Alternative Pain Treatments: Part 1

Doctor explaining prescription to patients

We read statistics on opioid use disorder every day when covering the crisis. According to a study published earlier this year in the New England Journal of Medicine, one in 48 patients receiving an opioid prescription becomes a long-term opioid user, and four in five new heroin users starts out by misusing prescription opioids, according to the American Society of Addiction Medicine.

While opioids have reigned supreme in recent years for pain treatment, as our research shows, they are just one way way of dealing with pain. This week, we’ll take a look at over-the-counter pain medication and other drugs like marijuana. Next week, look for our blog exploring non-drug options for pain treatment like physical therapy, Cognitive Behavioral Therapy, virtual reality, and more.

Over-the-counter pain medication

It has been shown that opioid addictions can start when undergoing treatment for short-term pain. Additionally, the use of opioids during short-term treatment has increased in the past few years. To avoid the risk of addiction, researchers have explored using Tylenol and Ibuprofen for pain rather than opiates. A study in the Journal of the American Medical Association found that on patients with broken bones and sprains, acetaminophen and ibuprofen worked as well as opioids at reducing severe pain.

During the study, patients were given acetaminophen (the main ingredient in Tylenol) in addition to either ibuprofen or one of three opioids: oxycodone, hydrocodone, or codeine. The patients were not told which combination they received. When asked to rate their pain, there were negligible differences between the groups. Most began with a pain rating of 8-9, and afterwards reported an average of 5. Dr. Andrew Chang, an emergency medicine professor at Albany Medical College in upstate New York, led the study. He notes that a pill combining ibuprofen and acetaminophen affects different pain receptors in the body, and can be highly effective. Pills that combine the two drugs are not yet available in the United States, and it’s also important to note that this study only looked at short-term pain relief in the emergency room.

Using ibuprofen and acetaminophen may not be ideal for long term use, according to Good Rx. NSAIDs (which includes ibuprofen, naproxen, and aspirin), are often the “first line of defense” for pain. However, long term use could lead to stomach and intestinal pain and bleeding. Acetaminophen is often used for treating pain for headaches, arthritis, and cancer pain, but can lead to liver damage/failure with prolonged use.

Other prescription medications

Tricyclic antidepressants has evidence for treating pain, especially nerve pain, reports Good Rx. Serotonin and Norephinephrine Reuptake Inhibitors could also treat nerve, muscular, and skeletal pain. Anti-epileptic medications, such as Neurontin and Lyrica may be an effective painkiller as well. Steroids can also decrease inflammation, swelling, and pain for cancer, back injuries, arthritis, joint pain, and nerve pain. Taking low doses for short periods of time can help avoid common side effects, such as weight gain, high blood pressure, and weakened immune system. Some patients have also treated arthritis, muscle pain, and headaches with injections, through nerve, trigger point, radiofrequency, and epidural injections.

Matthew Becker, a scientist at the University of Akron, has developed a polymer mesh that can be coated with a non-opioid medication, and implanted in the body, as the Canton Rep reported just this week. The patient’s body would gradually absorb the medication, which allows doctors to target their pain treatment and reduce the use of powerful opioids. Becker states “You only need pain management for about three days, and after that, you can take Tylenol,”

Cannabis

While using cannabis (marijuana) to treat pain may have less “mainstream” approval than other treatments, a report by the National Academies of Science, Engineering, and Medicine shows that it can be effective in reducing neuropathic pain, a form of chronic pain that can cause damaged nerve endings.

Cannabinoids are seen by many doctors as actually “safer” than prescribing opioids, PBS reports. There are lower rates of addiction, and they don’t affect the brain stem. That means when using cannabis, your breathing and other basic life support functions are not affected, avoiding the risk of fatal overdoses. Dr. Jordan Tishler, who handled emergency medicine at the Boston VA,  states that most patients only need low doses of cannabis to treat chronic pain: “The amount they find relief with is nowhere near what laypeople recommend to each other or what recreational users take.”

Last month, Your Voice Ohio journalist Jordyn Grzelewski also explored marijuana’s role in pain treatment. As she writes, it is key to note there has been little official research in the United States on the effects of using cannabis to treat pain. Currently, marijuana is classified as a schedule 1 drug by the DEA, meaning that it is seen as having “no currently accepted medical use and a high potential for abuse”. Because of this, it’s difficult for scientists to test the drug through current government channels, which are currently focused on studying the potential abuse of marijuana and dangerous side effects rather than pain treatment.

Grzelewski also notes that using marijuana to treat pain may not solve the bigger issue of substance use, or abuse. She quotes Dr Joseph Sitarik of Neil Kennedy Recovery Center, who said he “does not think people in recovery can safely use marijuana because all substance use, whether it’s marijuana or an opioid, ends the same way: Dopamine release.”

Opioids are extremely potent when it comes to providing immediate relief from severe, acute pain, and these newer approaches still have a long way to go in terms of scientific research. Next week, we’ll look at non-drug ways of treating pain.