10 alternatives to opioids

  | September 29, 2016

Opioids are often a first line of defense in treating chronic and acute pain. But as government agencies and state legislatures take steps to limit opioid prescribing, health systems are taking a harder look at alternative treatments.

Prescribing alternatives can be a challenge; many doctors face resistance from patients and roadblocks from insurance companies. Still, many pain physicians say these therapies are worth exploring, and potentially more effective than opioids.

“Even if a treatment offers 5 to 10 percent benefit for patients, then that's still benefit for someone in pain," says Anita Gupta, vice chair of the Division of Pain Medicine and Anesthesiology at Drexel University College of Medicine.

Here are 10 non-opioid treatment options for patients who are suffering from pain.

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Non-steroidal anti-inflammatory drugs

Known as NSAIDs, these drugs — which include aspirin and ibuprofen, are more than just pain relievers. They also reduce inflammation and lower fevers. Many NSAIDs can be purchased over the counter, which means they're widely available and relatively inexpensive. A recent study published in Lancet found that NSAIDs are effective in relieving pain, but prevent blood from clotting. So using them can put patients at an increased risk for heart attack and stroke, as well as gastrointestinal problems and ulcers.

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Acetaminophen

The generic version of Tylenol is easily obtained over the counter and is often used for patients who don't take NSAIDs because of stomach irritation or worries about heart attacks. Like NSAIDs, acetaminophen is useful in relieving pain, but more than 4000 mg should not be taken in 24 hours or acute liver failure may occur. A recent study published in the Journal of the American Dental Association found that 325 mg of acetaminophen taken with 200 mg of ibuprofen provided better pain relief than oral opioids for patients who had teeth extracted.

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Anticonvulsants

Anticonvulsant medications are effective in treating neuropathic pain conditions, which can cause burning and shooting sensations, according to the American Chronic Pain Association. Gabapentin (Neurontin) has been shown to be effective in high dosages, according to the American Academy of Family Physicians, but can cause dizziness, headache, diarrhea and confusion. Although anticonvulsants are not habit-forming, the American Chronic Pain Association advises against abrupt discontinued use. The medication is intended to be taken every day, whether or not the patient is experiencing pain.

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Antidepressants

Even when depression isn't recognized as a factor in a patient's chronic pain, antidepressants can provide relief. Tricyclic antidepressants, such as Amitriptyline, Imipramine and Clomipramine, are particularly effective in treating neuropathic pain. But a study published in Psychiatry (Edgmont) found that tricyclic antidepressants can cause a host of side effects, including weight gain and cardiovascular problems. In 2010, the FDA approved Cymbalta to treat patients with chronic musculoskeletal pain, and it is still the only antidepressant approved by the FDA for treatment of chronic pain. Side effects include dizziness and fatigue.

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Radiofrequency ablation

In this procedure, which was first used in 1931, a physician uses electric currents to decrease pain signals from a specific nerve. "RFA offers the most precise method currently available" for physicians to "control their patients' pain on a longer term basis," said an expert in a review on Medscape. But the procedure is rarely covered by insurance because it is still considered “experimental." Treatments can cost several thousand dollars.

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Steroid injections

Steroid injections are commonly given to relieve inflammation and pain associated with certain joints. Although frequently used, many physicians say there's a lack of consensus on their effectiveness. A systematic review of literature on the injections published in Anesthesiology found that the treatments might be helpful in the short-term, but there is no conclusive evidence about their long-term effects.

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Chiropractic care

Chiropractors are focused on neuromuscular disorders, and emphasize manual manipulation of the spine. Studies show mixed results, with some studies showing that chiropractic manipulation decreases pain and improves physical function, and others showing that the risks of manipulating the spine might not outweigh the benefits.

Because of mixed study results, insurance doesn't often cover all the costs associated with chiropractic care. Many carriers will cover the cost of short-term care, which can help patients with acute injuries, but coverage can be a challenge for patients who require extensive treatments. Medicare Part B, for example, only covers basic chiropractic care, such as spinal manipulation, but doesn't cover the initial physical exam or X-rays.

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Mindfulness

Many doctors are hesitant to prescribe mindfulness treatment to their patients because they didn't hear about it in medical school, says Carl Fulwiler, medical director of the Center for Mindfulness in Medicine, Health Care and Society at the UMass Memorial Medical Center.

“It's not a medication or a surgery, so they're not as sure of the science behind it," he says. “And they see it on the cover of Time magazine, so it seems like a New Age fad."

But mindfulness — the practice of acknowledging the present moment and accepting one's feelings — can be a great benefit to patients with chronic pain. Many patients spend much of their time in pain or worrying about when it will come back, and mindfulness helps them accept their situations and can reduce the intensity of pain, Fulwiler says. A study published in the Journal of the American Medical Association in adults with chronic back pain showed that, over the course of 26 weeks, mindfulness treatments resulted in greater improvement in back pain and functional limitations.

