Clearing's Chronic Pain Blog
Opioids For Pain: What You Need to Know (And the Best Alternatives)
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Maybe you’ve tried an opioid like OxyContin, and maybe it’s even worked. You might wish prescription opioids were easier to get in the healthcare system. Or maybe the opposite — you’ve been burned by opioids, are afraid you might get addicted to them or have already lost someone you love to these drugs.
On the one hand, for some people, opioids can be effective in providing short-term relief for acute pain. But on the other hand, these medications can also have severe side effects, and can be addictive. In the United States, about 10.1 million people misused prescription opioids in 2019. Given this, it’s very likely that you or someone you know has been impacted by opioids.
The history of opioid use
Opium, heroin and morphine come from poppies (and yes, even the poppy seeds speckling your breakfast muffin contain trace amounts of opium). As early as 3400 B.C., ancient Sumerians called the poppies “Hul Gil,” meaning “joy plant.” People took poppy extracts to help with toothaches, broken bones and pretty much anything else that hurt.
In 1898, Bayer started producing medical heroin for pain relief, though the U.S. government outlawed it by 1924. Still, soldiers injured during WWII welcomed morphine as a miracle drug, despite its addictive nature.
What are opioids?
Opioids, which are synthetic narcotics formulated to silence pain signaling in the body, share a lot in common with natural opium, which is a non-medical drug that induces a sometimes euphoric sense of lethargy and painlessness..
Opioids commonly prescribed for pain relief in the United States include:
How do opioids work?
Opium derivatives like morphine and synthetic opioids like Oxycontin and Fentanyl deliver a two-punch knockout to pain, first by jamming the body’s pain communication system while flooding the body’s natural painkiller receptors, and second by relaxing muscle groups, convincing the body and mind that everything is basically fine.
Unfortunately, this one-two punch is so “relaxing” that the body no longer notices pain signals and often lapses into a drowsy or euphoric state. At high doses, sometimes the muscles that control breathing relax too much, leading to a coma or even death.
Opioids also stimulate the brain’s reward center, which means that the mind and body associate opioids with feeling relaxed and pain-free. For some people over time, chemical dependence or full-blown addiction can develop.
“Opioids produce rapid pain relief, and are therefore suitable for short-term pain relief such as when managing pain after an acute injury or postoperatively,” says Dr. Jacob Hascalovici, MD, PhD,co-founder and Chief Medical Officer at Clearing.
For long-term pain (pain that lasts at least three months and often past six months), opioids are often not the best choice for long-term treatment because they do not always resolve the actual cause of the pain.
The pros and cons of opioids for pain
When you first start taking opioids for pain, some of the initial side effects may include:
- Sluggish metabolism and/or constipation
- Drowsiness or fatigue
- Slow, ineffective breathing, which is also known as respiratory depression
- Loss of appetite
When long-term use, side effects can be more severe, including:
- Drug tolerance (meaning doses need to be increased to achieve the former level of pain relief)
- Reproductive difficulties
- Loss of sex drive
- Chemical dependence
- Accidental overdose due to mixing medications, medication errors, or risks related to being in a high risk category, like having compromised liver function or being over 65
Quitting opioids is not always easy or free of side-effects and negative impacts, either. Withdrawal can feel wrenching and may require being monitored by a medical professional for safety. It typically starts within 24 hours of the last opioid dose, with symptoms that mimic the flu and can include severe cramping, vomiting and fever, not to mention vomiting and diarrhea.
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What is the opioid epidemic?
The late 1990s saw the launch of modern opioids for pain management, which coincided with a movement in the medical community to focus on pain as the “fifth vital sign.” To help manage patients’ pain, doctors often began prescribing opioids, which manufacturers promised were relatively non-addictive. Opioids, however, proved problematic in several ways, and claims about them being non-addictive did not pan out.
