Author: Anjali Talcherkar, PhD

If you suffer from acute intense pain due to headaches, back pain, surgery, sports injuries, or an accident, your doctor may prescribe an opioid pain medication. While these medications can be effective in treating severe pain, they are intended for short-term use rather than long-term pain management. Opioids use can also lead to physical dependence which may contribute to misuse, even when the medication is used as prescribed.¹ Many effective non-narcotic pain medications and treatments are available to manage pain, including non-opioid analgesics and a variety of complementary and alternative therapies.²

In This Article:

• The Problem with Opioid Painkillers
• Non-Narcotic Pain Medication Options
• Complementary and Alternative Therapies

The Problem with Opioid Painkillers

Opioids have previously been considered the standard of care for managing acute to severe pain. However, opioids are generally no longer considered the first-choice medication for treating long-term pain, such as chronic pain or permanent injury. Reasons for this shift include opioids’ lack of long-term efficacy, their side effects, and the potential for misuse and addiction.¹

Nearly 12 million Americans misused opioids in 2016.³ The most commonly misused prescription opioids are oxycodone, hydrocodone, codeine, tramadol, morphine, and fentanyl.³

The effects of opioid use include:⁴

• Constipation
• Nausea, vomiting, and dry mouth
• Sleepiness and dizziness
• Confusion
• Itching and sweating
• Slowed breathing

Using prescription opioids for an extended period of time can lead to an increased risk of addiction and overdose.⁴

Because of the risks and diminishing effectiveness associated with long-term opioid use, the International Association for the Study of Pain recommends that doctors use caution in prescribing opioids for chronic pain.²

Other professional pain associations are going even further. For the management of acute pain and pain from cancer, the American Pain Society recommends combining non-opioid pain medications with non-pharmacologic treatment, including psychological approaches and complementary therapies.² The American College of Physicians advises the use of medication or surgery only in cases where a person’s pain cannot be managed any other way.²

Non-Narcotic Pain Medication Options

Non-opioid pain medication can be used to treat various types of pain. The most commonly used non-narcotic painkillers include:²

• Acetaminophen—The pain-relieving and fever-reducing effects of acetaminophen (Tylenol) are well-known. It is available over-the-counter, and is one of the safest non-opioid analgesics available, although liver damage is a concern when used in large quantities.
• Aspirin and other NSAIDs—Aspirin and other NSAIDs, including ibuprofen, diclofenac, naproxen, and COX-2 inhibitors, alleviate pain and reduce fever and inflammation. These non-opioid analgesics are used to treat mild to moderate pain such as joint and muscle pain, toothache, headache, menstrual pain, and postoperative pain.
• Antidepressants—Several antidepressant drugs have demonstrated the ability to treat chronic pain. Tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been used to treat neuropathic pain with success. Antidepressants have also been effective in treating migraine and tension headaches. Amitriptyline is the antidepressant with the most evidence of pain relief, although it may come with an increased risk of falls.
• Anticonvulsants—Several drugs used to treat epilepsy have demonstrated pain-relieving properties by reducing neurotransmitter activity. Gabapentin and pregabalin are recommended for the treatment of neuropathic pain. Pregabalin has also shown promise in clinical trials to treat pain from fibromyalgia, with mild side effects.
• Topical treatments—Topical non-opioid analgesics such as lidocaine and capsaicin are used to reduce pain by applying a medicated patch to the skin. They work by blocking nerve signals that send the feeling of pain from the site of injury to the brain. They provide a temporary loss of sensation in the area to which they are applied.

Complementary and Alternative Therapies

Various holistic treatments offer alternatives to opioids and can work as supplements to non-narcotic pain medication. Complementary therapies are treatments used in conjunction with conventional medicine, while alternative therapies are used in place of mainstream medicine.

Approximately 38% of adults and 12% of children use some form of complementary or alternative medicine in the U.S.⁵ More health insurance companies are covering the use of non-traditional medicine, including physical therapy, nutrition counseling, biofeedback, acupuncture, and osteopathic and chiropractic care.⁶

Some popular complementary and alternative therapies include:

Physical Therapy

Physical therapy (PT) involves hands-on treatment that focuses on the prevention and management of injuries or permanent disability. PT helps to manage pain, promote healing from injury, restore function and movement, and reduce the symptoms of many chronic conditions and diseases.⁷ PT may be ordered by your primary care doctor for any pain that does not resolve with acute care or over-the-counter pain medication, such as post-surgical pain that lasts longer than expected.

Chiropractic Care

Chiropractic treatment involves spinal manipulation and other strategies to reduce pain and improve physical health.  Based on research documenting the effectiveness of chiropractic treatment, the American College of Physicians recommends spinal adjustments as a leading strategy to manage low back pain. In addition to performing spinal manipulations, chiropractors provide education and guidance concerning healthy posture, ergonomics, and body mechanics.⁸

Massage

Therapeutic massage has been shown to relieve pain by relaxing painful muscles, tendons, and joints.  Massage also relieves stress and anxiety, helping people to relax and sleep better, leading to improved healing.⁹ Massage can be done with a variety of pressures to your comfort level and assist in releasing stiffness in muscles.

Acupuncture

A form of traditional Chinese medicine, acupuncture involves inserting very thin needles through the skin at specific points on the body. Practitioners believe the needles help to open up and rebalance energy channels in the body. While this perspective does not translate to Western medicine, studies show that acupuncture is effective in relieving pain.¹⁰

Dietary Changes

Altering your nutrition may help reduce pain. Elimination diets for pain target foods associated with inflammation, such as processed sugar and high amounts of carbohydrates. Various dietary and nutritional strategies have been associated with improved management of chronic pain for different medical conditions.¹¹ Before making significant dietary changes, consult your doctor. Work with a registered dietician (RD) or registered dietician nutritionist (RDN) for evidence-based guidance to meet your specific nutritional and pain management needs.

