February 22

Non-narcotic (Non-opioid) Pain Management

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In this article, we will explore:
Physical Therapy
Psychological Therapy
Acupuncture
Spinal Manipulation
Herbal Treatments

Does anyone actually enjoy feeling pain? As much as we dislike it, pain protects us by acting as a warning when there’s something wrong with our bodies. However, when pain lasts for prolonged periods of time, it can be more of a nuisance than something to appreciate. 

Pain that lasts less than 3 months is known as acute pain. When pain persists for more than 6 to 12 weeks, it’s known as chronic pain. Chronic pain is a condition that affects many people on a daily basis, and signifies a deeper problem that should not be overlooked.

There are many types of pain one can experience. Nociceptive pain is associated with traumatic injury, musculoskeletal conditions, and any ischemic or inflammatory conditions. When medical or surgical treatments for these conditions fail, nociceptive pain can transition into chronic pain. 

Another type of pain is central sensitization, which affects the somatosensory system responsible for pain perception. Central sensitization results from the brain thinking that you’re experiencing more pain than what is actually happening. Neuropathic pain also involves a maladaptive response of the somatosensory system, where damage to a part of the nervous system results in increased or altered perceptions of pain. These different types of pain play a role in the transition from acute to chronic pain.

There are also specific risk factors associated with the development of chronic pain. These include biological factors like age and comorbidities. The more advanced the age, the more likely that acute pain will transition into chronic pain. Prolonged uncontrolled blood glucose or hyperglycemia can also damage the peripheral nerves which alter pain perception. 

Blood diseases like sickle cell disease and autoimmune inflammatory diseases can increase the risk of developing chronic pain. A previous diagnosis of any mental health disorder, high tobacco and alcohol use can also increase this risk. Lastly, the socioeconomic status of a person – such as where they live, their income level, any disabilities they have, as well as how easily they have access to health care, also act as risk factors for chronic pain. The lower their socioeconomic status, the higher the risk.

In America alone, approximately 11-40% of adults suffer from chronic pain. An estimate of $560 billion a year is spent on medical costs, productivity loss, and disability programs. Many adults seek professional help for chronic pain, as it greatly impairs their daily lives, makes them dependent on narcotics or opioids, and increases their anxiety and depression. Overall, those that suffer from chronic pain experience a lower quality of life.

When pain becomes chronic, its management often becomes multidisciplinary. This is because it now involves social, psychological and developmental contexts. A person’s emotions and expectations play a role in the outcomes of any management. For example, negative thoughts and expectations associated with how pain impacts everyday life – such as at a job, and in their relationships or family, can exacerbate the pain itself.

Most people with chronic pain either learn to live with it, or become dependent on medications that pose several risks. Aside from over-the-counter painkillers, opioids and narcotics are another class of drugs used for treating both acute and chronic pain. Some of the most commonly prescribed opioids include OxyContin and Vicodin, which come with risks like dependence and tolerance. Those that become tolerant to a drug, require more frequent and higher doses to feel the same effect.

At high doses, opioids may even lead to increased perceptions of pain. It’s use has also been associated with side effects such as dysphoria and euphoria. Hence, the line between medical pain relief and opioid addiction and abuse is still controversial and subject to strict regulations. To this day, there is a lot of uncertainty in the use of opioids as a long-term medication for chronic pain.

If you’re looking for alternative solutions, here are some non-narcotic pain management techniques you can try. 

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Physical Therapy

Exercise has shown to play an important role in improving health conditions, including chronic pain. Studies have found that low-level exercise with incremental increases in intensity benefits those that are experiencing chronic pain. As well, individuals that suffer from joint pain can try aquatic exercises like walking in water or performing water arm lifts. The American College of Physicians recommends specific structured forms of exercise like tai chi,  yoga, and progressive relaxation for chronic pain. 

If you are hindered by the fear of movement or exerting yourself, you can try stretching programs. This type of physical activity has also been proven to provide relief for those with chronic low back pain. Physical activity has a positive influence on the musculoskeletal system. It strengthens your muscles, increases your endurance, improves your balance and enhances your flexibility.

You may be wondering: how exactly does exercise relieve pain? As of today, there’s no specific mechanism that can explain why it improves symptoms of chronic pain. However, there are several physiological bases for it. One of these bases argues that exercise promotes the release of endorphins, which can reduce the perception of pain and even improve a person’s mood.  According to one study, exercise can also clear several inflammatory substances that exacerbate low back pain. Regular physical activity has also shown to be beneficial for the spine, by optimizing the metabolism of the intervertebral disc.

