Opioids are effective in treating and managing pain. However, there are safer alternatives to opioids for pain relief that can be considered in cases of mild or moderate pain; situations where a patient is starting to show signs of opioid addiction or not responding appropriately to the current treatment, etc.
Despite the fact that there are some tools, such as an opioid converter, that are built towards more effective management of opioid dosage mixtures and prescriptions, opioid misuse is still a real problem. On that note, non-opioid pain medication or therapy can be quite useful for pain management with varying levels of success.
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Reasons For Seeking Opioid Alternatives
Opioids, as a class of drugs, require extreme care and close monitoring when prescribing. Opioids like narcotics have high possibilities of developing a chemical dependency.
The use of specific opioids is becoming increasingly controversial, with an opioid crisis lawsuits already looming for some pharmaceutical companies all over the country.
Using opioid alternatives diminish the risk of overdose on opioid as the patient will not need to use them as frequently – or possibly even at all.
Avoidance of overdoses through the use of opioid alternatives will also have the rebound effect of a reduced occurrence of opioid withdrawal syndrome.
Additionally, using alternatives will reduce or strike out the risks of side effects associated with them, such as opioids and constipation.
Non-Opioid Pain Relievers: What Are They?
Different classes of drugs and substances can function as non-opioid pain meds. These include (but is not limited to):
- Local anesthetics
- Acetaminophen & NSAIDs
It is essential to note that some of opioid alternatives also have addictive properties and should be taken only after obtaining a medical prescription.
Originally, alpha-2-agonists were best known for their role in treating hypertension and similar health disorders. However, since the turn of the century, they have increasingly been applied more widely – especially in anesthesia and pain management without opioids. It was discovered that alpha-2-agonists are effective in enhancing the analgesia provided by traditional analgesics, and this sole discovery unlocked the idea that these non-opioid analgesics could be applied effectively to treat cases of chronic, neuropathic, myofascial, and acute postoperative pain.
Despite this already-broad spectrum of possible clinical application of alpha-2-agonists in the management and treatment of pain, new applications continue to pop up as time passes. Examples of alpha-2-agonists that are currently clinically certified to be effective for anesthesia and pain management in humans include tizanidine, clonidine, and dexmedetomidine.
Anticonvulsants As Opioid Alternatives
Anticonvulsants are typically used for controlling seizures – especially in people who have epilepsy. Experts believe that the effectiveness of this non-opioid analgesic for severe pain may be down to the function of opioids in blocking the flow of signals from the central nervous system.
Anticonvulsants have proven to be useful for nerve pain, and these drugs have also proved to be useful as opioid alternatives for reducing persistent back pain and chronic pelvic pain. In these instances, anticonvulsants can be used as non-opioid painkillers. Carbamazepine particularly has proven to be effective for managing pain.
Ketamine has been proven to be used as an alternative to opioids for pain management, especially when dealing with postoperative rehabilitation. Additionally, Ketamine has also been widely used as a third-line drug for the management of cancer pain. It has been tested as management for refractory cancer and chronic cancer pain, albeit with limited evidence.
Local Anesthetics As Opioid Alternatives
Here’s another good example of a non-opioid alternative for managing moderate to chronic pain. Local anesthetics, like opioids, are effective for postoperative relief and are also useful in the therapeutic treatment of acute and chronic pain. Additionally, drug delivery systems (e.g., microparticles, nanoparticles, and liposomes) have been considered as local anesthetic delivery systems for prolonged anesthesia.
Non-opioid local anesthetics are classified into three groups. These include:
- Amino amides (e.g., Etidocaine, Dibucaine)
- Amino esters (e.g., Lidocaine, Tetracaine)
- Naturally derived local anesthetics (e.g., Menthol, Cobratoxin)
Acetaminophen And NSAIDs
Acetaminophen, also known as Tylenol, and NSAIDs such as ibuprofen, aspirin, or Naproxen are effective for managing moderate pain and can be administered intravenously or orally. They do not exactly function the same way, but due to the less number of severe side effects that can be caused by them, physicians sometimes prescribe both drugs together for relief.
