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Alternatives to Opioids for Chronic Pain

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We all suffer from pain at some point in our lives. In fact, it is one of the most likely symptoms that would prompt us to schedule a visit to our healthcare provider. While opioid pain medications such as hydrocodone or oxycodone are often an appropriate and effective way to relieve pain for a short term event such as surgery, the medical community has realized these same medications may not continue to provide relief of chronic pain and may put the patient at risk of further problems. We have found that treating chronic pain often requires a multi-modal approach that may involve a team of medical professionals, varied treatments, but also placing the patient at the head of the team to set goals and make sure they feel in control of their pain and increasing their ability to function.

Chronic pain is often defined as pain lasting greater than 3-6 months. Approximately 11% of US adults have reported pain every day for the previous three months. In the last 20 years, opioid pain medications have been increasingly prescribed by well-intentioned physicians wanting to address the immediacy with which pain presents. However, with continued use of an opioid for chronic pain, tolerance develops and the same dose that was previously effective no longer has the same pain relief effect. Tolerance is different than addiction; addiction is continued behavior or use of a substance that one impulsively continues even in the face of detrimental effects in other areas of their life such as family, social and work settings. In that case, the opioid is definitely causing more harm than benefit. On the other hand, tolerance will occur even if cautiously following the physician’s instructions for usage. The problem with tolerance is that achieving the same initial effects will require continually increasing doses of the same medication or a switch to stronger and more potent opioids. It was once thought that treating chronic pain could be managed in just that fashion, always increasing doses. We now know that increasing opioids causes tolerance, dependence and even opioid hyperalgesia: When taking higher doses of pain medication actually makes the pain worse than would be without medication.

Instead of turning to pain medication to mask the symptoms, we recommend focusing on improving function. What activities are you not doing because pain prevents you? This type of approach requires an individualized treatment plan. This may include non-narcotic medications that specifically treat various pain etiologies, complementary approaches such as acupuncture, massage, and gentle movement and exercise under the guidance of a physical therapist. Chronic pain can cause depression and anxiety and patients often benefit from learning coping strategies with cognitive-behavior therapy, mindful meditation, and may significantly improve with assistance from a psychologist or psychiatrist. In addition to some of these more patient driven treatments, numerous non-invasive and often non-surgical procedures exist to treat the specific source of pain and can provide pain reduction and improve the ability to increase exercise tolerance. Finally, continual progress in surgical techniques means there may be numerous options for patients in whom conservative care has not been satisfactory.

In conclusion, opioids may fall short of providing long term benefit and are not recommended as the mainstay treatment of chronic pain. The guidance of a pain management physician can help develop an individualized plan to help reduce pain and improve your life.

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