Posted on May 07, 2018
Opioids Do Not Work Better Than Other Drugs Such as Acetaminophen or Ibuprofen for Certain Types of Pain
This is now proven. The recent study results published in the Journal of the American Medical Association on March 06, 2018 by Dr. Erin Krebs and her team at the Minneapolis VA Center for Chronic Disease Outcomes Research found that the use of opioid versus non-opioid medications over a 12-month period did not yield better pain-related function. The population in this randomized clinical trial comprised of 240 patients with chronic back pain or hip or knee osteoarthritis pain.
The results of this study could be summarized as follows:
#1 Groups did not significantly differ on pain-related function over 12 months.
#2 Pain intensity was significantly better in the non-opioid group over 12 months.
#3 Adverse medication-related symptoms were significantly more common in the opioid group over 12 months.
Prescription opioids like oxycodone, hydrocodone, tramadol, fentanyl, and codeine are being held responsible for the opioid crisis in the country. While their use and value in end of life situations and short-term pain management such as for trauma and surgery is not questioned, their more widespread prescribing had resulted in a peak of over 250 million opioid prescriptions issued in the US in 2012. This number has steadily decreased since then but remained above 200 million in 2016. As a result, opioid abuse and overdose death rates have skyrocketed in recent years, and currently on average, 115 people a day die from an opioid overdose.
What makes it worse with the results from the recent clinical study above is that opioids were probably not the most effective treatment of choice in the first place for many of these patients.
So, what are the other options for pain treatment?
Non-opioid drugs of course come to mind next. Particularly after reviewing the above study results. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, acetaminophen or tylenol, antidepressants, anti-seizure medications, and muscle relaxants can be effective without the adverse side effects and risk of addiction associated with opioids. It is important to consult with a pain specialist because each person is unique in how they respond to different therapies.
Alternatives to Opioid and Non-opioid Medications
There are several viable alternatives to managing pain without medications. Alternative, or complementary medicine, focuses on the mind-body connection as well as behavioral and lifestyle changes that can help in the management of chronic pain. Now, the Department of Veterans Affairs, the CDC, and the American College of Physicians among others, recommend starting with these alternative therapies for chronic pain before moving to medication management. Six of the recognized alternative therapies are noted below:
- Physical therapy– A physical therapist who specializes in pain management and rehabilitation can develop a specialized exercise regimen that focuses on the sources of pain and helps build up the muscles and improve function. Therapy may also include therapeutic massage and the use of heat therapy and the sauna.
- Acupuncture– A trained specialist uses very fine needles inserted into various pressure points throughout the body to interrupt pain signals. Acupuncture can be used for chronic pain caused by conditions including migraines, fibromyalgia, arthritis, and back pain/injury.
- Chiropractic manipulation – When performed by a trained and certified chiropractor, spinal manipulation can help relieve back and neck pain.
- Yoga– Studies have shown that the ancient practice of yoga has many health benefits including stress management, hormone balance, and management of chronic pain. Yoga encompasses a series of postures, breathing techniques, and meditation and helps lengthen and strengthen muscles throughout the body. Yoga helps individuals achieve a mind-body balance and can go a long way in building a stronger body and easing symptoms of long-term pain.
- Reiki– According to the NCCIH, Reiki is a complementary health approach in which practitioners place their hands lightly on or just above a person, with the goal of facilitating the person’s own healing response. Reiki has been studied for a variety of conditions, including pain, anxiety, fatigue, and depression.
- Meditation, Mindfulness, and Relaxation therapy– For some people, practicing relaxation techniques and meditation can help not only relieve chronic pain but reduce stress by turning the mind’s focus away from the feelings of discomfort. Hypnosis, meditation, and relaxation/breathing exercises may help certain individuals manage pain.
What option or combination is right for an individual? A specialist at a nearby integrative pain management program can help figure this out for a patient, recognizing that each person is unique, and their needs and responses therefore vary.