How to safely manage chronic pain with and without opioids

Written by Dr. Kristy Deep, associate professor of internal medicine in the UK College of Medicine and co-chair of the UK HealthCare Opioid Stewardship Committee.

Treating pain is important, and for many people, the reliance on opioids or narcotics may not be the best answer.

The amount of opioids prescribed in the U.S. has quadrupled since 1999 despite the fact that the overall amount of pain reported hasn’t changed. There are also risks from opioid pain medicines, including side effects and the risk of overdose. According to some studies, as many as 1 in 4 people receiving prescription opioids long-term in a primary care setting struggle with addiction.

Chronic pain

Chronic pain, or pain that lasts longer than six months, is different than acute pain like the pain that comes from an injury. In chronic pain, there are changes in the way the brain “listens” to signals from the body. The goal in treating chronic pain is to help the brain interpret those signals in a different way so that the pain is less severe and does not impact a person’s quality of life.

New evidence and serious risks

New evidence shows opioid pain medications may not be the best answer for chronic pain. The risks of harmful side effects or addiction must be taken into consideration before prescribing or taking opioid pain medications.

In some cases of moderate to severe acute pain, such as after surgery or in the treatment of cancer pain, prescription opioids are important treatment options. However, it is important to remember the serious risks, especially if you have other medical conditions or are taking medications that can interfere with opioids. You should also work with your health care provider to make sure you are getting the safest, most effective care.

Controlling your pain

People often believe that they won’t be able to control pain without opioids, but non-narcotic medicines are often found to be better for providing pain relief. In short, if you suffer from chronic pain, many medications and non-medication treatments should be considered as an alternative to opioids.

The most important action you can take is to talk to your healthcare provider about ways to manage your pain that doesn’t involve prescription opioids – or keeps your dose as low as possible. Some of these options may actually work better and have fewer risks and side effects.

Options may include:

• Pain relievers such as acetaminophen, ibuprofen and naproxen.
• Some medications that are also used for depression or seizures.
• Physical therapy and exercise.
• Cognitive behavioral therapy – a psychological approach in which patients learn how to modify physical, behavioral and emotional triggers of pain and stress.

Important things to remember

However, if you are prescribed opioids and your doctor believes it is the best regimen for your pain, keep in mind some important tips:

• Never take opioids in greater amounts or more often than prescribed.
• Talk about ways to help manage chronic pain without prescription opioids.
• Talk about any concerns and side effects like sleepiness or constipation.
• Help prevent misuse and abuse by never selling or sharing prescription opioids.
• Never use another person’s prescription opioids.
• Store prescription opioids in a secure place and out of reach of others.

Next steps:

• Check out our post on the positive effects of using physical therapy to treat chronic pain.
• Read about our own Dr. Rae Brown, an anesthesiologist at UK HealthCare whose work has helped tackle the opioid crisis.