Non-Opioid Treatment Options for Chronic Pain

According to the Centers for Disease Control and Prevention (CDC), approximately 24.3% of adults live with chronic pain, and 8.5% of adults live with chronic pain that often limits life and work activities. In the United States, chronic pain is associated with a decreased quality of life and is one of the most common reasons adults seek medical care. While opioids can provide relief for acute pain, they are not always the best treatment option for chronic pain.

In This Article:

Why Opioids May Not Be the Best Treatment Option for Everyone

The National Institute on Drug Abuse (NIDA) defines opioids as a class of natural, semi-synthetic or synthetic drugs that are used to treat severe pain. They work by attaching to proteins, called opioid receptors, on nerve cells in the brain, spinal cord, gut and other parts of the body, blocking pain messages sent from the body to the brain. Common opioid medications include codeine, fentanyl, hydrocodone, oxycodone, oxymorphone and morphine.

While opioids can be an effective treatment for pain, the side effects can range from mild to severe, and potentially life threatening. Milder symptoms include sleepiness, constipation and nausea, while more severe symptoms include shallow breathing, slowed heart rate, loss of consciousness and opioid use disorder.

“Opioids can be appropriate for certain patients and clinical situations; however, they are not the most effective or safest long-term treatment for every type of chronic pain,” P. Lynn Bell, DO, with Hattiesburg Clinic Physical Medicine & Rehabilitation, said. “Potential risks include physical dependence, opioid use disorder, respiratory depression, overdose, constipation and hormonal changes.”

Because opioids promote brain activity that can create hormonal changes and changes in mood and thinking, such as increasing feelings of happiness and relaxation, another risk associated with opioid use is addiction. According to NIDA, approximately 5.7 million Americans live with opioid use disorder.

Non-Opioid Treatment Options for Chronic Pain

According to the CDC, non-opioid therapies are preferred for subacute and chronic pain; this includes both pharmacologic and nonpharmacologic treatment options.

Many noninvasive, nonpharmacologic therapies can improve function with less chance of side effects and other risks. Nonpharmacologic therapies can include:

  • Exercise (aerobic, aquatic and/or resistance)
  • Physical therapy
  • Mind-body practices (tai chi, yoga and qigong)
  • Weight loss
  • Cognitive behavioral therapy
  • Manual therapies (joint mobilization and manipulation, soft tissue mobilization, myofascial release and trigger point therapy)
  • Mindfulness-based stress reduction
  • Low-level laser therapy
  • Acupuncture
  • Massage
  • Spinal manipulation

Exercise, mind-body interventions and behavioral treatments can encourage patients to actively participate in their care plan, allowing them to better understand the effects of their actions on their pain.

Nonopioid pharmacologic therapies can be effective treatments for chronic pain conditions. Some nonopioid pharmacologic treatment options include:

  • Topical and oral nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Acetaminophen
  • Tricyclic and tetracyclic antidepressants
  • Serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressants
  • Anticonvulsants
  • Capsaicin and lidocaine patches
  • Steroid injections and local anesthetic injections

Because nonopioid medications can be associated with certain risks, particularly in older adults, pregnant women and patients with certain comorbidities, it is important patients take medications as directed.

“A comprehensive pain management plan may include both medication-based and non-medication therapies,” Dr. Bell said. “Treatment should be tailored to the patient’s diagnosis, overall health and functional goals.”

The Importance of Knowing Treatment Options

The first step in chronic pain management is finding and diagnosing the cause. But when that is not possible, an effective approach is often a combination of medications, therapies and lifestyle changes. Because symptoms can vary from person to person, there is not a one-size-fits-all treatment; effective therapy must be tailored to each patient, their circumstances and their experiences. Knowing what options are available can help patients actively participate in their care plan and make informed decisions about their treatment.

“Education about nonopioid pain management options empowers patients to make informed decisions and understand that effective pain relief does not always require opioid medication. A multimodal approach can improve function, quality of life and the ability to manage chronic pain while reducing exposure to opioid-related risks,” Bell said. “The goal is not simply to reduce pain scores, but to help patients participate in daily activities, improve physical functioning… and achieve the best possible quality of life through safe, individualized, evidence-based care.”

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About Hattiesburg Clinic Physical Medicine & Rehabilitation:

Hattiesburg Clinic Physical Medicine & Rehabilitation providers are nerve, muscle and bone experts who treat injuries or illnesses that affect how you move and function. They have completed training in the medical specialty physical medicine and rehabilitation (PM&R).

About Hattiesburg Clinic:

Hattiesburg Clinic is Mississippi’s largest privately-owned, multispecialty clinic. Founded in 1963, Hattiesburg Clinic has expanded to include over 450 physicians and providers, along with 2,500 employees, serving patients across more than 17 counties in Mississippi. Hattiesburg Clinic is committed to being the health care provider of choice in the communities we serve.