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Pain Management Options for Opioid Addicts

Pain is part of the usual human experience, but at times, pain can be intense and overwhelming. Physicians may prescribe a short-term course of opioid painkillers after surgery or other injuries. In addition, doctors may prescribe opioid painkillers on a longer-term basis for people with chronic pain, such as cancer-related pain or pain associated with other chronic, debilitating health issues.

However, many people want to avoid opioids, whether due to a past problem with opioids or out of concern of becoming dependent on them. This article will discuss some of the concerns around using opioids for pain management and alternatives to opioids.

Opioid Pain Management

Older woman suffering from chronic pain, taking opioids to deal with pain.Opioids are a class of medications that interact with opioid receptors in the brain to provide pain relief. 1 Commonly prescribed opioid painkillers include oxycodone, hydrocodone, morphine, and codeine. Brand names include OxyContin, Percocet, and Vicodin.1

When people experience acute pain, such as the pain one might experience after surgery, or from an injury such as a broken bone, they may be given opioid painkillers to help manage their pain for a short period.2 While many people take a short-term course of opioids for acute pain without any problem, the inherently rewarding properties of these drugs sometimes prompt their misuse, which could eventually give rise to opioid use disorders and increase certain health risks such as overdose.2

In addition to opioids that are given for acute pain, doctors sometimes prescribe longer-term courses of opioids for people who suffer from chronic pain. Chronic pain is pain that lasts longer than 3 months, or that which persists beyond the time of a normal healing process. 3 It has been estimated that 100 million Americans suffer pain daily, but many studies don’t support the long-term benefits of opioid use in managing these chronic pain scenarios.4

While many people take opioids for a longer period of time without developing compulsive patterns of misuse, there may be a higher likelihood of eventual abuse the longer an opioid is taken. The latest estimates indicate that around 21-29% of people who take opioids for chronic pain misuse them and around 8-12% of them will develop an opioid use disorder.5

The reasons why opioids can lead to a substance use disorder is related to their chemical structure and the resulting impact that opioids have on the brain.1 Given their molecular structures, opioid drugs are able to bind to and activate specialized proteins throughout the body known as opioid receptors, many of which are found in the brain. 1 When these receptors are activated, a person’s perception of pain is modified. 1 In addition to analgesic effects, opioid receptor activation is also accompanied by an increase in activity of the brain chemical dopamine, which reinforces sensations of pleasure and reward. In some people, these sensations are powerful, and the person wants to keep experiencing them again and again.1

In addition to the risk of developing an opioid use disorder, the likelihood of experiencing an opioid overdose may increase as a result of prolonged opioid use. In 2017, an estimated 47,000 Americans died from an opioid overdose.5 While the prescription opioid abuse problem extends beyond these three medications, hydrocodone, oxycodone, and methadone are the 3 most commonly involved in overdose deaths.6 Although anyone may be at risk of opioid use disorders, women are more likely to struggle with chronic pain conditions, be prescribed opioid painkillers, as well as take opioids for longer periods of time. Additionally, there is evidence that woman may become dependent on opioids more quickly than men.7

American Addiction Centers is in-network with many insurance providers. Depending on your policy your treatment at AAC could be free.

Alternatives to Opioids for Chronic Pain

Many people assume that opioids are the only viable option to control pain, whether acute or chronic. However, non-opioid drugs, alternative therapies (e.g., yoga, acupuncture, physical therapy), and counseling can also be used to manage pain.8, 9  Some people may opt for alternatives to medication because they might have a history of an opioid use disorder or fear they may develop one.

Non-Opioid Drugs

Non-opioid drugs that may be useful for pain management and decreasing reliance on opioid painkillers include:4, 10

  • Non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and ketorolac (Toradol).
  • Acetaminophen.
  • Glucocorticoid steroids.
  • Beta-blockers, including esmolol and labetalol.
  • Anticonvulsants, such as gabapentin and pregabalin.
  • Antidepressants, such as duloxetine, amitriptyline, and nortriptyline.

While some of these alternative options are more effective than others for different types of pain, and while they may have certain risks of their own, studies indicate that non-opioid medications can be effective for managing various chronic pain syndromes.4

Holistic Pain Management

Researchers have studied several types of non-pharmaceutical pain management methods, including:11, 12

  • Acupuncture, which involves the insertion of needles at specific points on the body, to interrupt pain signals.
  • Massage and chiropractic treatment, which use hands-on manipulation techniques to effectively manage pain.
  • Yoga, which is based on Hindi practices and uses a holistic approach to mind, body, and spirit and can help manage pain.
  • Mindfulness meditation.
  • Exercise, including therapeutic exercises.
  • Nutritional therapies, which remain popular but require further research to understand their role in pain management.

