Is there an Alternative to using Opioids to treat Chronic Pain?

For the past 20 years, pharmaceutical companies, medical literature and the health care community have advocated the effectiveness and use of opioids in alleviating chronic pain.  However, recent reports in the media on the epidemic number of accidental overdoses and cases of opioid addiction have caused many health experts and the public to reverse their opinion on the widespread use of opioids for treating pain. This reversal in thinking about opioids is particularly concerning to persons suffering from chronic pain, many of whom have relied on opioid medications for years to manage their pain.  Although not all health experts agree that opioid medications are not the best option for alleviating pain, the question remains, ‘what alternative treatments are available to effectively manage pain?’

What is ‘Chronic Pain’?

Chronic Pain typically results after an acute injury or illness. When the pain from an illness or injury persists for more than six months, it is generally considered to be ‘chronic pain’.   However, chronic pain is, in many cases, more complicated than the pain that’s directly associated with an injury or illness and it often involves pain that persists after the initial injury has healed.

As well as the symptom of the pain itself, chronic pain is frequently associated with other symptoms or complications which can worsen the person’s pain and suffering.  The most common secondary complications include: difficulty sleeping due to pain; tiredness; frustration and impatience with minor problems; and difficulty coping.  It’s easy to understand that this combination of symptoms is related because the pain leads to trouble sleeping, which causes tiredness, which leads to impatience and so on.  Depression is also a not uncommon outcome for sufferers of chronic pain.  The resultant effect of these symptoms is a disabling condition which impacts a person’s home life, relationships and their ability to function at work and in other activities.

When a sufferer finds that their relationships and work ability are being undermined, they often suffer from stress, which worsens their difficulty sleeping and intensifies other symptoms causing a vicious circle of complications.  Stress can also, in itself, have a physical effect on the nervous system.  Stress can make the nervous system more reactive, which can further intensify the pain signals communicated to the brain.

For persons suffering from chronic pain after their initial tissue has healed, the nervous system often reaches a heightened state of reactivity which is characterized by a lower threshold for stimuli causing pain.  For a person with lower back pain, for example, this heightened sensitivity causes them to feel pain from simple movements that wouldn’t normally be painful, such as standing up or sitting down. The reason for this is that the nerves in the person’s lower back are increasingly sensitive so any stimuli is enough to result in pain.

Treatment for Chronic Pain

The health community currently faces a predicament in terms of what is the most compassionate and effective treatment for persons whose lives are impacted by chronic pain.  On a simplistic level, there appear to be two choices: physicians manage opioid use for persons with chronic pain, which exposes them to the risk of accidental overdose and addiction; or sufferers can be safe from addiction and overdose by not taking opioid medication, but potentially, must live with disabling and intolerable pain.  Both of these options appear problematic.

Medical professionals at the Chronic Pain Institute have proposed a third option for managing chronic pain: chronic pain rehabilitation.  Chronic pain rehabilitation has been proven to be effective, in years of studies, by teaching sufferers how to self manage their pain without taking opioid medications.

The idea of self-managing pain without opioid drugs faces an uphill battle in terms of acceptance.  For years, persons with chronic pain have been encouraged by doctors to take opioids, often despite the patient’s ambivalence about opioid use and a sense of sensitivity about reliance on these drugs.  Further, chronic pain sufferers have been told that it’s okay to take these drugs and they should not be ashamed of doing so, given the chronic and disabling nature of their pain.  Now, many medical professionals are asking patients to trust them when they say that taking opioids actually present a substantial risk.  Also, long-term sufferers are understandably afraid of being exposed to pain if they stop taking opioid medication and instead, participate in a pain rehabilitation program.    

Administrators at chronic pain rehabilitation clinics don’t believe patients should feel in any way ashamed of taking opioids – it’s entirely understandable why a person with long-term and debilitating pain would take opioid medication when it manages their pain and allows them to have a more normal life.  Rather, chronic pain rehabilitation providers encourage patients to self-manage their pain without opioids, and thus provide hope that they can take back control over their life, no longer governed by the effects of pain.

Chronic pain rehabilitation focuses on treatment of the nervous system and is aimed at ‘down-regulating’ the nervous system so that it is less reactive and acts on the normal threshold for pain.  Chronic pain rehabilitation involves interdisciplinary components including: training in cognitive-behavioural coping skills, mild aerobic exercise, relaxation therapies; exposure-based situational therapies; and using anti-depressants and anti-epileptics for pain. The various therapies are coordinated and implemented over weeks, often 3 to 4 weeks, until the patient has learned to apply them independently over the long-term.  

If you have been suffering from pain for a prolonged period that effects your activities and enjoyment in life, you may be a good candidate for chronic pain rehabilitation.  The following are among the conditions where sufferers may find that this treatment reduces their level of pain:  headaches (including migraine headaches), whiplash, musculoskeletal pain, fibromyalgia, degenerative disc disease, chronic back pain (including sciatica), herniated discs, phantom limb pain, peripheral neuralgia, spinal stenosis and scoliosis.

Sources:

www.instituteforchronicpain.org/understanding-chronic-pain/what-is-chronic-pain/chronic-pain-syndrome

www.instituteforchronicpain.org/blog/item/176-79is-it-time-to-talk-about-managing-pain-without-opioids

www.instituteforchronicpain.org/blog/item/165-68chronic-pain-rehabilitation

healthbound.ca/chronic-pain-program/