Pain Management and Opioid Addiction Prevention

A twisted ankle, stubbed toe, torn rotator cuff, or whiplash injury from a car accident can cause severe pain for many people.

12/23/20224 min read

A twisted ankle, stubbed toe, torn rotator cuff, or whiplash injury from a car accident can cause severe pain for many people. While it may be unpleasant at first, the wounded tissue recovers within a few weeks and the person can resume their normal activities. However, for some people, the pain persists even after the tissue has healed, and these patients suffer with chronic pain that will almost certainly never go away.

How can Chronic Pain be Managed in a Safe and Effective Manner? Is there a Place for Opioid Drugs in This?

Chronic pain is classified as a bio-psycho-social disorder. This suggests that pain is caused by more than just an injured tissue. Our psychologic and social circumstances also contribute to pain. When people are worried, they may experience anxiety and sadness, prompting them to avoid activities, causing even more stress and discomfort. A quarrel with a significant other, financial difficulties, or merely feeling lonely and alone, for example, can all exacerbate the agony. As a result, properly managing chronic pain necessitates a broader approach that includes assisting patients in controlling their mood and social situations.

What Therapeutic Alternatives are Available for Chronic Pain Management?

The CDC suggests starting with non-medication treatments for persistent pain. Non-pharmaceutical treatments for chronic pain include:

  • Physical therapy is a type of treatment that is used

  • Exercise

  • Yoga

  • Acupuncture

  • Aquatherapy

  • Chiropractic treatment

  • Massage

  • Ultrasound tens unit

  • Heat/ice

  • Supplements made from herbs

Working with a therapist to manage stress, anxiety, and depression can also help to reduce pain and improve overall quality of life. Even if the pain is still present, patients should engage in meaningful activities and interests. There are three types of therapy that have been shown to help people with chronic pain. You can also work with your therapist to develop goals to improve your quality of life using any technique.

Evidence-based treatments for chronic pain include:

1-Cognitive Behavioral therapy is the first step (CBT)

Patients are taught how to change their beliefs in order to improve their behavior by therapists. ex: "This ache now warns me that I'm overdoing it." I need to set a better pace for myself so that I can be active while managing my pain."

2- Use of Biofeedback

Patients are taught how to spot physical indicators of stress and anxiety, such as elevated heart rate, body temperature, and muscular tension, using electronic sensors attached to specific body locations, and how to respond to alleviate these symptoms.

3- Be Present in the moment

Using techniques like body scanning, progressive muscle relaxation, and meditation, teaches patients how to be present "in the moment" and slow down anxious thoughts.

Medications Available

Non-opioid drugs are the preferred treatment for chronic pain, according to the CDC. Many drugs that have been demonstrated to help with chronic pain can be recommended by your primary care doctor or psychologist.

Topical treatments such as lidoderm patches (which numb the area of discomfort), diclofenac gel (which acts as an anti-inflammatory), muscle relaxants, and steroid injections are available to many individuals (that also work as an anti-inflammatory).

SNRIs (venlafaxine and duloxetine), TCAs (amitriptyline and nortriptyline), and anti-epileptic drugs (gabapentin and pregabalin) are examples of pharmaceuticals that have been found to aid with both chronic pain and mood.

Is it Safe to Take Opioid Drugs for Chronic Pain?
Opioids (such as oxycodone/Percocet, hydrocodone/Vicodin, Dilaudid, morphine, codeine, fentanyl, and methadone) are not recommended as first-line or routine treatment for chronic pain, according to the CDC. Anti-inflammatory drugs, such as ibuprofen, have been proven in recent research to function equally as well as opioids in managing acute pain flares.

Only 44% of those taking opioids experienced pain alleviation of at least 50%, according to another study. This means that while opioid drugs may aid some people, they will have little effect on the majority of people.

Opioids all have negative side effects. The following are some of the most common opioid adverse effects:
  • Erectile dysfunction (ED) is a condition that affects men

  • GI symptoms include nausea and constipation.

  • Drowsiness

  • Sweating

  • Retention of urine

  • Suppression of respiration

  • Apnea (sleep deprivation)

Furthermore, our bodies become "accustomed to" these opioids over time, a process called as tolerance. That implies you'll soon stop experiencing pain relief and will require more and higher doses to achieve the same level of comfort. When used for more than a few weeks, your body becomes reliant on them. If you skip a dose, you'll have unpleasant withdrawal symptoms like as agitation/anxiety, nausea/vomiting/diarrhea, and sweating.

Addiction is also a possibility. In fact, 10% of patients who are taken opioids for chronic pain develop an addiction, in which they lose control of the prescription, it controls their lives, and has several personal and professional ramifications (losing trust of loved ones, losing a job, unable to take care of kids or fulfill daily adult responsibilities).

If your doctor decides to prescribe opioids for chronic pain, he or she will do so after carefully weighing the advantages and risks (also with an understanding that medications are only one small part of treating chronic pain).

If you're using opioids for chronic pain, you may need to stop taking other medications that interact with opioids and put you at danger of overdosing and death. You will be monitored on a regular basis to ensure that you are taking opioids safely and that you do not develop an addiction.

Signing a pain contract, frequent clinical visits, urine toxicological testing, pill counts, and having your doctor check the state's prescription monitoring program to ensure you're taking your prescriptions correctly are all common examples. In the event that you overdose, your doctor may prescribe the life-saving medicine naloxone.

Is it possible to utilize buprenorphine/naloxone (Suboxone) to treat chronic pain?

Buprenorphine (a partial opioid) is a pain reliever that is present in the medicine Suboxone. This is not, however, how it was intended to be used. Buprenorphine/naloxone (Suboxone) can aid individuals who have developed an opioid addiction by reducing cravings, withdrawals, and overdose.

Buprenorphine has a variety of different uses, including acting as a modest mood enhancer. While it is used to treat addiction as a type of drug for addiction therapy (MAT), it can also give pain relief and enhance mood. Other buprenorphine formulations (a patch and an under-the-tongue formulation) are used to treat pain rather than addiction.

Putting Everything Together

Chronic pain affects many sufferers on a daily basis. While a patient's pain will almost certainly never be "fixed," and they will always live with some level of discomfort, this does not mean they must suffer. "What would my life be like if my suffering didn't exist?" is a good question to ask yourself. Thinking about this subject can help you set goals for yourself that will make you happier even if you are still in pain.

There are a plethora of pain management options available. Many of them do not require the use of pharmaceuticals, and it will be critical for you to choose the best techniques for achieving your objectives. Opioids have numerous negative effects, are potentially dangerous, and can lead to addiction, overdose, and death. As a result, they aren't recommended as a first-line treatment for chronic pain.