Therapies and Counseling

Physical therapy is also used by many people to aid in the management of chronic pain. A recent study showed that physical therapy is effective for chronic lower back pain.13

Several types of behavioral therapies have been proven effective in chronic pain management; these include:14

Both of these models have been shown to result in better psychological adjustment to pain and coping with it.14

Opioid Addiction Treatment

If you have issues with chronic pain and are concerned that stopping the use of opioids will lead to severe pain and discomfort, know that many options are available for you. 15 The good news is that opioid agonist treatment medications (e.g., methadone and buprenorphine) can help you stop the misuse of opioid painkillers (or illicit sources of opioids) and control both your symptoms of withdrawal and cravings for opioids while helping to manage your pain. 15 In addition, various non-opioid medications and alternative therapies can be used to supplement ongoing pain management as you manage your opioid use disorder.15

If you or a loved one are struggling with opioid use, you are likely considering addiction treatment. Call American Addiction Centers’ 24/7 confidential helpline at today to learn more about our opioid abuse treatment options.

Managing Chronic Pain in Recovery

When you have chronic pain, know that recovering from opioid addiction does not mean that you will not be able to manage your pain. While using opioids to manage acute or chronic pain may not be possible, there are numerous non-opioid pain management interventions, including: 8, 9, 11

  • Non-opioid medications.
  • Physical therapy, massage, and chiropractic interventions.
  • Yoga, exercise, and acupuncture.
  • Cognitive-behavioral therapy (CBT).

Aftercare and Support

Regardless of which methods you use to manage your chronic pain, recovery from opioid use disorders involves not only treatment, but also ongoing aftercare and support to help you maintain your recovery. Aftercare may include:

Chronic pain is a serious issue, and unfortunately, it sometimes leads to the misuse of opioids to try to manage that pain. Consistent misuse of opioids can increase the risk of overdose and other health issues as well as contribute to the development of an opioid use disorder, or addiction.

One of the fears you may have about getting help for opioid dependence may be that your pain will be uncontrollable without your usual dose of opioids. However, numerous non-opioid drugs and alternative treatments, such as yoga, massage, and behavioral therapy, are available to help manage your pain effectively. If you still have questions about how you can begin recovery for an opioid use disorder, but still effectively manage your pain, please call us today to discuss your treatment options.

 

Sources

  1. National Institute on Drug Abuse. (2020). Prescription opioids: Drug facts.
  2. Centers for Disease Control. Opioids for acute pain. What you need to know.
  3. Centers for Disease Control. (2019). Opioid overdose. Guideline overview.
  4. Nicol, A. L., Hurley, R. W., & Benzon, H. T. (2017). Alternatives to opioids in the pharmacologic management of chronic pain syndromes: A narrative review of randomized, controlled, and blinded clinical trialsAnesthesia and Analgesia125(5), 1682–1703.
  5. National Institute on Drug Abuse. (2020). Opioid overdose crisis.
  6. Centers for Disease Control. (2017). Prescription opioids.
  7. American Society for Addiction Medicine. (2016). Opioid addiction 2016 facts and figures.
  8. Barry, D. T., Beitel, M., Cutter, C. J., Joshi, D., Falcioni, J., & Schottenfeld, R. S. (2010). Conventional and nonconventional pain treatment utilization among opioid dependent individuals with pain seeking methadone maintenance treatment: a needs assessment studyJournal of addiction medicine4(2), 81–87.
  9. Phillips JK, Ford MA, Bonnie RJ, editors. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington (DC): National Academies Press (US); 2017 Jul 13. 2, Pain Management and the Intersection of Pain and Opioid Use Disorder.
  10. White, P. F. (2017). What are the advantages of non-opioid analgesic techniques in the management of acute and chronic pain? Expert Opinion on Pharmacotherapy, 18(4), 329-333.
  11. American Society of Anesthesiologists. Pain management: Non-opioid treatment.
  12. US Department of Health and Human Services. (2019). Pain management. Best practices inter-agency task force report.
  13. Martin, S., Tallian, K., Nguyen, V. T., van Dyke, J., & Sikand, H. (2020). Does early physical therapy intervention reduce opioid burden and improve functionality in the management of chronic lower back pain? Mental Health Clinician10(4), 215-221.
  14. Turner, J. A., Anderson, M. L., Balderson, B. H., Cook, A. J., Sherman, K. J., & Cherkin, D. C. (2016). Mindfulness-based stress reduction and cognitive behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trialPain157(11), 2434–2444.
  15. American Society of Addiction Medicine. (2016). Opioid addiction treatment.

 

Last Updated on September 10, 2020
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Scot Thomas, MD
Industry Expert
Dr. Scot Thomas is Senior Medical Editor for American Addiction Centers. He received his medical degree from the University of California, San Diego School of Medicine.
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