Alternatives To Opioid Painkillers | Understanding Non-Opioid Pain Medications
Opioids like oxycodone, codeine, hydromorphone, and hydrocodone play a vital role in the United States medical system. They provide critical pain relief for those experiencing moderate to severe pain following surgery or traumatic accidents, or in cases of serious chronic pain.
However, taking opioid drugs is not without risk. In addition to a considerable potential for abuse, long-term and high-dose use of these prescription drugs results in tolerance and physical dependence, which can make discontinuation of opioid painkillers difficult and unpleasant.
This is one reason why some medical professionals and patients are interested in alternatives to opioid painkillers.
Options For Non-Opioid Pain Management
Opioid narcotic drugs aren’t the only option for long-term pain management. They aren’t even considered first-line pain management solutions for certain types of pain, including chronic pain outside of active cancer treatment, palliative care, and end-of-life care.
While opioid drugs are unique in their ability to reduce the intensity of severe pain signals coming from the body and change how the brain perceives pain, a variety of other options exist to control chronic pain or deal with pain coming from specific injuries.
Instead of controlling pain with opioid prescriptions, doctors are placing a new focus on resolving the pain, promoting healing, and stimulating the release of the body’s own natural endogenous/natural opioids.
Some of these common therapeutic interventions include:
- heat and cold treatments
- exercise, stretching, and movement
- physical therapy
- occupational therapy
- rehabilitation therapy
- massage therapy
- chiropractic care
- cognitive behavioral therapy
- transcutaneous electrical nerve stimulation (ENS)
These therapies, while they have few side effects, are limited in that they focus on specific areas and are generally best suited for mild to moderate pain control as treatment progresses.
Common pain relief medications used as alternatives to opioids include:
Acetaminophen, also known as paracetamol and sold under the brand name Tylenol, is a first-line analgesic (pain reliever) that you can pick up over-the-counter in drug and grocery stores across the nation.
Its mechanism is not entirely understood, though it provides effective mild to moderate pain relief and is used to treat fevers.
It’s important to note that acetaminophen may cause severe liver damage or liver failure when taken in high doses, or over a long period of time. Acetaminophen is best used as a short-term option for pain control, with a limited maximum dose as indicated.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are another variety of common first-line analgesics that you probably have in your home right now. These drugs include aspirin, ibuprofen (Motrin, Advil), celecoxib (Celebrex), and naproxen (Aleve).
NSAID pain medicines are generally more effective than acetaminophen when used for pain relief and work by blocking cyclooxygenase (COX) enzymes, which interferes with the body’s production of prostaglandins and, in turn, the body’s pain and fever (inflammation) responses.
Unfortunately, NSAIDs have the potential to cause gastrointestinal bleeding and other stomach problems. They may also increase the risk of heart attack and stroke (except aspirin), and they can contribute to kidney and liver failure. These risks are greatest with chronic or high dose use.
These drugs are used as a first-line treatment for neuropathic pain and as anticonvulsant drugs. There is some potential for side effects including sedation and dizziness, but in general they are safe and effective for dealing with low to moderate nerve pain.
As with acetaminophen, it’s not entirely clear what effect these drugs have on the nervous system or how exactly they work to treat pain.
Even when depression isn’t a concern, several different categories of antidepressants are used to control chronic pain including pain due to arthritis, nerve damage, migraines and headaches, low back pain, and multiple sclerosis.
The pain relief potential of these drugs is typically moderate and takes time to develop, and the mechanism by which these drugs provide relief is, again, poorly understood.
Tricyclic antidepressants (TCAs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and selective serotonin reuptake inhibitors (SSRIs) are all used in different circumstances, and each class of antidepressant has its own range of common and uncommon side effects.
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Written by Ark Behavioral Health Editorial Team
©2023 Ark National Holdings, LLC. | All Rights Reserved.
This page does not provide medical advice.
Centers for Disease Control and Prevention (CDC) - Alternative Treatments Fact Sheet
Harvard Health - Non-opioid options for managing chronic pain
United States Food and Drug Administration (FDA) - The Benefits and Risks of Pain Relievers: Q & A on NSAIDs with Sharon Hertz, M.D.
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