Alternatives for managing pain that aren’t opioids

opioid-alternatives

Opioids are all over the news these days, with the U.S. Department of Health and Human Services in 2017 declaring opioid abuse a public health emergency.

More than 2 million Americans are now addicted to the class of narcotic painkillers that includes commonly prescribed drugs like morphine, oxycodone (Percocet), codeine and hydrocodone (Vicodin). Overdoses resulted in more than 42,000 deaths across the country in 2016.

Fortunately, safe alternatives for alleviating pain do exist, including many common, over-the-counter drugs. What’s more, opioids do a poor job managing many common types of pain, says Roy Soto, M.D., Beaumont anesthesiologist and member of the Michigan Prescription Drug and Opioid Abuse Commission.

For example, Dr. Soto says opioid do nothing to alleviate menstrual cramping pain caused by dilation and curettage (commonly known as “D&C”) procedures, or procedures done on the kidneys, bladder and uterus. Those procedures typically don’t involve much actual cutting, for which opioids are better are providing pain relief.

“There are a lot of medications available for pain control that are not opioids,” says Dr. Soto, who’s also president of the Michigan Society of Anesthesiologists. Here are several examples:

  • Nonsteroidal anti-inflammatories, of which the painkillers Motrin, Advil and Excedrin is a readily available example. A lot of pain is caused by swelling, Dr. Soto says, and these drugs help decrease inflammation. Naprosyn is another example, packaged commercially as Aleve.
  • Acetaminophen, commonly sold under the brands Tylenol and Panadol, also works great for managing mild to moderate pain. Acetaminophen isn’t an anti-inflammatory, but it can be taken together with Motrin without side effects, Dr. Soto says. A recent study in the Journal of the American Medical Association showed opioids were also no more effective at reducing pain than combining non-opioids like acetaminophen and ibuprofen.
  • Non-opioid prescription drugs, which can also be used in combination with Motrin or Tylenol. Examples include a class of antidepressants called tricyclic antidepressants, which are especially good at treating nerve pain and have the added bonus of treating depression, which is thought to be a major risk factor for addiction. Another example is a class of medication called gabapentinoids, originally used as antiseizure drugs but useful in calming down over-firing nerves.
  • Localized numbing of problem areas. For example, when you undergo shoulder surgery, you’ll receive an injection of anesthetic in the lower neck that numbs the area for 18 hours. “Some operations are ripe for nerve blocks,” Dr. Soto says.
  • Non-drug treatments like ice, massage, exercise, physical therapy, acupuncture and relaxation training can be especially useful in treating chronic pain.

Dr. Soto says it’s also incumbent on medical providers to explain to patients how to use medications. For example, for patients about to undergo gallbladder surgery, they should start taking Tylenol before surgery and continue taking the painkiller every six hours for three days, only using a narcotic if it’s absolutely necessary.

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