Understanding Opioids and Other Pain Treatment Options
What are opioids? How do they work? What are the possible alternatives?
What are opioids?
Opioids are a type of narcotic pain medication prescribed by a doctor.
They work by attaching themselves to tiny receptors on nerves, blocking normal function and creating new feelings and sensations.
Opioids act in different ways in different parts of the brain and nervous system, including:
- The limbic system, which controls emotions. Here, opioids can create feelings of contentment, pleasure or relaxation.
- The brainstem, which controls automatic functions of the body, such as breathing and some pain response.
- The spinal cord, which receives messages and sensations from the body before sending them to the brain. Opioids can decrease feelings of pain from even serious injuries.
Types of opioids include:
- codeine (only available in generic form)
- fentanyl (Actiq, Duragesic, Fentora, Abstral, Onsolis)
- hydrocodone (Hysingla ER, Zohydro ER)
- hydrocodone/acetaminophen (Lorcet, Lortab, Norco, Vicodin)
- hydromorphone (Dilaudid, Exalgo)
- meperidine (Demerol)
- methadone (Dolophine, Methadose)
- morphine (Kadian, MS Contin, Morphabond)
- oxycodone (OxyContin, Oxaydo)
- oxycodone and acetaminophen (Percocet, Roxicet)
- tramadol (Ultram)
Heroin is also an opioid but it is illegal.
These drugs are not opioids: cocaine, meth (methamphetamine), ecstasy, LSD, GHB, Ketamine, Xanax and steroids.
Reasons Patients May Want To Avoid or Reduce Opioid Medication for Pain Control
Prescription pain medication may be an appropriate choice for some patients. Sometimes this medication is for short-term use, such as during recovery from an injury or surgery. Other patients may be prescribed pain medication due to a chronic condition.
All medications have some level of side effects. Opioid medication side effects include:
Additionally, longer-term use of opioid medication can cause:
- Feeling sleepy, not alert, or in a mental fog. Patients should not operate motor vehicles while taking opioids.
- Higher risk of falling
- Difficulty concentrating
- Low testosterone levels in men, leading to fatigue, muscle loss and low libido
- Rebound headaches
- Kidney and/or liver damage
- Addiction to the medicine
- Taking opioid pain medication and benzodiazepines (Valium, Xanax) together increases the risk of a drug overdose, resulting in suppressed breathing.
- Certain kinds of opioid medicines can cause serotonin syndrome. Symptoms of this syndrome include increased heart rate, seizures, increased temperature, etc.
- Opioid medication can have a negative reaction to other medications already in the body. Doctors and pharmacists carefully review any possible drug interaction. Taking an opioid for pain might mean changing medicine for other conditions.
Possible Alternatives to Opioid Pain Medication
Deaconess Comprehensive Pain Centers and ProgressiveHealth offer a variety of treatments and therapies that can be helpful in treatment of pain, helping to reduce (or even eliminate) the need for opioid medications.
Injections or Minimally-Invasive Procedures
- Most commonly treat low back pain, migraine and sciatic pain. Injections that can block the nerves that send or receive pain messages. Depending on the site of the injection, nerve blocks can treat pain in nearly any specific location in the body.
Minimally Invasive Lumbar Decompression
- Injections into specific joints for purpose of decreasing pain and inflammation. Joints considered for injections are shoulder, elbow, knee, hip and sacroiliac.
Spinal Cord Stimulation
- Can reduce back pain from spinal stenosis. Decompression is a surgical procedure performed to reduce pain caused by pinched nerves. Lumbar decompression includes removing a small portion of bone or disc material and making more room for the nerve root.
Trigger Point Injection
- Can treat a variety of types of pain. A small medical device implanted near the spine that uses electrical pulses to interfere with pain messages reaching the brain. This can be used for diabetic neuropathy, facial pain, low back, leg and arm pain.
- An injection placed in the muscle and ligaments of the body to relieve pain. Trigger points are knots of muscle that form when muscles do not relax.
Physical Therapy and External Treatments
- Nociceptive pain — pain caused by damage to body tissue (the body’s normal response to intense stimulation) usually described as sharp, aching, dull, or throbbing
- Treatment options:
- NSAIDs (nonsteroidal anti-inflammatory drugs) — work by inhibiting COX enzymes responsible for producing prostaglandins that cause inflammation and pain—ibuprofen, naproxen, meloxicam, celecoxib, diclofenac, etc.