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Psychological Therapy

Besides physical benefits, exercise can also present psychological benefits. As chronic pain is a biopsychosocial problem, a person’s mindset also contributes to chronic pain management. Regular exercise can reduce stress and anxiety, providing chronic pain suffers with peace of mind.

Several psychological forms of therapy like cognitive-behavioral therapy (CBT) have been studied extensively as a treatment for chronic pain. During CBT, your thoughts and behaviors regarding pain can be addressed and analyzed. You become more aware of negative thoughts that may exacerbate painful symptoms.

Those that enroll in CBT are taught relaxation techniques and breathing exercises, as well as how to identify certain environmental triggers like situations or scenarios that exacerbate pain.

Sleep improvement is also an important factor to consider in CBT, as improvement in sleep can also help in reducing the severity of  chronic pain. People who undergo CBT feel less stressed because they can manage their pain better. For many participants, the main driving force behind these results is improvement in their mood. 

No CBT session is exactly the same. Your CBT sessions are unique and focused on helping you overcome specific personal problems. In fact, one of the best things about CBT is that you don’t even need to leave your home. There are forms of CBT that can be done over the internet, or through the telephone. This is especially beneficial for those that have difficulty travelling or moving around. 

Besides CBT, another psychological form of therapy you might consider is complementary and integrative health (CIH) therapy. This type of therapy focuses on mindfulness-based stress reduction, meditation, massage therapy, and biofeedback.

During mindfulness-based interventions, you learn about sitting, walking, and body scan meditations. During sustained mindfulness, you learn how to focus on different parts of your body one at a time. The program originated from Buddhist concepts that were eventually integrated into behavioral science. It lasts for 8 weeks, with 2.5-hour group sessions and an 8-hour “silent retreat”.

These types of interventions pose no adverse risks. We encourage anyone who suffers from chronic pain to try these psychological interventions. 

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Acupuncture

Acupuncture is a traditional Chinese medicine practice that makes use of the principle of yin and yang – positive and negative energy. Needles are used to target pressure points in the body to release stress, tension, and negative energy.

As the Chinese believe that pain and illnesses stem from blockages in energy, releasing these blockages through acupuncture can restore a person’s health. From a scientific standpoint, it is believed that the insertion of needles at these points promotes the release of endorphins – our body’s natural painkillers.

There have been numerous studies done on the role of acupuncture for chronic pain. A meta-analysis compared and compiled these studies and discovered that acupuncture can not only decrease the severity of chronic pain, but also extend these pain-relieving effects for long periods of time.

Acupuncture is also effective for musculoskeletal-related pain like osteoarthritis and even headaches. Researchers recommend acupuncture as a solution for anyone that suffers from chronic pain.

Afraid of needles? There’s nothing to fear about acupuncture. Contrary to what most people believe, acupuncture is actually very relaxing and soothing. In addition to pain relief, some people also report improvements in sleep, alertness, and digestion.

If you’re thinking of trying out acupuncture as a solution, it’s important that you go to a licensed and certified acupuncturist. In the US, there are 3 associations that are responsible for this: The Council of Colleges of Acupuncture and Oriental Medicine (CCAOM), The Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM), and The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). As not all practitioners are professionally qualified, you’ll want to ensure your acupuncturist is certified before getting poked.

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Spinal Manipulation

Spinal manipulation is another form of therapy for reducing chronic pain. During this process, force is applied to the spine in a certain direction. For those suffering from chronic pain related to spinal misalignment, realigning the spine can help to reduce or eliminate pain. Medical experts who can perform spinal manipulations include licensed chiropractors, osteopathic physicians or physical therapists. 

This form of therapy is common in the United States. Many people that consult for spinal manipulation have specific ailments they want cured, while others simply want to achieve optimum health. 

Research has found that spinal manipulation can help to reduce pain – especially lower back pain. According to one study, it’s been shown to be efficient in decreasing pain intensity and incidence of disability, as compared to other typical interventions.

Some studies also show that pain-relief from spinal manipulation therapy can last for up to 3 months. For those looking to overcome chronic pain, a combination of exercise and spinal manipulation is ideal.