Cognitive Behavioral Therapy 

Cognitive behavioral therapy (CBT) involves practical techniques to reduce stress and improve daily functioning. This approach teaches coping strategies and relaxation techniques to deal with pain in a healthy way.²

Hypnosis

Hypnosis is a set of techniques designed to improve concentration, minimize mental distractions, and implant “suggestions” to change thoughts, feelings, behavior, or one’s physiological state. Research shows that hypnosis is effective in managing acute and chronic pain in a variety of conditions, including burns, childbirth labor pain, headache, backache, fibromyalgia, and cancer-related pain.¹²

Biofeedback

Used in medical centers, physical therapy clinics, and hospitals, biofeedback devices receive information from electrical sensors attached to a person’s body. Depending on the type of device, biofeedback monitors brain waves, heart rate, breathing, blood pressure, skin temperature, sweating, or muscle activity. Studies show that biofeedback may help manage many different physical and mental health conditions, including chronic back pain, fibromyalgia, headache, and irritable bowel syndrome (IBS).^13,14

Mindfulness Training

While the mechanisms of how mindfulness affects brain and body functioning are not well understood, mindfulness meditation is effective in treating both physical pain and mental health issues. Studies indicate that mindfulness meditation relieves pain for a variety of conditions, including chronic pelvic pain, migraine, fibromyalgia, and irritable bowel syndrome. Mindfulness practices have also been shown effective in helping people manage anxiety, stress, and depression, all of which are linked to an increase in physical pain symptoms.¹⁵

Deep Breathing Exercises

Exercises that involve consciously bringing your awareness to your breathing to relax the mind and body can ease symptoms of perceived pain. It also distracts the mind from overly focusing on the pain.¹⁶ Deep breathing exercises may be combined with mindfulness exercises.

Yoga

Yoga combines movements, stretches, and muscle strengthening with breath control and meditation. There are a variety of yoga practices, including practices focusing solely on grounding and breathing techniques to practices targeting stretching and strengthening of targeted muscle groups. Studies show that yoga can help people manage many types of chronic pain, including arthritis, fibromyalgia, migraine, low back pain, and osteoporosis.¹⁷

Qi Gong

Qi gong is an ancient art rooted in traditional Chinese medicine. Qi Gong exercises develop balance and resiliency, build strength and flexibility, and can release tension and relieve pain.¹⁸

Whether you don’t tolerate opioids well, are considering your pain management options after your prescription ends, or don’t want to risk opioid dependence, there are non-narcotic pain medications and treatment options available.¹⁹ Speak with your doctor about which options may be best for you.

For more information on recovering from a substance use disorder, including non-narcotic treatment options, call 800-934-1582(Who Answers?) to learn about recovery options.

References

1. Rosenblum, A., Marsch, L. A., Joseph, H., & Porten­­oy, R. K. (2008). Opioids and the Treatment of Chronic Pain: Controversies, Current Status, and Future Directions. Experimental and Clinical Psychopharmacology, 16(5), 405–416.
2. Finnerup, N. B. (2019). Nonnarcotic Methods of Pain Management. New England Journal of Medicine, 380, 2440-2448.
3. Substance Abuse and Mental Health Services Administration. (2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health.
4. National Institute on Drug Abuse. (2017). Mind Matters: The Body’s Response to Opioids.
5. National Institutes of Health. (2016). The Use of Complementary and Alternative Medicine in the United States.
6. Pelletier, K., & Astin, J. (2002). Integration and reimbursement of complementary and alternative medicine by managed care and insurance providers: 2000 update and cohort analysis. Alternative Therapies, 8(1), 38-48.
7. American Physical Therapy Association. (2021). Benefits of Physical Therapy.
8. Harvard Health Publishing. (2021, February 15). Chiropractic care for pain relief. Harvard Medical School.
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10. National Institutes of Health. (2011). Understanding Acupuncture. NIH News in Health.
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12. American Psychological Association. (2004, July 2). Hypnosis for the Relief and Control of Pain.
13. Sielski, R., Rief, W., & Glombiewski, J. A. (2017). Efficacy of Biofeedback in Chronic back Pain: a Meta-Analysis. International Journal of Behavioral Medicine, 24(1), 25-41.
14. Mayo Clinic. (2021, March 18). Biofeedback.
15. Zeidan, F. & Vago, D. (2017, June 1). Mindfulness meditation–based pain relief: a mechanistic account. Annals of the New York Academy of Sciences, 1373(1), 114-127.
16. Busch, V., Magerl, W., Kern, U., Haas, J., Hajak, G., & Eichhammer, P. (2012). The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing―an experimental study. Pain Medicine, 13(2), 215-228.
17. Harvard Health Publishing. (2021). Yoga for pain relief.
18. Vincent, A., Hill, J., Kruk, K. M., Cha, S. S., & Bauer, B. A. (2010). External qigong for chronic pain. American Journal of Chinese Medicine, 38(4), 695-703.
19. Prater, C. D., Zylstra, R. G., & Miller, K. E. (2002). Successful Pain Management for the Recovering Addicted Patient. Primary Care Companion to the Journal of Clinical Psychiatry, 4(4), 125–131.