There are plenty of consumer offerings for mindfulness, but many are pricey, and the services are rarely covered by insurance.

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Acupuncture

The Chinese practice involves an experienced practitioner sticking hair-thin needles into the skin at specific points in the body. The insertion is thought to correct imbalances in the flow of energy in the body, which then helps ease pain. The approach is particularly effective in patients with joint-based and orthopedic pain, says Melissa Rathmell, a trained acupuncturist and the director of Integrative Medicine at the University of Massachusetts Medical School.

A review of 29 studies involving 18,000 patients published in the Archives of Internal Medicine found that acupuncture relieved pain by about 50 percent. But insurance coverage is limited, when it exists at all, and treatments can range from $65 to $125 per session.

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Cognitive Behavioral Therapy

Many people with unrelenting chronic pain can feel hopeless. Cognitive behavioral therapy can help them practice “acceptance theory," which can lead to changed behaviors and perceptions, and increase a patient's' confidence and self-efficacy for managing pain.

A review published in American Psychologist found that cognitive behavioral therapy had a small to moderate effect on decreasing pain compared to a patient's usual treatment, and a moderate impact on a patient's mood. The therapy could have a greater impact, the authors wrote, if interventions were part of a coordinated approach and incorporated into primary care settings.

Allison Pohle is a writer based in Boston

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Have you read your own article closely? Other than your non-opioid medications listed which are mild analgesics at best, all your listed alternatives have VERY limited success rates, have highly questionable overall study results, are pricey, and poorly covered by insurance. The result is that in practice they are NOT realistic as reliable alternatives to opioid medications. As a pain practitioner do I utilize the modalities you mention – YES – all of them – BUT in the long run (3 months) they are successful therapies for only a very small percent of my overall patients with true chronic pain.

Name: 
Gary
Email: 
test@test.com

That is good that you are opinion minded.-In my case, they actually 3 dr.s have asked me what am
I?—i am in good physical shape, i have severe foraminal stenosis, osteo , spondylitis. , no acl, demyelinating. disease , neuropathy And THEY are killing my lge which goes from 1??–9 with my medicine when i need it .they had me on fentynyl every 2 days, 100 , w/ 2 opana 20s & 4 percocets a day, one day i said i dont want all this shit.they got mad.-MY neurosurgeon said i could not endure all the surgeries because i would die from the anesthetic duration, & fusions limit motion, put weight on above & below disks, cortisone does nothing, pain pumps, radooblation?–my GOD in OHIO , the depression & torture, iis because they wont keep me on my few pills i have been o n for 14 years, i am on 1/8 medication.-I WAS.the scar tissue & osteophytes and the pain pump make s you a junkie, People that dont study about medical pertaining to them are blind followers.There is nothing that helps me more than my pills with no tylenol, ,my body may be addicted, but i never get a tolerance.-I am not stupid enough to do what i know is bad.i want my gd pills back, they are making people kills themselves that are in chronic pain.People know their body, and the shots , the pumps, the fusions are rarely needed & do much more harm.-If you want to od, they can’t stop anybody, when you are in that much pain you want to die & thats what they need to feel for 1 hr , 1x.i need a dr. near akron, ohio, i am alone & cannot get up, they shut my ymca pas, because i can strengthen the ligatures supporting the bone diseases etc, because they fight over a few pills , this country controls your pain, controls how to raise your children, Government leave medicine with DR’S -People that lives are in bed is because they cannot live,in chronic pain, not everyone is taking pain pills for fun.If you can help -pLEASE MAIL ME BACK soon.-As this is no life

