No one wants likes being in pain, but fears about opioid addiction might make you feel there are no good ways to relieve it.
There’s a full menu of ways to address pains without opioids, says Anthony Karam, DO, an interventional pain medicine specialist with the Hartford HealthCare Ayer Neuroscience Institute in Milford and Westport.
“Therapeutic measures won’t change anatomically what’s going on in there. But there are many ways to ease the pain and help patients get back to the things they enjoy doing in life,” says Dr. Karam.
Why not opioids?
Opioid pain medications often leads to tolerance, which means you need an increasingly higher dosage to achieve the same effect. And the resulting dependence has resulted in more addiction and an “opioid epidemic” across the country.
“Opioids are extremely powerful medications and definitely have their place in our arsenal of weapons for managing pain. But many patients who are on these medications for long periods of time develop dependence, tolerance and, in some cases, full-blown addiction,” he says.
Opioids also have unwanted side effects, including constipation, respiratory depression and sedation. This can be problematic for a number of patients, Dr. Karam adds.
“The question for physicians becomes ‘Are you really helping them by giving them opioids or are you doing them a disservice down the road?’”
What else works?
There are alternatives to opioid for pain management, and Dr. Karam uses a conservative approach.
“We will basically exhaust everything before progressing to more invasive procedures,” he says.
Some options include:
- Interventional procedures. This ranges from epidural injections, facet blocks and peripheral nerve blocks to more invasive procedures like spinal cord stimulation implants, minimally invasive lumbar decompressions, and peripheral nerve stimulation. Pain management technology is constantly progressing and changing with new procedures being developed all the time, Dr. Karam says.
- Medication. Non-opioid medication options includes topical agents like anti-inflammatory creams or lidocaine cream/gel along with oral medications like those used for nerve pain, muscle relaxants, anti-inflammatories or acetaminophen. The location and characteristics of the pain might determine which approach works best. “Topical agents are good on the knees and shoulders because they penetrate the skin and help with arthritis pain,” Dr. Karam says. “Lidocaine patches desensitize an area so they can help with muscle and sometimes nerve pain.”
- Movement. Yoga, massage therapy, physical therapy and low-impact aerobic exercise can all help ease pain.
It hurts to move, but it hurts more not to.
In speaking with his patients, one of Dr. Karam’s most consistent suggestion is to move more, even though chronic pain might make them want to rest.
“In patients with long-term pain, I ask them what they’re doing to move,” he says. “Inactivity can make you feel worse.”
Moving regularly – even just a short walk – is a daily must. Understand, Dr. Karam says, that it might feel worse before it starts to feel better.
“Stick with it because the reward is going to be worth it!”