Pain Management Without Opioid Drugs: Is It Possible?

Pain Management is a way of life for over 100 million Americans who live with long-term pain.

Since the 1990s, physicians’ go-to treatment for constant pain has been prescription opioids, such as oxycodone or hydrocodone. Though the evidence that opioids work for long-term pain is scarce, Americans get more prescriptions for them than anyone else in the world. This prescribing epidemic has led to a national crisis of opioid misuse, overdose, and death. Now, as policymakers work to stem the tide of abuse, patients and worry that changes will take pain medications out of their hands of people.


pain management


Pain Management: Are New Drugs The Answer For Chronic Pain?

Access to painkilling medications that can’t cause addiction, abuse, and overdose would make life easier for prescribers and could save the lives of patients.Development of such drugs has been slow-going, in part because scientists don’t completely know how chronic pain works. They believe the body has multiple pathways to chronic pain, and that means multiple targets for painkillers. But researchers don’t have proven ways to identify which pathway is causing the pain in each person.For example, drugmakers may have zeroed in on a target for chronic back pain and osteoarthritis pain. The FDA recently fast-tracked the drug tanezumab for approval. Federal regulators had previously halted work on tanezumab and other drugs like it over concerns about side effects.

The non-opioid blocks the production of nerve growth factor, a substance that’s needed for certain types of pain to happen. Several other anti-nerve growth factor drugs are in clinical trials.


Pain Management: Alternatives To Opioid Drugs

Opioids address pain in a different way. They look like chemicals that the body produces naturally to regulate pleasure, pain, and emotions. So, when you take an opioid, the drug attaches to parts of nerve cells called opioid receptors, where they can block pain. But they also cause the pleasurable feelings that make people want more opioids. And they slow breathing, which is why overdoses can kill.

A team of researchers at Wake Forest University and the University of Bath in the U.K. is exploring a new kind of opioid that could relieve pain without affecting breathing or raising the chance for abuse. The new drug, only called by its chemical compound name BU08028, relieved pain in rhesus macaque monkeys. When they had the opportunity to take as much of the drug as they wanted, they didn’t abuse it. When taken off the drug, they didn’t show signs of painful withdrawal.

Although in early development, safely and successfully using the drug in this type of monkey is a key step on the path toward human clinical trials.

A second drug, also in early development, could harness the pain-relieving effects of opioids while bypassing the negative effects. The drug eased pain in mice. It’s still a long way from human testing.


Pain Management: New Approaches

The bottom line is that opioids should not be the first thing doctors try in patients who have chronic pain. The CDC’s latest guideline for opioid prescribing, released in 2016, notes that most proof of how well opioids work is based on short-term pain. It directs doctors to try nondrug treatments, such as physical therapy and talk therapy, as well as non-opioid treatments first. If those aren’t enough, before adding opioids, doctors should work with patients to set realistic goals for easing pain, with an emphasis on making the body work better rather than eliminating pain.
The U.S. Department of Health and Human Services, too, released a “National Pain Strategy” in 2016 that emphasized many of the same points. The HHS document also called for an approach to treatment that would include mental health, social and work concerns of the patient, and alternative therapies.

Exercise, physical therapy, and talk therapy have proven benefits in the areas of function, or making the body work better, and coping. Health care providers ought to approach long-term pain with a combination of those treatments, says Ellen Edens, MD, a psychiatrist who treats veterans with chronic pain and long-term opioid use in the VA Connecticut Healthcare System.“It’s not clear [in clinical trials] that opiates actually improve function in the long run,” she says. “In fact, there’s some evidence that people on chronic opiates lose function over the long run.” Loss of function is due in part to the side effects of these drugs, which include nausea, vomiting, and constipation. While they might ease pain, the side effects can keep a person from getting on with their life. What’s more, most people typically need to increase the dosage over time to keep getting the same level of pain relief.


Pain Management: HHS Guidelines

HHS has compiled a report for doctors to use when treating long-term pain that summarizes the research behind many non-drug treatments and how they work.

An opiate might bring your pain score down from an 8 to a 6.5, but if we add physical therapy, we can bring you down to a 6.  Ibuprofen might bring you down to 5.75. Then you get  therapy for your depression and your mood. Then acupuncture will bring you down to 5.25 and so on.

Health insurance plans might soon include more non-drug ways to treat chronic pain.Patients suffering from chronic pain should develop realistic expectations that their chronic pain may never be eradicated. Accept it and adapt to it. Non-opioid remedies might just be that ticket; relief without the harmful opioid side effects.