Pain, whether it is chronic, acute, breakthrough, referred, nerve pain, soft tissue pain, bone pain or phantom pain can be unbearable for many individuals. Physical pain can result in missed work and school and can take a toll on one’s social and home life. Physical pain, especially chronic pain is also highly linked to depression and therefore pain management is an important area of medicine. A common misconception regarding pain management is that pain is best treated with opioid prescriptions such as codeine, fentanyl, tramadol, oxycodone, hydrocodone, and morphine, however, prescription opioids are used for very specific types of pain such as cancer-related pain and acute post-surgical pain. Unfortunately, opioids are overprescribed and therefore overused resulting in abuse, addiction, and even death. There are many pain non-opioid pain medications that are efficacious and have a higher safety profile compared to opioids that are over the counter or can be prescribed at higher dosages without a dangerous addiction profile.
Non-steroidal anti-inflammatory medications
Non-steroidal anti-inflammatories commonly referred to, as NSAIDs are a class of medications that work to relieve pain and inflammation. A lot of pain is caused by swelling and inflammation. Medications such as Motrin, Advil, Excedrin, and Aleve can relieve a lot of pain without having the risk of addiction. Prescription NSAIDs include celecoxib, diclofenac, and naproxen. NSAIDs work by blocking the effect of enzymes called cyclo-oxygenase (COX) enzymes. COX enzymes help to make other chemicals called prostaglandins. Some prostaglandins are involved in the production of pain and inflammation at sites of injury or damage. NSAIDs can result in stomach ulcers and therefore it is best to talk to your physician before you start taking NSAIDs as long-term pain relievers or in high dosages.
Acetaminophen, commonly sold under the brand name Tylenol is an effective mild to a moderate painkiller. Although acetaminophen is not an anti-inflammatory, it can be taken together with an NSAID such as Motrin to help relieve pain and reduce inflammation. A recent study in the Journal of the American Medical Association showed opioids were also no more effective at reducing pain than combining non-opioids like acetaminophen and ibuprofen.
Tricyclic antidepressants, commonly called TCAs, are non-opioid prescription drugs that are used to treat pain. This class of antidepressants includes the following medications:
It is still unclear exactly how TCAs act in the body to reduce pain however it is believed that these antidepressants may increase neurotransmitters in the spinal cord that reduce pain signals.
Other antidepressants that can be used for pain relief include serotonin and norepinephrine reuptake inhibitors (SNRIs). Some SNRIs, such as venlafaxine (Effexor XR), duloxetine (Cymbalta) and milnacipran (Savella), may help relieve chronic pain. Individuals with chronic pain often develop depression along with their chronic pain. Venlafaxine and duloxetine offer the advantage of being effective for depression and anxiety at the same dosages useful for treating pain.
Alternatives to pharmaceutical pain relievers
Although there are many great (non-opioid) over the counter and prescription pain medications, there are additional alternatives to pain pills. These alternatives can be used in conjunction with pharmaceutical pain medications or can be used as a substitution.
- Acupuncture: The Eastern medicine approach aims to relieve pain by placing small needles at specific pressure points in the body.
- Physical therapy: A physical therapist can help strengthen muscles and tissues around the injured joint to relieve acute pain and prevent chronic pain. Physical therapy can be performed in a gym, in an office or at an individual’s home.
- Nerve blocks: Using imaging techniques, pain medicine physicians can inject numbing medication that blocks or dampens pain, and might even stop chronic pain from developing. The location of the injection depends on the source and type of pain. For example, blocking nerves in the neck can relieve pain in the arm or face. Relief may require a series of injections and repeated treatment.
- Steroid injections: Similar to nerve blocks steroid injections are often injected into the joint space to relieve arthritic pain. Common steroid injections include knee joint, shoulder joint and hip joint injections to relieve pain often caused by arthritic changes.
If you are in pain, regardless if it is acute or chronic, keep in mind that there are many other alternatives to prescription opioid pain medications. Opioids, are not bad per say and do work to relieve certain types of pain, but they come with a dangerous addiction profile and are often overprescribed when a non-opioid pain medication such as Aleve can help relieve the pain instead.