Alternatives to Opioids

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Advantages to Opioid Alternatives

Disadvantages to Opioid Alternatives

Non-Opoiod Medications

Acetaminophen (tylenol) — Relieves mild–moderate pain, and treats headache, muscle aches, arthritis, backache, toothaches, colds and fevers.

* Overdoses can cause liver damage.

Non-steroidal anti-inflammatory drugs (nSaids): Aspirin, Ibuprofen (Advil, Motrin), Naproxen (Aleve, Naprosyn) — Relieve mild–moderate pain, and reduce swelling and inflammation.

* Risk of stomach problems increases for people who take NSAIDs regularly. Can increase risk of bleeding.

Nerve Pain Medications: Gabapentin (Neuraptine), Pregabalin (Lyrica) — Relieve mild–moderate nerve pain (shooting and burning pain).

* Side effects include: drowsiness, dizziness, loss of coordination, tiredness and blurred vision.

Antidepressants: Effexor XR, Cymbalta, Savella — Relieve mild–moderate chronic pain, nerve pain (shooting and burning pain) and headaches.

* Depending on medication, side effects can include: drowsiness, dizziness, tiredness, constipation, weight loss or gain.

Medicated creams, Foams, Gels, lotions, ointments, Sprays and Patches: Anesthetics (Lidocaine), NSAIDs, Muscle Relaxers, Capsaicin, Compound Topicals — Can be safer to relieve mild-moderate pain because medication is applied where the pain is. Anesthetics relieve nerve pain (shooting and burning pain) by numbing an area; NSAIDs relieve the pain of osteoarthritis, sprains, strains and overuse injuries; muscle relaxers reduce pain by causing muscles to become less tense or stiff; and capsaicin relieves musculoskeletal and neuropathic pain. Compounded topicals prepared by a pharmacist can be customized to meet a patient’s specific needs.

* Skin irritation is the most common side effect. Capsaicin can cause warmth, stinging or burning on the skin.

Interventional Pain Management: Includes anesthetic or steroid injections around nerves, tendons, joints or muscles; spinal cord stimulation; drug delivery systems; or permanent or temporary nerve blocks. Medicates specific areas of the body. Can provide short-term and long- term relief from pain.

* Certain medical conditions and allergies can cause complications.

Non-opioid anesthesia: Opioids can be replaced with safer medications that block pain during and after surgery. A health care provider or an anesthesiologist can provide options and discuss side effects.

Alternative Therapies

Advantages to Alternative Therapies

Disadvantages to Alternative Therapies



Cold and heat: Ice relieves pain and reduces inflammation and swelling of intense injuries; heat reduces muscle pain and stiffness. Can provide short-term and long-term relief from pain.

* Too much heat can increase swelling and inflammation.

Exercise and movement: Regular exercise and physical activity can relieve pain. Simply walking has benefits. Mind-body practices like yoga and tai chi incorporate breath control, meditation and movements to stretch and strengthen muscles.

* Maintaining daily exercise and overcoming barriers to exercise can be a challenge.

Rehabilitation Therapies

Occupational therapy: Occupational therapists* treat pain through the therapeutic use of everyday activities. Can relieve pain associated with dressing, bathing, eating and working. Therapy includes activities that increase coordination, balance, flexibility and range of motion.

* Therapy interventions and recommendations will not help if the patient does not practice as instructed.

Physical therapy: Physical therapists* treat pain by restoring, enhancing and maintaining physical and functional abilities.

* Therapy interventions and recommendations will not help if the patient does not practice as instructed.

Behavioral and Mental Health therapies

Psychiatrists*, clinical social workers*, marriage and family therapists* and mental health counselors* provide therapies that identify and treat mental disorders or substance abuse problems that may be roadblocks to pain management. When used to manage pain, these therapies can take time.

Complementary Therapies

Acupuncture: Acupuncturists* insert thin needles into the body to stimulate specific points to relieve pain and promote healing. Can help ease some types of chronic pain: low-back, neck and knee pain, and osteoarthritis pain. Can reduce the frequency of tension headaches.

* Bleeding, bruising and soreness may occur at insertion sites.

Chiropractic: Chiropractic physicians* practice a hands-on, approach to treat pain including manual, mechanical, electrical and natural methods, and nutrition guidance. Can help with pain management and improve general health.

* Aching or soreness in the spinal joints or muscles sometimes happens—usually within the first few hours after treatment.

Osteopathic Manipulative treatment (OMt): Osteopathic physicians use OMT—a hands-on technique applied to muscles, joints and other tissues—to treat pain. Clinically-proven to relieve low-back pain.

* Soreness or stiffness in the first few days after treatment is possible.

Massage therapy: Massage therapists* manually manipulate muscle, connective tissue, tendons and ligaments. Can relieve pain by relaxing painful muscles, tendons and joints. Can relieve stress and anxiety—possibly slowing pain messages to and from the brain.

* At certain points during a massage, there may be some discomfort—especially during deep tissue massage.

Transcutaneous electrical nerve stimulation (tens): TENS is the application of electrical current through electrodes placed on the skin with varying frequencies. Studies have shown that TENS is effective for a variety of painful conditions. The intensity of TENS is described as a strong but comfortable sensation.

* Allergic reactions to adhesive pads are possible.

Sources: American college of Surgeons, centers for disease control and Prevention, national institutes of Health, the Food and drug administration, Harvard Health and Wexner Medical center (ohio State University)