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What can I expect from pain management treatment?
The overriding requirement for successful pain management is diagnosis and treatment of the cause of the pain.
Treatment of comorbidities is also necessary to manage chronic pain, including treatment for: anxiety, depression, PTSD, Substance Use Disorder obesity, sleep Apnea, insomnia, and Dental disease. Mental resiliency is improved with education about the likely healing process, expected prognosis and recovery period along with knowing if further tissue damage is not expected.
What can I do to help chronic pain without opioids?
Effective pain management is delivered in most cases without opioids. Adequate nutrition, sleep, exercise and community support improve the ability to tolerate chronic pain.
Outpatient programs like Recovery Road help patients understand and practice coping strategies to improve resiliency to chronic pain increasing function and reducing the need for dangerous pain medication.
Cognitive Behavioral therapy provides training in behavioral techniques modifying situational factors and cognitive processes that exacerbate pain, reducing disability and catastrophic thinking. Exercise therapy also has been shown to reduce pain and improve functioning in chronic lower back, hip, and knee pain as well as improve wellbeing and symptoms in Fibromyalgia.
Multimodality treatment is effective in reducing chronic pain through the use of PT, psychotherapy, group counseling, Biofeedback or relaxation training, movement therapy, manipulation, Acupuncture, nutrition education, medications, injections, surgery, spine interventions (such as epidurals) or intrathecal pain pump.
NSAIDS (non steroidal anti-inflammatory drugs) effectively reduce musculoskeletal pain and the inflammation causing the pain.
Some Anticonvulsants and tricyclic antidepressants and SNRIs (selective serotonin norepinephrine reuptake inhibitors) effectively reduce neuropathic (pins and needles, burning, phantom) pains.
Herbal preparations such as Curcumin are also effective in reducing pain.
What are my alternatives if my pain cannot be effectively treated without opioids?
Usually these methods are adequate to provide enough pain relief to maintain adequate independent function.
Unfortunately sometimes we cannot use these methods (for example we would not treat pain with NSAIDs in a person with worsening kidney function to prevent further harm to the kidneys).
If non opioid methods are insufficient to allow independent function or likely to cause more problems, then use of low dose opioids or lower risk opioids such as buprenorphine can assist with pain control. Buprenorphine is also a good choice for pain management if the risk of abuse of the opioid is high for a particular person.
What are the risks of taking opioids for pain management?
Unfortunately chronic opioid use sometimes leads to tolerance (reduced effectiveness of the opioid) and dependence (withdrawals if the opioid is abruptly discontinued) and sometimes Substance Use Disorder (compulsive use despite harm). Risk of overdose from opioids increases gradually with increasing dose and increases by an order of magnitude when combined with benzodiazepines. Higher doses of opioids are associated with a higher rate of overdose, fractures, cardiovascular events, endocrinological harm, and road trauma.
A person is at increased risk of overdose from opioid use if that person has obstructive sleep apnea, or sleep disordered breathing, renal or hepatic insufficiency, is of older age, is pregnant, has a mental health condition, or has an alcohol or other substance use disorder. No evidence shows a long term benefit of high dose opioids on pain and function. We have extensive evidence of possible harms of opioids (opioid use disorder, overdose, Motor vehicle injury) and extensive evidence suggesting some benefits of non-pharmacologic and non-opioid pharmacologic treatments of pain.
The rate of opioid prescriptions has fallen but the rate of opioid overdoses has not.