Name: 
dab
Email: 
test@test.com
Seriously- other than Chiropractic the rest of your list is a joke. Now for someone with a pulled muscle yes some will work. FYI - a recent study showed Tylenol has NO pain relief ability Back to work on that list. ps: do you work for CDC ?
Name: 
John S
Email: 
Jsandherr@gmail.com
I have tried every one of your suggestions with no relief at all. I have been to therapy and 10 different doctors all who have said we can't help. Would love to be off opioids but it gives me 50 per cent relief. I use as prescribed.
Name: 
Sam
Email: 
Spgentile@zoominternet.net
The "epidemic"of opiod abuse is not occurring among the chronically ill with incurable diseases. And it is not your specialty MD who is over-prescribing! It is the strip-mall pain storr-front pill mills, taking "cssh only"payments from the 20-30 somethings who sell them for income because they are too lazy to work! You don't need to change the rules for everybody! My God, if u don't have a chronic long-term disease for which you have exhausted all these puny suggestions and u have not been in a severe accident which has been debilitating, nobody should get these. These strip mall docs and pharmaceutical companies are getting RICH by subscribing to someone who had a tooth extraction or pulled muscle and then just keep on going. Nobody under 50 except the 2 situations above should b given these meds. The rest of us need them to just barely function and now you have us sign a form saying it is "not approved" to drive!! Really!! Most if us r on meager disability incomes and unable to supplement it. This is discrimination because we r sick!! The gteedy docs and big pharma snd entitled lazy party crowd have created this crisis and we should not b penalized for it! I'm 64 - I have had RA sauce I was 19 and been thru the gammet of meds available. I would love to try acupuncture but I can't afford it on disability income snd ins does not cover. You r penalizing the people who truly need pain control becsuse of a problem created by the industry itself!!
Name: 
Brenda Hall
Email: 
praz2him@gmail.com
Preach,girl! Brenda Hall, you are exactly right. I am also over 50 and on disability. I have been suffering from arthritis in my knees since I was 12 and pain in my ankle since birth. In the past ten years, the rest of my joints have decided to join in the fun of torturing me. I am in constant, severe pain. I can't use NSAIDs because of my kidneys and can only use pain meds for a few months at a time before they start making me itch causing me to have to switch them for something else for a few months. But now, every month I have to fight with my doctor to get the bare minimum of pills because he is afraid that I'll become addicted and he'll get in trouble for over-prescribing narcotics. This is no way to live, but it's what I have to deal with because a generation of bored, over-privileged millennials have decided to make prescription pill-popping the newest indoor sport. I often think that it would be much easier to get the help I need if I was an addict. At least then I would be considered as having a disease and would be given the pills I need as part of my treatment.
Name: 
Lady L
Email: 
lewislg66@gmail.com
I totally agree with you, Brenda Hall. I'm sick and tired of hearing about the Opioid Epidemic! The people who actually need opioids (those suffering from CHRONIC pain) are suffering due to the scare tactics used to keep doctors from prescribing medications to those who actually need it. And it's not for a 'high.' It's to help restore a bit of quality to our miserable pain-filled days. I'd love for one of these doctors, researchers, or even the author of this ridiculous article to try living one month in my shoes. I use to say one day, but that isn't enough time to feel every single symptom my conditions flood my body with.
Name: 
Carolyn
Email: 
flrklir1@gmail.com
I have tried numerous alternative therapies.. they help at times but then there are those days when the pain is unbearable. It is unfortunate that the CDC would like to throw the baby out with the bath water. I have NEVER ABUSED MY MEDICATION AND HAVE TRIED AND TRIED TO STAY OFF IT... it works for a month or so and then the flare up - the excruciating pain. Thank God there are medications that allow me to somewhat function. I would be bed-ridden without them. I am in physical therapy and have severe back problems, have had steroid injections that have ballooned my weight for 15 years, back surgeries.. it is horrible. I would love a "real" alternative. Not a generic answer. As far as Ibuprofen - i have stomach ulcers and cardiac issues.. Now what? I am 60 years old and unfortunately opiates are a necessary evil.. I take 3 a day and no more and have NEVER ABUSED MY MEDICATION.
Name: 
Katherine Osuna
Email: 
katherin.osuna@att.net
A joke & shame on you folks for telling patients that the modalities listed can replace Opiates - they can't! My MEDS now cut 75% and now I'm falling ( Drop foot) so more harm caused from < medication My life sucks & im worse daily. My long time Dr's agree I need Opiate pain meds but PM Dr is afraid of DEA / CDC. A pain Pump can't be done because my Spinal Cord is compressed & will not accommodate the pumps delivery needle- in other words my spinal cord is nearly crushed. Everyday I think about death & im no longer afraid of it. The CDC has an AGENDA with DEA and it isn't helping. The results will be catastrophic- patients will suffer and die all in the name of - Opiates cause constapation : worst side effect. And why does CDC bury all studies that show chronic pain patients benefit from Opiates long term ? Something isn't quite right with this and I'll bet MONEY is one big reason, When did the government last step in and be helpful ? Answer; NEVER
Name: 
John S
Email: 
Jsandherr@gmail.com
