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Pain is one of the leading causes of disability in the United States and the number one reason Americans seek medical care, the National Institutes of Health (NIH) publishes.
One out of every four people in the United States suffers from pain lasting longer than a day.
Acute vs. Chronic Pain
Loss of employment and interpersonal relationship issues are possible side effects of chronic pain.
Opiates for Pain ManagementMedications that are prescribed for chronic pain often include extended-release opioid drugs and long-term opioid therapy. Opioids are a class of drugs that dull pain sensations by interacting with the central nervous system, nerve firings, and the chemical makeup of the brain. Opiates fill opioid receptors in the brain and increase levels of dopamine while slowing down blood pressure, respiration, and heart rates.
These drugs are considered highly addictive, and they are not generally intended to be prescribed on a long-term basis. When taken over a period of time, they may actually serve to make chronic pain symptoms worse, as the brain can increase pain signals to try and override the medication’s blockade. A tolerance to the drugs can form, rendering them ineffective at lower doses and causing a person to have to increase the dosage, or switch to more potent opiates, to find relief.
Drug dependence is a common side effect of long-term opioid use, as the brain relies on the drug to maintain its chemical balance. When the drugs wear off, withdrawal symptoms that are both physically and emotionally difficult can occur.
Opioid drugs impair thinking and coordination, cause mood alterations, and are highly addictive in nature. The American Society of Addiction Medicine (ASAM) publishes that 2 million Americans struggled with addiction involving prescription opioid medications in 2014. Furthermore, the Centers for Disease Control and Prevention (CDC) reports that one out of every four people in primary care settings who receive long-term opioid therapy battles addiction to these medications.
Alternatives to Opiates for Chronic Pain
Chronic pain is a disease that impacts many aspects of a person’s life. As such, it should be treated with a comprehensive and multidisciplinary approach. Opioids are generally considered the go-to answer for treating chronic pain, but there are additional methods available that have fewer risks and may be viable options for individuals who are recovering from opioid addiction. Alternative medications, holistic and adjunctive therapies, as well as counseling and physical therapy can all help to minimize chronic pain. Medications
There are many non-opiate medications out there that are marketed for pain and also ones that may be used off label to treat chronic pain. Medications like these are often optimally combined with other treatment methods for a complete care plan.
- Anticonvulsants (antiepileptic medications): Medications like gabapentin (Gralise) and pregabalin (Lyrica) are generally considered frontline medications for the treatment of many forms of neuropathic (nerve) pain. The exact method as to how they work is not fully understood, but both gabapentin and pregabalin are considered to be effective for nerve pain. Other anticonvulsants like topiramate, carbamazepine, lamotrigine, lacosamide, valproic acid, and oxcarbazepine may work as second-line medications when other methods don’t, as they have not been proven to be as effective for pain relief.
- Tricyclic antidepressants (TCAs): Typically prescribed to combat depression, these medications can help to improve moods and sleep disturbances that often accompany chronic pain. They may also be able to provide some relief from many types of neuropathic pain as they interact with brain chemistry and can have analgesic effects. TCAs for chronic pain include amitriptyline (Elavil), desipramine (Norpramin), and nortriptyline (Pamelor) to name a few. These medications can have serious side effects, especially in elderly patients, and should be monitored closely.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs): Currently, duloxetine (Cymbalta) is FDA-approved to treat depression and chronic musculoskeletal pain, fibromyalgia pain, and pain related to diabetic peripheral neuropathy. Venlafaxine (Effexor) has also shown promise in treating diabetic peripheral neuropathy.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Typical over-the-counter analgesics like Tylenol (acetaminophen) and Motrin (ibuprofen) are likely ineffective in treating chronic pain. Some prescription strength NSAID medications may be helpful, however. The journal Practical Pain Management publishes that NSAIDs may treat pain related to osteoporosis, rheumatoid arthritis, and headaches. Drugs like meloxicam (Mobic) and celecoxib (Celebrex) are newer NSAIDs that work as COX-2 inhibitors and can treat chronic pain. These medications may carry an increased risk for stroke and heart attack, however. Topical NSAIDs, like diclofenac (Pennsaid solution, Voltaren gel, and the Flector patch) may help with chronic musculoskeletal and osteoarthritis pain when used directly at the site of discomfort.
Complementary and alternative medicine, often called CAM, can be helpful in treating various types of chronic pain and may help to improve a person’s overall quality of life, the journal Practical Pain Management reports. CAM is often used as an adjunctive therapy method, meaning these measures are combined with other, often traditional, techniques.
