Alternatives to Opioid Medications

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Chronic pain can be a severe and debilitating condition, which can lead to a decrease in the ability to function and poor quality of life. Chronic pain comes in many forms and from many different conditions and causes. It can come from nerve injury, spinal cord or brain injuries causing neuropathic pain, low-back pain, and pain from inflammation or arthritis (just to name a few!).

Did you know?

There has not been shown to be a difference nor benefit to taking opioids over non-steroidal anti-inflammatory (NSAID) drugs, such as ibuprofen, for long-term pain relief or to improve physical functioning. In fact, there were greater risks to taking opioids over NSAIDs with an increased risk of addiction and side effects, such as vomiting, without any added benefits or long-term relief.

Alternatives:

Physical Therapy

  • Physical therapy is recommended by the Center for Disease Control (CDC) to improve pain in patients with long-term and chronic pain.
  • Exercise and strength training can improve function in low back pain and improve overall wellbeing. Also, improvements for physical therapy for knees and hips have been shown to last at least 2 to 6 months.
  • Physical therapy provides a space to focus on strengthening muscles around the injury or the injured area itself to provide a better quality of life. In addition, it provides a time to focus on what helps and hurts your injury.
  • Physical therapists can help show you ways that you can change in your daily life to help you live with less pain.

Dry Needling

  • Dry needling, or what is commonly known as acupuncture, is a part of Chinese traditional medicine.
  • It can be combined with electric nerve stimulation to provide additional benefits in pain relief and deeper stimulation of the muscles.
  • The needling stimulates the muscles to contract and release providing pain relief. In addition, the twitch in the muscle is proposed to increase blood flow to the area of pain and change how the muscles react to create the pain response in the body.
  • Medical dry needling is done by a trained professional. Many physical therapy offices provide dry needling in addition to the nerve stimulation.

Magnesium Supplements

  • NMDA receptors are found throughout our body and are known to be connected to multiple types of pain. Many pain medications turn off these receptors, so you do not feel the pain in your body.
  • Magnesium has also been known to turn these receptors off. This results in pain relief.
  • Magnesium has been shown to play a role in acute and chronic pain relief, especially with:
    • menstrual cramping
    • headaches
    • migraine relief
    • neuropathic pain
  • Additionally, magnesium could may help provide relief from post-herpetic neuralgia (recurring pain after shingles episode), diabetic neuropathies, and pain associated with chemotherapy.
  • You should always discuss using magnesium with your pharmacist or doctor before starting magnesium or any over the counter medications.

 

References:

Coutaux A. Non-pharmacological treatments for pain relief: TENS and acupuncture. Joint Bone Spine. 2017;84(6):657-661.

 

Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016; 65(1):1–49.

Na H, Ryu J, Do S. The role of magnesium in pain. Vink R, Nechifor M, eds. Magnesium in the central nervous system. [Internet]. Adelaide (AU):University of Adelaide Press; 201. https://www.ncbi.nlm.nih.gov/books/NBK507245/ Accessed 6/18/19.

Vickers AJ et al. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The Journal of Pain. 2018;19(5):455-474.

 

Mary Moore, PharmD Candidate 2020
Leighton Thumm, PharmD Candidate 2020

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