PAIN RELIEF WITHOUT OPIOIDS

Most doctors and other experts agree: Opioids should be a last resort for managing pain. Here are some of the alternatives to opioids that many patients find effective.

HIGH-TECH TREATMENTS

Transcranial magnetic stimulation, which uses a machine to apply magnetic fields to the head to stimulate brain cells, has shown in studies to help with certain types of painful nerve conditions. In addition, cervical spine stimulation, which sends small jolts of electricity to the spine, has been shown to be helpful for some types of arm and back pain. Researchers are exploring new ways of applying energy to different types of chronic pain. “Researchers are always working on new, non-pharmaceutical, noninvasive techniques to help with pain,” says John Kelly, a professor of addiction medicine at Harvard Medical School.

Kelly adds that genetic tests currently under development may in the coming years help doctors do a better job of matching the right drug or treatment to individual patients—including identifying patients who may be candidates for short-term opioid prescriptions without much risk of dependence or addiction.

PHYSICAL TREATMENTS

Physical therapy, in which patients are directed to move in particular ways, often against resistance, can help with a variety of painful conditions, especially those involving musculoskeletal problems that cause back, neck or limb pain. Massage therapy helps many patients as well, even providing a feeling of well-being for some. Acupuncture can help, too, with studies suggesting the insertion of fine needles may interrupt nerve pathways that carry pain.

EMERGING MEDICATIONS

Sixteen new non-opioid pain-relief drugs are currently in phase III trials, which means some of them could come to market in the next few years, and some may be available now to patients willing to be part of a trial. In addition, eight new pain-relief drugs based on cannabis-derived compounds are currently in phase III trials. Another highly experimental drug, AT-121, isn’t as far along the testing pipeline, but early studies show that it may ease pain and help with opioid addiction recovery. Researchers are also looking into the pain-relief properties of herbal medicines. The FDA has announced that it is working with drug developers to try to bring more new non-opioid pain relievers to market as quickly as possible.

OVER-THECOUNTER DRUGS

The most common treatment for all types of pain is one of the many nonsteroidal anti-inflammatory drugs (NSAIDS), including ibuprofen, Naproxen and Celecoxib. Different NSAIDS often work better for different types of pain, such as headaches, back pain or surgical pain, and they also sometimes come as skin patches or gels for more targeted and longer-lasting relief. Studies indicate that while NSAIDS don’t provide the feeling of well-being and comfort that opioids do, they can equal or even exceed opioids’ ability to reduce pain. NSAIDS are often combined with Tylenol, and in some cases with muscle relaxants, anti-seizure medications or antidepressants, all of which have been shown to help with some types of pain. Injectable nerve blockers can provide extra relief for extreme pain that’s localized.