A Dozen Ways to Ease Your Pain: Opioid Alternatives in the Overdose Age

More people died of opioid-related overdoses than car crashes in 2016, according to the Centers of Disease Control. “It’s an outright epidemic everywhere, even in Nebraska and Iowa,” said Christopher Criscuolo, MD, a pain medicine specialist at CHI Health.

Physicians and care providers are taking on the problem of opioid overuse and abuse – and that’s changing how these pain medications are prescribed. “There’s a misconception among patients that there’s always going to be someone who will prescribe an opioid for them. That’s not the case anymore. The access to opioids is going to be controlled,” he said.

In fact, the current medical recommendations are to not use opioids for people with chronic back pain and instead use other methods of pain control. It’s important for patients to realize several options exist beyond opioids. “Different things work for different types of pain,” Dr. Criscuolo said.

A dozen alternatives to opioids:

1. Physical therapy tackles inflammation, stiffness and soreness and also encourages the body to produce natural pain-relieving chemicals.
2. Weight management can help ease joint and back pain by simply reducing the amount of pressure on joints. Exercise is important. “Sometimes patients think pain is a free pass to being sedentary for the rest of their lives,” Dr. Criscuolo said. “The body likes to move, it’s a machine.”
3. Smoking cessation. Studies have found that long-term smoking causes receptor desensitization, which can create a perception that pain is more severe.
4. Massage therapy and chiropractic massage work by relaxing muscle tissue and reducing nerve compression.
5. Tai chi and yoga combine physical strengthening with meditation. “Especially for fibromyalgia, the level of physical conditioning is important and yoga and Tai chi are especially good for that,” Dr. Criscuolo said.
6. Acupuncture involves inserting fine needles into specific points of the body. “We don’t know the exact mechanism of how it works. But it’s a really good modality for chronic pain,” said Dr. Criscuolo. He’s been an acupuncturist for 27 years.
7. Dry needling, which evolved out of acupuncture, involves inserting a needle into muscle or tissue trigger points. “It works by reducing the spasm,” Dr. Criscuolo, who advises patients to work with an experienced practitioner.
8. Biofeedback, meditation and mindfulness help increase relaxation and can provide distraction from the perception of pain. “Hypnosis can also work in rare cases,” Dr. Criscuolo said.
9. Anti-depressants are sometimes prescribed for pain. “These increase the amount of serotonin and norepinephrine in the brain, which works to inhibit pathways so you can decrease pain signals in the brain.”
10. Radiofrequency ablation uses an electrical current to destroy a small area of nerve tissue. “The problem is the nerves can grow back, so it might work for six to eight months. And it can be expensive if it’s not covered by insurance,” Dr. Criscuolo said.
11. Transcutaneous electrical nerve stimulation (TENS) sends an electrical current to stimulate nerve pathways. The resulting tingling sensation can reduce the perception of pain. “It basically sends a confusing signal to the nerve system,” Dr. Criscuolo said. Available over-the-counter, it’s not safe for those with pacemakers and some forms of cancer.
12. Supplements like glucosamine chondroitin and even the spice turmeric can ease inflammation. “Some people get good relief from arthritis pain with this glucosamine,” Dr. Criscuolo said.

As a pain medicine specialist, Dr. Criscuolo is open to patients trying a variety of alternative therapies. It’s best, he says, to begin with the basics.

“We start by looking at how patients are living and how their lifestyle affects their pain,” he said. “Someone with back pain who is also overweight can reduce their pain by losing some pounds. So we always focus on healthy living factors like not smoking, sleep hygiene, weight control, a healthy diet.” 

It’s natural to want to make the hurt go away; however, easing pain is a more realistic expectation. “The number one misconception is that patients will get rid of all their pain. They think they will be pain-free. That’s not possible with chronic or even acute pain,” he said. “Pain management is pain management, it is not pain cure.”

A multidimensional approach can provide the best results. “Always be leery of anyone who says that one specific modality will be the cure-all,” Dr. Criscuolo said.