These misuses and overdoses can happen when the body gets used to a certain opioid dose and then requires a higher dose to adequately address the pain. Opioid trouble is not restricted to people buying drugs off the black market or using them recreationally, but can also affect patients with medical prescriptions, including teenagers, veterans and senior citizens.
For these reasons, the FDA lists “cutting the rate of new opioid addictions” as one of their highest priorities, and guidelines for prescribing opioid medications have become stricter.
In the U.S., the department of Human Health and Services (HHS) advocates a five-point strategy against opioid misuse:
- Offer better access to treatment and recovery services
- Support drugs that reverse overdoses
- Use public health principles to learn more about the epidemic
- Conduct better research on pain and addiction
- Find and publicize better approaches to pain management
According to the CDC, overdose deaths from prescription opioids were five times higher in 2016 than in 1999.
What are alternatives to regular use of pain medications?
The pain management landscape still has a long way to go. We now know, however, that it’s best to avoid opioids when possible for chronic pain. We also know that many alternatives to opioids for pain relief have been developed, including:
Multidisciplinary clinics that unite a team of healthcare professionals working together to provide long-term pain management. You can often find physical and occupational therapists, nutritionists, neurologists and nurses at interdisciplinary pain clinics.
Cannabis and its derivatives, including CBD, are becoming extremely popular in the chronic pain treatment space. New legislation that allows cannabis to be prescribed for chronic pain has led to a host of innovations.
Acupuncture, Massage Therapy, and Chiropractic Therapy
These treatments administered by professionals who practice alternative medicine. A growing body of evidence demonstrated by clinical trials supports the use of these treatments.
Cognitive-Behavioral Therapy (CBT) was originally developed to treat depression and anxiety. One of the basic tenets of CBT for chronic pain is that your brain can be trained to change its interpretation of the events that happen to you, including pain. A mental health professional can help you establish coping mechanisms and a feeling of control over your pain, which may actually decrease your pain’s influence on your life.
Outpatient physical therapy has become a popular option for rehabilitating old injuries or building strength in weak muscles to manage chronic pain.
Topical Pain Relief Creams
The Clearing alternative
To sum it up, we know opioids have their place, but we will not be prescribing them at Clearing. Instead, we will be doing everything we can to match you with opioid-free options for long term relief, so that treatments are as safe and supportive as possible. Our personalized, whole body treatment plans combine non-opioid medications, personalized exercises and stretches, nutraceuticals, health coaching and high-quality care from a team of specialized providers delivered via our telehealth platform.
Many patients have been troubled by changes in healthcare and insurance policies and coverage that result in more restrictions on opioid use and may sometimes taper patients off opioids altogether. We know this can introduce a sense of despair or of not being understood – you may even feel hopeless at the prospect of being unable to find anything else that addresses your pain. While we do not prescribe opioids at Clearing, we do work with each patient to find a customized pain management solution. The science of pain management is a developing field that has been introducing many new possibilities for addressing chronic pain. We make sure to track these ongoing developments so we’re aware of treatments that may replace or even surpass opioids.
One thing we recommend is to review your overall needs and pain management strategies. Lifestyle medicine is one area of pain management, for example, that shows patients how to change everyday eating, sleeping and stress management habits to lower pain. Other places you can start including reviewing your medications or evaluating your mental approach to pain. We would like to help out however we can, so if you’re feeling stuck or puzzled, we are confident we could help you pick a good place to start.
It’s a great question, and it would certainly be wonderful to have a “silver bullet” medication that instantly quells pain without any side effects. Pain, however, resists single-medication treatments because it is a very complex phenomenon that involves both the mind and the body. Multiple pathways within the mind and body perceive and interpret pain signals, so it has proven very difficult, so far, for researchers to devise an ideal pain medication. Current science shows that a biopsychosocial approach that combines multiple different treatments (many of them not involving medication) often works better than an approach that relies solely on medication.
This article is for informational purposes only and does not constitute professional medical advice. Always seek the advice of your healthcare professional with any questions or concerns you may have regarding your individual needs and medical conditions.