There are 3 things that I can glean from this article. #1) The author CLEARLY does not experience chronic pain. #2) Someone is paying you off if you can in any way recommend and/or endorse the BRAIN DESTROYING POISONS called neurontin/gabapentin/lyrica with a clear conscience. #3) You sound like every other fool out there who thinks they are being original & helping by telling me that my history of 8 spinal fusions and every complication imaginable (including partial paralysis & meningitis) can be remedied even partially by something as ridiculous as an ice pack & deep breathing. I could have acupuncture needles stuck in me until I looked like a porcupine & that's not going to help me at this point! This is insulting to those of us with actual CHRONIC pain....dont you think most of us have tried most of this already? Most people will do *anything* to avoid going under the knife repeatedly like I have! The only thing that could be considered "holistic" or "alternative" that really helps is kratom. Its a plant that truly does have opioid properties but you dont get "high or stoned" in any way. Coming from a 20+ year medical career myself, I *never* thought I would endorse anything botanical but it really does help. With all the new regulations put on doctors about prescribing limits now, there is no way I could make it through the month until my next refill if I did not use kratom. Its safe. Its legal. Its natural and there's exactly ZERO overdoses or deaths from it.
Name: 
Mary P
Email: 
teddybeanz@aol.com
I have tried several things to help with my chronic back pain. I was on fentynal for 12 years with 10/325 Percocet. Dr. Retired so had to go to pm. They took me off the 100 mc patch and gave me 60 mg of morphine and cut my Percocet to 5/325 and cut the quantity in half. I BEG him every month to increase in and he won't. I'm just ready to give up....
Name: 
Teabyrdz
Email: 
Teabyrdz@yahoo.com
I, too, am distressed that in all of the 'opiate epidemic' rhetoric, no one addresses those of us who suffer with chronic pain. I have been a medical writer and have edited a medical magazine aimed at physicians. I'm now retired, with a fused ankle from arthritis and arthritis in both knees, both hips, and my spine, and a number of soft tissue issues from previous injuries. My doctor is reputable and knowledgable, and she too is frustrated by the back and forth guidelines. Ten years ago doctors were told to treat pain, not let patients suffer. Now the hoops that need to be jumped through are absurd. I am on two percocet 5/325 daily, and have been for years. I have taken mindfulness courses, and have tried neurontin, and all of the other alternatives mentioned. Why are the reputable doctors not trusted to do what they believe is best for their patients? We spent most of my last visit discussing these issues rather than my health.
Name: 
Cee
Email: 
auk72002@yahoo.com
My doc tried all these methods BEFORE he put me on meds. I live with debilitating chronic pain due to several medical issues, including severe spinal stenosis, fibromyalgia, peripheral neuropathy, just to name a few! If they are take away I go back into a wheelchair. Why does it seem that those who follow the rules always have to pay for those who do not? In addition, here in Florida I now have to go to my doc once a month just to get my script. On a fixed disability income and a $45. copay, this has become ridiculous and my understanding is that this is just the beginning. You people really need to talk to the docs trying to help us with chronic pain before you print such ridiculous articles!
Name: 
Lanie
Email: 
lanieh55@comcast.net
Unfortunately for us with true chronic pain we won't survive this disgusting and unfair change of prescribing necessary meds for us. I personally can't live due to I am immobile, can't eat ,had heart attack, severe malabsorption to where I have to drive 100 miles a day to an infusion center and receive daily bags potassium and magnesium and all vitamins and still my muscles draw and cramp. And from constant pain I have just been put on 5 different blood pressure meds because I never stop hurting. But at least 2 10 mg percocet a day let's me want to live in this pain. Taken away then I can't stand the pain and don't want to live. This verdict is going to cause far more suicides to stop the pain than the deaths of the people who have stolen or robbed or are junkies like Michel Jackson, Prince, and Elvis Presley. Us poor alone folks with no money will just have to ask for God's forgiveness as the system we have supported all I lived until we could no more has decided to kill us off one by one. Hopefully a just God will hold all of the ones doing this to us real sick people pay and not us because all I want is for the pain to ease and I have done everything every Dr has asked. So my death with be on the government and these people and so will a lot others who are just barely getting by.
Name: 
Deborah Jones
Email: 
georgiegal53@yahoo.com
What if you've already done all of these plus surgeries and want to be weaned off of the opiods but are still having chronic pain? What replaces the opiods?
Name: 
karen
Email: 
kmarie225@outlook.com
I have chronic pain. The Pain Management doctors are cutting my medicine back 50mgs so far another 20mgs this week. I finally found a way to keep my pain in check and got pretty functional. Now, I've gained weight and I'm pretty confined to my wheelchair. I've started physical therapy which is causing me more pain and the therapist says probably can't even help me. Now it looks s cognitive behavioral therapy. I've excepted this is my life. I'm tired of the Pain journal. I'm always in pain there is nothing that stops it except medicine. So, the government takes it from me. If you had my pain one day I would love to see you endure. If they are going to take opioids away have something to replace it besides Nsaids and Tylenol. I don't know what to do. I go to pain management to help me manage my pain and now they are not. Do I go out on the street where I don't know what I'm taking??! Or do I fine a way to end this life full of suffering??
Name: 
Cynthia Crosby
Email: 
cindylittlecat59@gmail.com

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10 alternatives to opioids