There are many different forms of CAM, and what works for one person may not work as well for another. These methods are generally noninvasive, and a person is safe to try multiple different methods to find what may work best for them.
- Acupuncture: The Chinese practice of placing needles in certain pressure points along the body is said to improve circulation and blood flow, and thus relieve pain by promoting a healthy flow of energy, or chi.
- Herbal remedies and supplements: There are many different things on the market that are marketed for the treatment of various ailments, such as probiotics, Omega-3s, and glucosamine. These remedies and supplements may be helpful; however, they should be taken with care and discussed with a healthcare provider to ensure their safety, as they can potentially interfere with prescription medications.
- Chiropractic care: This technique of manipulating the body physically to provide relief is performed by a trained professional. Chiropractic care can help to better align the body and thus offer some pain relief.
- Massage therapy: Massage and touch therapy can provide relaxation, reduce tension and stress, and help to alleviate many types of pain. A massage therapist can use their hands and fingers to work out physical pain and improve a person’s emotional state at the same time.
- Yoga: This meditative practice that originates in India teaches people how to control their breathing and put their bodies into specific poses in an effort to improve the connection between body and mind. In so doing, tension and stress can be relieved, and pain can be reduced.
- Mindfulness meditation: This is a relaxation technique that helps a person to become more aware of their body and therefore better able to manage their emotions. Mindfulness meditation has been shown to reduce chronic pain by more than 50 percent during clinical trials, Psychology Today publishes. Mindfulness meditation uses breathing and relaxation methods to improve self-awareness and control tension and stress.
Physical therapy can help to improve body functioning and therefore help to manage chronic pain. The nerves of the body may need to be retrained, and the hyperactive nervous system reset, especially when long-term opioid therapy has been used. The body will need to relearn how to not perceive every touch or sensation as painful, and careful exercise can help to restore these damaged nerves.
In addition to help from a physical therapist, mental health providers can provide valuable tools for enhancing quality of life and managing pain. Cognitive Behavioral Therapy (CBT) is often beneficial for individuals suffering from chronic pain, as it can teach stress management and healthy coping mechanisms. It can also improve a person’s state of mind, which is often negatively impacted by chronic pain.
Counseling services can help a person to work through issues related to chronic pain, teach problem-solving skills, control anxiety levels, improve social functioning, and help a person to take back control of their life.
Tips for Managing Chronic Pain in Recovery
People who suffer from chronic pain and are in recovery for opioid addiction still need tools for managing pain that are not medication-based. Holistic, alternative, and adjunct methods as well as therapy and counseling are highly beneficial for both physical and emotional support.
There are some things a person can do to manage chronic pain while in recovery. These include:
- Get good quality sleep. Sleep improves mental functioning and can help the body to heal. Having a healthy sleep schedule and structured routine promotes good sleep.
- Eat nutritious and balanced meals. Stick with foods that are rich in nutrients, high in protein, and low in refined sugars and saturated fats. Providing your body with the building blocks necessary for healing is essential in managing physical health and emotional wellbeing.
- Improve communication and avoid isolating behaviors. Talking and engaging with friends and family can improve moods and relieve stress and tension.
- Attend therapy and counseling sessions. Communication and new life skills for managing pain and keeping emotional balance are fostered in therapy.
- Build problem-solving skills. Work toward solutions with a growth mindset. This can be empowering and help in many facets of life.
- Participate in something meaningful. Helping others and volunteering can improve a person’s mental outlook and sense of purpose.
- Find a creative outlet. Art, music, journaling, and more can help to keep the mind occupied and provide a respite from pain.
- Keep up with physical fitness. Physical therapy and healthy amounts of exercise can improve self-esteem, blood flow, and help to restore the body.
- Engage in relaxation techniques. Yoga, breathing exercises, and mindfulness mediation are all helpful in reducing physical and emotional tension.
- Join a support group. Peer support and a healthy social network can be highly beneficial in minimizing relapse and offering helpful coping strategies and tools.
Pain medications should be used on an as-needed basis and under the careful and direct supervision of a highly trained healthcare provider who is well versed in the history of the individual. There should be no secrets surrounding medications. The individual in recovery needs to be sure that roommates, spouses, mentors, and substance abuse treatment providers are all aware of what medications are being taken, the proper dosages, and the amount of time they will need to be taken for. Close monitoring and holding oneself accountable are vital in helping to minimize potential relapse.
The pain needs to be treated, but with as low and few of doses of medications as possible. Addiction treatment specialists, mental health providers, and medical professionals need to all work together to ensure that both chronic pain and addiction are properly managed in order to promote a sustained recovery.