Reducing long-term pain without opioids

About one in five Americans suffer from some form of long-term pain. Opioids are medications used to help ease this type of pain. Opioid misuse is a major problem. In 2018, almost 70% of drug overdose deaths involved an opioid.

While lower doses of opioids can help people cope with short-term pain, long-term use can lead to dependency, undesirable results and negative side effects. In this article, we talk about other ways to handle long-term pain.

What is chronic pain?

Chronic pain is any pain that lasts longer than expected. Chronic pain usually cannot be handled with the first care given. Common sources of chronic pain include:

• Arthritis
• Cancer
• Nervous system problems
• Low back pain
• Headaches
• Post-traumatic stress disorder (PTSD)
• Anxiety
• Depression

Pain is a natural part of life, and your chances of having long-term pain go up as you age. While getting rid of all pain is often not possible, there are ways to manage your pain without using opioids. The specialists at The Polyclinic can help. 

10 ways to handle pain 

Here are 10 ways to handle pain:

• Exercise
• Environment
• PRICE
• Medication
• Lumbar braces
• Acupuncture 
• Trigger point injections
• Ultrasound-guided injections 
• Epidural steroid injections
• Radiofrequency nerve ablation (RFA)

Exercise 

Our physical therapists (PTs) can work with you to create an exercise program just for you. “It’s not about exercise for fitness; it’s about exercise to solve a problem,” said Dechie Bello-Rapoport, a Polyclinic physical therapist. 

PTs teach patients exercises in the clinic as well as how to practice those exercises at home. “We teach patients ways to move that help ease pain,” said Bello-Rapoport.

Environment

Your environment — the places where you live and work — affect how you move in your daily life. For example, repeatedly doing an activity incorrectly or with the wrong equipment can be a major cause of discomfort and injury. 

Our physical therapists can help you with posture and ergonomics (how to move correctly) to help lessen injuries. They can also suggest equipment that may include running shoes, a desk chair or a bicycle. 

“We are like detectives in simulating the environment that causes the patient’s pain,” said Bello-Rapoport. After meeting with you, the PT teaches you correct and less harmful ways to do your work or sport to help stop you from getting hurt again. 

PRICE

“The most important way to manage sudden and serious pain is to reduce swelling,” says Dr. Jeremy Johnson of The Polyclinic’s sports medicine department. “The acronym PRICE will help you remember how to do this.”

PRICE stands for: 

• Protection — Protect the injured area from weight-bearing activity with a splint, crutch, walking boot or scooter.
• Rest — Don’t do activities that cause pain.
• Ice — 20 minutes on, then 30 minutes off.
• Compression — Bandages can help stop swelling.
• Elevation — Keep your legs above your hips and your arms above your heart.

Medication 

Antidepressants can help stabilize the emotional response to pain. This can help other types of care have better results. 

“Centrally acting antidepressants can be effective for treating chronic low back and knee pain, neuropathic pain and fibromyalgia in many patients,” said Diana Ferdana, nurse practitioner in The Polyclinic’s physical medicine department.

Lumbar braces

Many patients who seek care in physical medicine complain of chronic lumbar back pain. Even after trying nonsurgical interventions, patients may still have pain in the lower back when doing some activities, such as vacuuming, washing dishes or cooking a meal. 

A medical-quality lumbar brace can make a difference in how well you can move and in your quality of life. Lumbar braces should be medically fitted and used only as instructed by your doctor so you don't weaken your core and lumbar muscles.

Acupuncture

Acupuncture is a form of traditional Chinese medicine often used for treatment of pain. It involves inserting ultrathin, flexible needles into the skin in key places, such as:

• Where nerves enter muscle
• At the midpoint of a muscle
• Where muscle connects to bone
  

“Acupuncture can play a complementary role in reducing pain symptoms,” said Diana Ferdana, nurse practitioner, who treats patients with acupuncture at The Polyclinic.

Trigger point injections

A trigger is something that causes a bad response. Another way to help with pain is having an injection into a specific site if the pain source is concentrated in the muscle or a set of muscles that have tender trigger points. 

Trigger point injections sometimes have a numbing agent, such as lidocaine. After the injection, the trigger point becomes inactive and there is less pain. Some people never have pain again. Some people may need ongoing therapy with repeated injections.

Ultrasound-guided injections 

An ultrasound uses sound waves to form pictures of the inside of the body. After determining the most likely cause of pain, your provider may suggest an ultrasound-guided injection. 

This treatment is an injection with corticosteroid into the sac-like cavity between tissue where friction takes place. It can often help lessen the pain caused by inflammation resulting from muscle weaknesses or osteoarthritis. 

If your pain is caused by an unhealthy tendon, your provider may suggest you try platelet rich plasma (PRP) or dry needling. These procedures direct your body’s own growth factors and inflammatory mediators to the tendon that's not working well. 

Epidural steroid injections

Epidural steroid injections often help with radiating pain, such as neck pain that travels to the arms or lower back pain that extends into the legs. The shot will be given in a specific area around your spine.   

This can lessen the inflammation causing the pain. A single injection can provide long-term help for pain. Sometimes no more treatment is needed. 

Radiofrequency nerve ablation (RFA)

Another effective treatment for some types of neck and lower back pain is radiofrequency nerve ablation. Dr. Pearl Ren uses this nonsurgical method to block the delivery of pain signals to the brain. 

RFA uses heat generated by radio waves to find and burn off specific nerves that are causing pain. The nerves will grow back over time, but patients are often pain free for up to three years.

Make an appointment

The Polyclinic’s musculoskeletal department includes providers from related specialties who often work together to help patients with pain, including:

• Orthopedics
• Sports medicine
• Physical medicine
• Physical therapy
• Podiatry
• Rheumatology (care for bones, muscles and joints)

Sources

• Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. Accessed November 23, 2020.
• Centers for Disease Control and Prevention. Opioid Basics. Accessed November 23, 2020. 

The information provided is for general informational purposes only and is not intended to be medical advice or a substitute for professional health care. You should consult an appropriate health care professional for your specific needs.