Beyond Opioids: Alternatives for Treating Pain

The CDC reports that more than 50 million Americans suffered from chronic pain in 2020, defined as “pain on most days or every day in the past 6 months.” Nearly 20 million experience high-impact chronic pain, defined as “limiting life or work activities on most days or every day in the past 6 months.”*

If you’ve seen our Be SAFE campaign, you know that SAFE Project recommends asking about alternatives anytime a doctor wants to give you or a family member an opioid prescription for mild to moderate pain. It’s no secret that one cause of our nation’s deadly addiction epidemic was the medical professionals who prescribed far more painkillers than patients actually needed. You can tell your doctor that you want treatment that is patient-focused, not just prescription-focused.

SAFE Project believes patients and doctors should partner to decide what medications are right for managing pain, and be fully informed about the potential hazards associated with opioids. 

Need-to-Know Pain Alternatives

The options for non-opioid pain treatment can be overwhelming, so we broke them down below, using five categories: Medications, Restorative Therapies, Interventional Procedures, Behavioral Health, and Complementary & Integrative Health. These categories originated from a 2019 Health and Human Services’ Report on  “Pain Management Best Practices by the U.S. Department of Health and Human Services.

#1 Medications

The fact is that opioids have been found to be no more effective than non-opioids for pain relief. Pain management can include both opioid and non-opioid classes of medications. The most common non-opioids can include familiar over the counter drugs like acetaminophen, ibuprofen, or topical analgesics. It also includes nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants & tricyclic antidepressants, anticonvulsants, musculoskeletal agents, biologics (a complex class of medications derived from human and animal cells), and anxiolytics (anti-anxiety medication). 

#2 Restoratives Therapies

This alternative includes treatments provided by physical therapy (PT) or occupational therapy (OT) professionals, physiotherapy, therapeutic exercise, and other movement modalities provided as a component of interdisciplinary, multimodal pain care.  Some may be very familiar to you: like the use of cold or heat to treat pain symptoms, massage therapy, traction, or bracing (semi-rigid and non-rigid for joints).  

Transcutaneous electric nerve stimulation (TENS) and electroceuticals are noninvasive methods that deliver a small, targeted electrical impulse to treat chronic pain.  (More commonly known types of electroceuticals are pacemakers and cochlear implants.) For pain, they are applied at various frequencies to alleviate a wide range of painful conditions including fibromyalgia, postpartum, menstrual, phantom limb, neuropathy and knee osteoarthritis.  

There is still some debate on the role of TENS in pain management. While many of these devices have been cleared by the FDA for temporary symptomatic relief of chronic pain, the HHS report stated;

“….studies of its efficacy are lacking in number and design, with high risks of bias commonly reported …. Despite the overall limited evidence of efficacy, partially stemming from a lack of large RCTs (randomized controlled trials), TENS is considered a safe self-care option for patients (with appropriate education).”

Light therapy, or photobiomodulation, is an emerging tool. In July 2019, an international group of researchers and clinicians issued new guidelines for using photobiomodulation for the treatment of oral mucositis in cancer patients. Mucositis, or oral ulcers, are painful and debilitating acute side effect from radiation when treating head and neck cancer..

#3 Interventional Procedures

This medical sub-specialty treats pain with minimally invasive interventions, such as epidural steroid injections, or nerve blocks for lower back or leg pain. Injections of steroids or numbing medicine along the nerve can quiet symptoms, and frequency of injections varies by patient. Image-guided treatments like ultrasound or x-rays can make it easier to deliver the therapy to the exact pain source. This type of procedure can also include major joint injections, medial branch blocks/facet joint injections, or  radiofrequency nerve ablation under X-ray guidance, which delivers heat to temporarily and selectively disable nerves causing pain.  Many of these therapies can be done on an outpatient basis.

#4 Behavioral Health

Chronic pain can disrupt every aspect of a patient’s life, whether it’s everyday tasks, sleep, or fearing any physical activity that could cause reinjury. It is often associated with other conditions such as PTSD, anxiety, or depression, so developing a behavioral or psychological health plan in conjunction with your care provider can help. Co-occuring issues like depression and anxiety can often develop in people who experience chronic, widespread pain syndromes such as lupus, fibromyalgia or  irritable bowel syndrome. 

Types of behavioral health interventions include talk therapy (psychotherapy), cognitive behavioral therapy,  stress-reducing techniques (meditation, coping skills), support groups (online and in-person), telehealth options, or psychophysiological approaches such as biofeedback. These behavioral health strategies can be used on their own to treat pain or may be combined with other parts of a pain management plan.

#5 Complementary and Integrative Health

These therapies and remedies offer multiple options as a part of a pain management plan.  Mind-body techniques can include meditation, biofeedback, or relaxation training. Physical movement like yoga or tai chi often integrates both pain management and mind-body techniques. For some, hands-on manipulative techniques like acupuncture, massage therapy and osteopathic or chiropractic manipulation may bring relief.

Keep In Mind

Pain takes many forms, so creating a safe and effective plan that includes alternative treatments has to work for you and your lifestyle. The most important part of any plan is finding what provides you the greatest relief and peace of mind. 

• SAFE Project understands and supports people with chronic, long-term pain who require long-term opioid therapy to experience meaningful pain relief. We know that their pain therapy – in partnership with their doctors — is essential to their quality of life.

Want to know more? Download the full HHS federal task force report  to learn more about multidisciplinary approach to pain management. 

Further Resources:

NIH National Center for Complementary and Integrative Health

VA Health Administration Pain Resources

Amerian Association of Physical Therapists

American Society of Anesthesiologists