Description of Strategy
It is important to note that while opioids serve a legitimate medical use, they are not without risks. It is necessary when taking, or prescribing opioids as part of a treatment program, to also consider alternative options. Alternative pain treatments are a collection of non-opioid treatment options used either alone or together in an effort to relieve physical pain. There are several categories of alternatives:
- Non-opioid medications: While all medication carries risk, non-opioid medication can limit the possibilities of opioid use disorder, while still treating the underlying condition. There are a number of medications that can be used in place of opioids, such as acetaminophen, NSAIDs (such as aspirin or ibuprofen), anticonvulsants, musculoskeletal agents (including baclofen, tizanidine, and cyclobenzaprine), or antianxiety medication (HHS, 2019).
- Physical Therapy: The treatment of pain through physical methods such as massage, heat treatment, or exercise rather than medication. It has also been shown that for those with acute pain, therapeutic exercise can be effective (Sahin et al., 2017).
- Cognitive Behavioral Therapy: A psychological approach where patients change patterns of thinking and behavior in an effort to relieve physical, emotional, and behavioral pain triggers.
- Interventional Therapies (Injections): Interventional therapies treat pain with minimally invasive injections or nerve blocks. While they should be considered as part of a holistic treatment program, they should not be considered to be a first-line of defense (Benzon et al., 2014).
In Wyoming
The Wyoming Board of Medicine advocates using opioids as a last resort for the treatment of chronic pain, and supports the use of alternative treatments as part of an overall treatment plan.
Discussion of Effectiveness
When used as part of a multi-dimensional approach to managing pain, there are alternatives to opioids that can effectively address both acute as well as chronic pain, including functionality, physiological, and psychological conditions (Gatchel et al., 2014). The efficiency of a coordinated and multi-dimensional approach has shown to reduce the severity of pain, as well as improve one’s mood, functionality, and overall quality of life (Gatchel & Okifuji, 2006; Stanos, 2012). In fact, there are a number of systematic reviews that attest to the effectiveness of cognitive behavioral therapy for treating chronic pain (Ehde et al., 2014).
References
Benzon, H.T., Wu, C.L., Argoff, C. E., Rathmell, J. P., Turk, D. C., & Hurley, R. W. (2014). Practical management of pain. Elsevier.
Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. The American psychologist, 69(2), 153–166.
Gatchel, R.J. & Okifuji, A. (2006). Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic nonmalignant pain. Journal of Pain, 7(11), 779–793.
Gatchel, R.J., McGeary, D.D., McGeary, C.A., & Lippe, B. (2014). Interdisciplinary chronic pain management: past, present, and future. American Psychologist, 69(2), 119–130.
Şahin, N., Karahan, A.Y., & Albayrak, I. (2017). Effectiveness of physical therapy and exercise on pain and functional status in patients with chronic low back pain: a randomized-controlled trial. Turkish Journal of Physical Medicine and Rehabilitation, 64(1), 52–58.
Stanos, S. (2012). Focused review of interdisciplinary pain rehabilitation programs for chronic pain management. Current Pain and Headache Reports, 16(2), 147–152.
U.S. Department of Health and Human Services. (2019). Pain Management Best Practices Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and Recommendations. U. S. Department of Health and Human Services.
Further Reading
CDC Guidelines for Prescribing Opioids for Chronic Pain
American Society of Anesthesiologists Guide to Alternative Pain Medicine