Canada: Long-Term Disability Series: Opioid Alternatives And Chronic Pain

Last Updated: September 7 2017
Article by Brad Moscato and Kaitlyn MacDonell

When the solution to a problem becomes a problem itself, something has gone seriously wrong. As public health officials express continued concern about the "opioid epidemic" – the over-prescription and overuse of habit forming opioids to ease chronic pain – people who may legitimately need this kind of medication as part of their treatment are often finding difficulties in obtaining such prescriptions.

While the campaign to limit opioid use has positive aims – reducing the potential for addiction and limiting the use of drugs that can lose their effectiveness in a person over time – if you suffer from chronic pain that requires medical intervention you may be concerned by the move away from opioids if you aren't familiar with the alternatives available.

In this blog post, we outline some alternatives to opioids to manage and treat chronic pain. While they vary in terms of effectiveness depending on the person and the nature of the injury or source of pain, these strategies may give you hope that prescription opioid painkillers are not your only option for relief.

Pharmaceuticals

Acetaminophen, found in over-the-counter pain relief medicines, has been recommended as a first-line of defense against pain. Other nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen may also be available in over-the-counter doses or by prescription at more powerful doses. Although these options are often good for short-term relief, long-term use for chronic pain should be co-ordinated with a medical professional to minimize the risks of side-effects such as organ failure and ulcers in some (particularly older) patients.

Cortiosteroids (both naturally occurring and synthetic) are used to reduce inflammation and inhibit injured nerves. These types of drugs may supress or otherwise alter immune function and sustained use may cause joint deterioration and gastrointestinal and psychiatric effects, however.

Prescription anti-depressants (serotonin and norephinephrine reuptake inhibitors) and anticonvulsants can also be used to inhibit pain by interrupting or suppressing pain signals in the brain. However, various side-effects – including sexual dysfunction, weight gain/loss, or increased thoughts of suicide have been reported by users and people taking these medications should monitor their reactions closely with a doctor.

Additionally, medicinal marijuana has found increasing acceptance among medical practitioners as a pain-reliever. The drug's THC cannabinoid reduces pain or anxiety by binding to receptors in the brain.

Finally, emerging research into endomorphin analogs (peptide-based drugs that mimic a natural neurochemical) has shown great promise. These experimental drugs target the same pain receptors as morphine but do not produce the same addictive side-effects nor bodily reactions that lead to tolerance of the drug (reducing its effectiveness).

Neurostimulators

This type of treatment is more invasive than drug therapy, but it has shown promise as an alternative to opioid use. By implanting electrodes into the body to interrupt nerve signals, neurostimulators stop pain signals from reaching the brain.

Spinal cord simulation (SCS) technologies have been particularly effective as neuromodulators for neck, arm, leg or back pain. By stimulating the dorsal root ganglion – which has been connected to chronic pain development – this treatment has demonstrated great success in treating focal pain.

Early generation SCS devices tended to cause discomfort in some patients through paresthesia. However, newer high-frequency options have been able to reduce pain without this side effect. Another newer option called closed-loop SCS is currently also showing promising results in clinical trials.

Holistic Options

Pharmaceutical medications and invasive treatments are not the only way some people have found success managing their chronic pain. Holistic and natural alternative treatments have found growing acceptance among chronic pain patients and even within the professional medical community.

Some of these options include:

  • Acupuncture – Using small needles to stimulate nerves at specific points on or under the skin. By stimulating nerves, acupuncture prompts the release of pleasure hormones such as endorphins, reduces inflammation that causes pain symptoms, and regenerates nerve growth. Used in Eastern medicine for centuries, clinical studies have found acupuncture can provide significant relief for some common forms of pain.
  • Chiropractic Medicine – Although the debate within the medical profession of the effectiveness of chiropractic treatments continues, promoters of this option suggest spinal manipulation and adjustments are effective to treat neuromuscular and skeletal issues, including back pain, neck pain, joint pain, headaches and fibromyalgia.
  • Massage – Soft tissue massage therapy has been used to promote relaxation. However, more recent research has discovered it can also reduce inflammation in the body which contributes to acute or chronic pain, including: lower-back pain, headaches, neck and shoulder pain, and fibromyalgia. A specialized form of massage performed by osteopathic physicians called Osteopathic Manual Treatment has been found to be especially effective in reducing lower back pain.
  • Hypnotherapy – By bringing a person into a highly focused mental state, hypnotherapists can introduce suggestions that promote relaxation and comfort.
  • Aromatherapy – This treatment stimulates the brain's limbic system (amygdala) to reduce chronic pain and improve mood. Certain scents have been found to provide relief for migraines, joint pain, labour pain in women, stress, anxiety, depression, and even to speed recovery of cardiovascular patients.
  • Herbal Medicine – Modern pharmaceuticals often have herbal remedy origins, and some herbs or plants (such as ginger or turmeric) have been found to have inflammation reducing effects similar to NSAIDs. Capsaicin, found in chili peppers, has been found to central nervous system pain sensation.
  • Exercise – Bodies in motion tend to stay in motion. Low-impact exercise, including swimming, yoga, or tai chi, can help to improve mobility, functional ability and also promote mental well-being.

Conclusion

When travelling down the road to relief from chronic or acute pain, the opioid expressway is not necessarily your only or best option. Alternative routes that employ other pharmaceuticals, neuro-stimulation, or holistic/natural treatment may be worth pursuing. Talk to your health care practitioner about all the options available to you so you can make an informed decision and be active in your treatment and rehabilitation.

If your chronic pain is the result of a personal injury or results in a disability that affects your ability to work, you may qualify for benefits, awards, or damages to use in your recovery.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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