Other studies show that spinal manipulation and physical therapy work equally well for reducing chronic lower-back pain. The National Center for Complementary and Integrative Health (NCCIH) recommends 12 sessions of spinal manipulation for the best results. 

Individuals suffering from neck pain may also wish to look into spinal manipulation. According to a study done by NCCIH in 2012, it can help to relieve symptoms associated with acute neck pain. 

When done by a certified and licensed expert, spinal manipulation poses no adverse risk. In some instances, you may experience temporary soreness or stiffness after treatment, which is considered normal.

However, if this pain lasts longer than a few days, it should be carefully monitored. When seeing a healthcare professional, always disclose any medications you’re currently taking, and any existing medical conditions you may have (National Center for Complementary and Integrative Health, 2019).

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Herbal Treatments

Lavender essential oil from Lavandula angustifolia  is one of the most common herbs used in aromatherapy. Besides relieving pain, it’s also used to improve sleep and mood.

In aromatherapy, essential oil from plants is absorbed by the body through the skin or through the nose. There are different forms of aromatherapy such as massage, inhalation, and baths. Their effects in various conditions have also been extensively studied. 

In one study, patients with knee osteoarthritis were asked to use 5mL of lavender essential oil diluted with sweet almond oil, to massage their knees for 20 minutes everyday for 3 weeks. Many participants reported a significant decrease in pain after the time frame. 

So why did lavender oil decrease pain? Researchers believe it stems from stimulation of the olfactory system, which is responsible for smell. This is because the emotional control center of our brain – also known as the limbic system, is directly connected to the olfactory system. Hence, the things you smell play an important role in affecting what your mood is.

The pathway between these two systems also involves the release of various neurotransmitters like enkephalins and endorphins, which trigger positive feelings. In essence, lavender essential oil affects not just the body, but also the spirit. 

In addition, applying essential oils to your skin allows for faster absorption into the bloodstream. Essential oils contain compounds such as linalyl acetate and linalool, which are associated with reducing pain, muscle spasms, and tension (Nasiri, Mahmodi, & Nobakht, 2016).

Despite its pleasant aroma, remember that lavender essential oil is toxic and cannot be ingested. When applying it to your skin, make sure it’s diluted, as lavender oil in high concentrations may actually be harmful. Perform small tests to check how your body will react, and ensure you are aware of proper concentration and dilution methods.

Rosemary essential oil from the plant Rosmarinus officinalis may also help in relieving pains such as headaches, musculoskeletal pain, and even seizures. It has been associated with anti-inflammatory and muscle relaxation properties as well. Rosemary oil has a woody aroma which can reduce stress and improve concentration.

 As mentioned earlier, narcotics or opioid use for pain can lead to dependence and tolerance. Luckily, rosemary essential oil can actually help in counteracting these effects. According to one study, rosemary oil was able to relieve pain for those people suffering from opium withdrawal. Hence, rosemary oil can also be used in the treatment of opioid addiction (Solhi et. al., 2013).

Like lavender, rosemary essential oil also needs to be diluted properly in a “carrier oil” to ensure the concentration is safe. Dilute 3-5 drops of rosemary essential oil with 1 ounce of olive oil to ensure a safe mixture (Burgess & Wilson, 2019).

Capsaicin is a substance that is present in chili peppers, and has been studied extensively since the 1990s. The substance itself produces a mild tingling sensation when applied onto skin, and can be used to lessen skin sensitivity and reduce pain by defunctionalizing pain fibers. 

In the past, topical capsaicin was used as a painkiller for post-surgical mastectomies and amputations. Nowadays, it’s more often used for neuropathic pain secondary to diabetic neuropathy, post-herpetic neuralgia, and trigeminal neuralgia. It can also be found in many pain-relieving products, such as in Qutenza patches which contain 8% capsaicin. Studies show that one 60-minute application of the product can relieve neuropathic pain for up to 3 months.

There are many ways to relieve pain. Besides taking medication, various forms of therapy such as acupuncture and spinal manipulation can also help. Other forms of treatment include using essential oils like lavender and tea tree oil to stimulate the olfactory system. But despite what research says, what’s important is to discover what works for you.

Our direct primary care clinic can help with non-narcotic pain management. At Well Life ABQ, we offer many treatments to help alleviate and reduce chronic pain. Our patients are treated with the utmost care and attention they deserve because we understand that it’s the most effective step towards discovering a solution. If you’re looking for ways to manage pain naturally, give us a call today at 505-585-2345!


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