The prescriptions come in tiny doses of each, to reduce the risk of side effects. NSAIDs may also be used as opioid alternatives to decrease the frequency of intake.
Acetaminophen is mostly effective for providing relief in mild and moderate cases, but NSAIDs take things a notch higher by reducing inflammation while also acting by providing relief.
Alternative Therapy Options As Non-Opioid Treatment For Pain
This misuse and disregard of the guidelines for using opioids by patients fuel the need for therapy alternatives instead of taking medicines. Moving away from medication, another method of dealing with suffering is through various forms of medical therapy. There are specific types of therapy that have proven to be effective in non-opioid pain management, including:
- Active Release Treatment
- Acupuncture or Acupressure
- Massage Therapy
- Clinical Pilates
Active Release Treatment
Active Release Treatment is a fairly versatile approach to non-opioid pain management therapy. It helps to reduce the suffering levels by working on the muscles, ligaments, and nerves. It is mostly applied by athletic or massage therapists that work the deep tissue, and these therapists can draw up to 500 different movements when applying the treatment.
Massage Therapy As Opioid Alternative
Massage therapy is a bit more surface-level than Active Release Treatment. It is not as intense and does not work the deep tissue like its counterpart.
However, it is also a useful form of therapy for non-opioid pain management. The therapy applies pressure to the affected areas of the body by pressing, rubbing and kneading the spot, bringing about a sense of relaxation and calm to the patient, improving blood circulation and relieving mild to moderate pain.
Acupuncture Or Acupressure
Both of these forms of non-opioid pain management therapy are derived from a Chinese tradition. The method of application in acupuncture is one where thin needles are poking into specific spots marked by the therapist to interrupt pain signals traveling around the affected area. When these marked pressure spots/points are targeted and pinned, the central nervous system relaxes a bit, leading to a reduction in pain and improvement in blood flow. Acupuncture has been known to be helpful for managing the sufferings caused by fibromyalgia.
Acupressure, on the other hand, is done solely with the hands and fingers of the therapist instead of needles. The therapist identifies the pressure points with fingers and applies pressure to them.
Clinical Pilates is different from regular Pilates. For one, engagement in Clinical Pilates has to be done with a personal, registered physiotherapist or an exercise physiologist. As an opioid alternative it is helpful for providing relief from repetitive strain injuries, pre and post-natal, neck and back pain, and sports injuries.
The therapist is knowledgeable about a series of exercises that will help to improve flexibility and strengthen weak muscles. Some of these exercises will be carried out with equipment such as weighted balls, strengthening mats, and yoga mats.
Hydrotherapy is carried out in bodies of water – usually a pool. It involves exercising the affected muscles while standing or laying in that body of water where pressure pushes against the body. The resistance provided by the water also helps to improve balance, making this form of therapy effective for people recovering from injuries or surgeries.
Please notice that some of the therapies described above are not scientifically proven to be effective. Set up an appointment with a doctor to discuss the opioid alternative treatment options without taking medications before undergoing any of these therapies.
What Is The Best Opioid Alternative?
Finally, recent epidemic and opioid history drive users to the question of choosing physical therapy or opioid alternative medication? On the surface level, in situations where the need in mild relief, it may be unnecessary to use medication as the aforementioned therapeutic approaches are effective for mild pain.
However, when dealing with severe or chronic pain, finding the best opioid alternative would require seeking professional treatment and advice from a professional medical practitioner as the choice would depend heavily on the specific situation of the patient. Most importantly, self-medication is never the best option.
- Smith H., Elliott J.; Alpha(2) receptors and agonists in pain management; October 2001.,https://www.ncbi.nlm.nih.gov/pubmed/17019139
- Rae Frances Bella, Eija Anneli Kalsob; Ketamine for pain management; September-October, 2018., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6181464/
- Kyle R Bagshaw, Curt L Hanenbaum, Erica J Carbone, Kevin WH Lo, Cato T Laurencin, Joseph Walker, and Lakshmi S Nair; Pain management via local anesthetics and responsive hydrogels; December 2015., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500150/