Non-Opioid Medications for Pain

Opioid Pain Management

Opioids are a class of medications that interact with opioid receptors in the brain to provide pain relief. ¹ Some commonly prescribed opioid painkillers include oxycodone, hydrocodone, morphine, and codeine.¹

When people experience acute pain, such as the pain one might experience after surgery, 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

Risk of Substance Abuse Development

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 misuse the longer an opioid is taken. Studies estimates that around 21% to 29% of people who take opioids for chronic pain misuse them and around 8% to 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 2023, over 81,000 Americans died from a drug overdose involving opioids.⁵ While prescription opioid misuse  extends beyond medications hydrocodone, oxycodone, and methadone, these three are 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, and take opioids for longer periods of time. Additionally, there is evidence that woman may become dependent on opioids more quickly than men.⁷

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 Pain Medications

Non-opioid drugs may be useful for pain management and decreasing reliance on opioid painkillers. Common non-opioid medications 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

Managing Pain Without Drugs

Holistic Pain Management and Alternatives to Opioids

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

Some types of behavioral therapies have been proven effective in chronic pain management, including:¹⁴

• Cognitive-behavioral therapy (CBT).
• Mindfulness-based stress reduction.

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 opiate treatment options 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

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:

• Family therapy, including couple’s therapy.
• Support groups, including 12-Step groups, such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or SMART recovery. In addition, American Addiction Centers also offers free virtual support meetings.
• Community support—family, friends, and AAC’s alumni group are all great sources of ongoing recovery support.

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.

If you or a loved one struggle with opioid use, American Addiction Centers (AAC) can help. AAC operates treatment centers throughout the United States and uses evidence-based therapies and individualized treatment plans to help you overcome opioid addiction. Reach out to connect with a knowledgeable admissions navigator, who is available 24/7 to answer your questions, explain your options, even verify your insurance coverage so you can begin your journey to recovery today.