmacological methods for pain management. All the methods described below have strong evidence that supports successful pain management. I want to emphasize the fact that certain medical condition like an end-stage disease, cancer, post-surgery to name few, do require pharmacologic interventions. So by any means, this article is not concentrated on not getting any pain medications. Rather, more on to provide some awareness by discussing few other pain management options.

Nonpharmacologic therapies have become a vital part of managing chronic pain (CP). Nonpharmacologic approaches can be classified as behavioral, cognitive, integrative, and physical therapies. Core principles in developing a treatment plan are explaining the nature of the CP condition, setting appropriate goals, and developing a comprehensive treatment approach and plan for adherence.

  1. Cognitive- Behavioral Therapy (CBT) for Pain Management:

Negative, inappropriate, catastrophic thoughts are often present in patients with pain disorders. Such thoughts are highly correlated to the intensity of pain complaints. Cognitive-behavioral therapy focuses on restructuring this negative cognitive schema into a more realistic appraisal of the patient’s current condition. CBT aims to gain a realistic perspective regarding the past, present, and future. As a result, patients may be able to more easily deal with their pain. CBT involves few techniques that can be used.

Relaxation training is often a component of cognitive-behavioral therapy for pain patients. A therapist can teach progressive muscle relaxation, stretch-based relaxation, deep breathing, and autogenic training as part of relaxation techniques.

Meditation:  Some examples of meditation techniques are including mindfulness meditation, concentration meditation, transcendental meditation, and several types of movement meditations.

Physical activity is another aspect of cognitive-behavioral therapy. It involves the practical application of skills that permit better coping with day-to-day pain. Finding an appropriate level of activity is important. When patients try to do too much on days that their pain is relatively good, they often find themselves nearly immobilized the following day.

2.  Integrative Therapy for Pain Management:

The National Center for Complementary and Integrative Health, a center within the National Institutes of Health, increasing evidence demonstrates that integrative therapies such as acupuncture, massage, yoga, and mindfulness-based stress reduction can decrease pain intensity, improve function, and promote better coping with chronic pain.

Acupuncture has been demonstrated to enhance endogenous opiates, such as dynorphin, endorphin, enkephalin, and release corticosteroids, relieving pain and enhancing the healing process.

Massage helps to treat pain and improves functionally related and health-related quality of life. Yoga improves fitness, flexibility, agility, muscle strength and exercise tolerance. It also helps in relaxing the body and reduces pain.

Pain Management

Mindfulness-based stress reduction works by making yourself aware of your own body, and environment. It works through breathing and meditation. There is still need for more evidence for exact mechanism and its effects at cellular level.

3. Physical Therapy for Pain Management:

Physical or occupational therapy can help in pain management in various ways. Electrical stimulation, stretching, strengthening, positioning etc are few examples of pain management techniques. Enhancing patient and family caregiver education and engagement around pain management and the risks of opioids is crucial. In addition, heat or cold therapy, contrast baths, aquatic exercises, pacing (energy conservation techniques) or aerobic exercises are few other alternatives to manage pain.

The positive part for pain management done by PTs is that they not only treat pain symptoms but also work on etiology of the pain. A PT will assess if a patient is having pain issues due to poor posture, improper techniques, muscle weakness or muscle imbalance etc.. That way a plan of care will include not only pain management but also prevention and education for future. I talk about some techniques for posture correction as well as specific stretching in my previous articles.

In conclusion, let’s try to consider other pain management options before getting yourself addicted to those pain pills.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000182/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4894245/

Patil, S.; Sen,S.; Bral, M.; Reddy, S.; Bradley, KK.; Cornett, EM.; Fox, CJ.; Kaye, AD. The Role of Acupuncture in Pain Management. Current Pain and Headache Report. 2016: 20-22.

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NOTE: The contents of this blog are for informational purposes only and are not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you have regarding a medical condition, and before undertaking any diet, dietary supplement, exercise, or other health program.