- Acetaminophen (Tylenol®) — indicated for mild to moderate non-inflammatory pain
- Neuropathic pain — pain caused by damage to or disease of the somatosensory nervous system often described as burning, tingling, shooting, stabbing, pins and needles, or numbness
- Treatment options:
- SNRIs (serotonin norepinephrine reuptake inhibitors) —duloxetine, venlafaxine
- TCAs (tricyclic antidepressants) — amitriptyline, nortriptyline, etc.
- Antiepileptics — gabapentin, pregabalin, carbamazepine
- Lidocaine topical
- Capsaicin topical
- Beneficial for any injury. This hands-on approach separates physical therapists from many other health practitioners. Manual therapeutic techniques, such as soft tissue and joint mobilization, massage, tactile cues and manual strengthening, help to re-educate the body into proper postures and movement patterns. These are effective ways to reduce or eliminate restrictions and help patients move better.
- Beneficial for recent painful injuries, inflammation and swelling. Ice works by constricting blood vessels, thus minimizing bleeding, swelling and inflammation. Professional and college athletes use the same style units available to our patients, which combine circulating ice water with intermittent vasopneumatic compression.
- Helpful for lingering injuries causing muscle spasms or joint and soft tissue stiffness. Heat results in vasodilation, which can decrease spasm and increase mobility in soft tissues such as muscles, tendons and ligaments. Warmer (and thus softer and more pliable) tissues respond better to stretching. Heating methods include whirlpool, hydrocollator packs, fluidotherapy or hot paraffin wax (both used primarily for hands).
- Most often used for connective tissue injuries. Ultrasound uses sound waves to generate heat at varying tissue depths. This helps the body’s natural healing response and prepares tissues for stretching and exercise.
- Effective for painful, superficial inflammation. Iontophoresis delivers medication, such as anti-inflammatory steroids, through the skin to an inflamed tissue. The medication is applied to a patch and pushed through the skin over several hours by a low current from a small battery in the patch.
- Can help with nerve entrapment. Injury or arthritic changes can crowd or pinch nerves and other tissue in our spine. Traction is a form of decompression therapy that reduces spinal pressure, and can be performed manually or mechanically. Since it is non-invasive, it is often an effective option to more invasive treatments.
- Very effective for relieving pain, relaxing spasm, restoring muscular strength. Depending on current parameters such as frequency, duration and waveform, this modality can relax or contract a muscle or alter the pain response from an injured or irritated tissue. Neuromuscular electrical stimulation (NMES), transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC/H-wave) are common types of electrical stimulation.
Postural & Positioning Education
- Best for arthritic conditions, those with chronic pain or poor balance. When land-based exercise is too much, aquatic therapy (or “water exercise”) may be a better choice. This form of exercise, in a warm water environment, combines beneficial movements with the support and safety of the water. The buoyancy of the water reduces forces on joints and muscles while reducing the fear of falling.
- Effective for any injury or painful condition. Postural awareness and proper positioning is critical in controlling even minor forces that can cause or worsen a patient’s symptoms. The goal is to minimize stress across irritated tissues during routine daily activities, or sports and recreational movements.
- Best for virtually any injury or illness. Although it may not be obvious, exercise--even simple movements--is now recognized as “the go-to” strategy to treat pain and prevent its reoccurrence. Targeted stretching and/or strengthening movements address injuries resulting from a less active lifestyle.
Treating Opioid Addiction
- Very effective for relieving pain and relaxing spasms. Dry needling is used by physical therapists as a technique that's part of a larger treatment plan. Physical therapists use dry needling with the goal of releasing or inactivating trigger points to relieve pain or improve range of motion. Research indicates that dry needling improves pain control, reduces muscle tension, and normalizes nerve impulses that are transmitted to muscles.
Deaconess Cross Pointe offers addiction treatment focused around the philosophy that chemical dependency is a disease with a specific set of symptoms, treatment objectives, and treatment techniques. Both inpatient and outpatient services are available, and the Medication Assisted Treatment program specializes in treatment of opioid use disorders. Learn more at Deaconess.com/DCP