In a previous article, we talked about opioid use for pain relief and the risks opioids present. In this and future articles, we’ll discuss some alternative options. Because let’s face it, if you still have pain, you just want it gone.
Pain is exhausting, especially when it’s constant and long-lasting. It often zaps your energy, makes you cranky and just makes you want to withdraw from the world. That’s no way to live. For those who have pain but don’t want to take opioids, what are they to do?
Turns out there’s quite a bit. These alternatives include non-opioid medications, injections, surgery, anti-inflammatory diet, exercise, chiropractic &/or physical therapy, massage therapy, cognitive-behavioral therapy, stress management and acupuncture. In Part 2, we’ll talk about the allopathic (conventional or Western medicine) alternatives for pain relief: non-opioid medications, injections and surgery.
Non-Opioid Medications
There are over-the-counter medications like acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs), like Motrin or Aleve. A medical doctor can even prescribe these medications at higher doses, if appropriate. But keep in mind, all medications come with side effects. Even “safer” over the counter medications have their side effects.
Acetaminophen has been linked to liver damage and Non-Steroidal Anti-Inflammatories (NSAIDs) may increase risk of heart attack and stroke, as well as causing gastrointestinal distress, such as stomach ulcers and bleeding.1 Another thing to remember is that medications are just a temporary solution and do not generally treat the underlying cause of the pain.
Injections
There are several different types of injections for pain management, including steroid, trigger point, nerve block, prolotherapy and PRP (platelet rich plasma) injections.2 Injections have provided relief for many, but it doesn’t work for everyone. Likewise, some have lasting relief after one treatment, but others may need to repeat treatment when the pain returns, which may or may not continue to be effective.
Steroid injections deliver a strong anti-inflammatory solution to the area of the body in pain. They can be used for arthritis, joint pain, tendon pain and lower back pain and their effects can last from months to even years.
Trigger point injections deliver medication into a trigger point within the body. The injections can be some form of anesthetic, like lidocaine, a corticosteroid, or a mix of the two. These are often used to treat fibromyalgia, chronic headaches, and myofascial pain.
Nerve block injections work to decrease inflammation and/or block pain signals along a single nerve or group of nerves. Nerve blocks are used for back pain, acute & chronic pain.
Prolotherapy injections3 use the body’s own ability to heal itself. The injection contains a solution of natural substances that stimulates the growth and repair of affected tissues, thereby reducing pain and increasing range of motion. It’s most often used for sports injuries, arthritis, or back injuries including bulging discs.
PRP (Platelet Rich Plasma) injections use a solution of the patient’s own blood, which is separated, and a concentrated solution of platelets is injected back into the injured tissue to promote healing. This also uses the body’s own healing factors to stimulate cellular repair. PRP injections can be used for osteoarthritis and sports injuries. Scientific evidence is inconsistent, but shows promising results for some conditions (e.g. knee osteoarthritis and lateral epicondylitis).4
Surgery
Surgical interventions are usually a last resort, when other pain management methods have failed. Although, we have seen patients who have opted for surgery before giving conservative methods, like chiropractic or physical therapy, a chance to work. Sometimes, the promise of quick relief is worth it to people, compared to the time it takes for conservative methods to begin to work. However, it’s important to know that surgery is not always successful. Some patients experience full and lasting relief, others may get temporary relief, and still others may not see any improvement or may actually feel worse following a failed surgery.
Spinal surgery is performed to treat herniated or ruptured discs, spinal stenosis (narrowing of the spinal column that puts pressure on the nerves), spondylolisthesis (when one or more vertebrae shifts out of place), vertebral fractures, and degenerative disc disease. There are multiple types of back surgery. The following are the most common types we have encountered5:
Laminectomy is used to treat spinal stenosis. The surgeon removes the bony walls of the vertebrae and any bone spurs to open up the spinal column and remove pressure on the nerves.
Discectomy is used to remove a disc when it has herniated and is putting pressure on a nerve root or spinal cord. Laminectomy and discectomy are frequently performed together.
Spinal fusion is used to permanently connect two or more vertebrae in your spine, eliminating motion between them. This procedure is used to improve stability of the spine, correct a deformity or reduce pain, as in the case of severe arthritis or after removal of a herniated disc. When joints are fused, they no longer have the ability to move, which decreases overall mobility.
Spinal Cord Stimulation6 involves use of an implanted device that sends low levels of electricity directly into the spinal cord to relieve pain. Patients control the device using a remote when they feel pain. Spinal cord stimulation is most often used after nonsurgical pain treatment options have failed to provide sufficient relief. The mechanism behind this treatment is not fully understood, but it appears the electrical stimulation replaces the sensation of pain. Therefore, the brain senses the electrical stimulation, often a light tingling, instead of pain.
Many of these options for pain management are often used as a first resort by many medical professionals. And in some cases, these measures are necessary. However, we believe these should be used as a last resort. Mainly because the methods are either invasive or come with side effects that are inevitable when using exogenous, manufactured medications.
We believe when it comes to musculoskeletal pain, a round of conservative treatment should be your first step. It is far less invasive, with few if any negative side effects, and can oftentimes target the root cause of the pain better than conventional methods.
References:
1 Harvard Health Publishing. 10 Things You Should Know About Common Pain Relievers. https://www.health.harvard.edu/pain/12-things-you-should-know-about-pain-relievers
2 Comprehensive Spine & Sports Center. https://cssctr.com/blogs/view/injections
3 Hauser, R. A., Lackner, J. B., Steilen-Matias, D., & Harris, D. K. (2016). A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain. Clinical medicine insights. Arthritis and musculoskeletal disorders, 9, 139–159. https://doi.org/10.4137/CMAMD.S39160
4 Hussain, N., Johal, H., & Bhandari, M. (2017). An evidence-based evaluation on the use of platelet rich plasma in orthopedics – a review of the literature. SICOT-J, 3, 57. https://doi.org/10.1051/sicotj/2017036
5 American Society of Anesthesiologists. Back Surgery. https://www.asahq.org/whensecondscount/preparing-for-surgery/procedures/back-surgery/
6 Johns Hopkins Medicine. Spinal Cord Stimulator. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/treating-pain-with-spinal-cord-stimulators
