Opioid pain medications, also called “opiates” or “narcotics,” are powerful prescription drugs, which work by using chemicals to activate receptors in the nervous system (brain, spinal cord, and intestines). Some examples are morphine, codeine, hydrocodone (Vicodin, Norco), oxycodone (OxyContin), hydromorphone (Dilaudid), fentanyl, tramadol, and methadone. Heroin is also an opioid, though it is illegal to use and cannot be prescribed by doctors.
These drugs act like unusually large amounts of our own natural hormones, called endorphins, which reduce pain and produce a sense of emotional well-being. We evolved these natural abilities in order to help us survive injuries, as well as to bond with one another. Unfortunately, if we use medicines to artificially activate these abilities over and over again, it often leads to problems.
There are many alternatives to opioid medications, and these alternatives tend to work best when used in combination.
NSAIDS and acetaminophen
Non-opoid pain medications, which can be prescribed by a doctor but are also available over-the-counter without a prescription, are an alternative to opioids. Like all drugs, they have risks and benefits. Non-steroidal anti-inflammatory drugs (NSAIDS) such as aspirin, ibuprofen (Motrin) and naproxen (Aleve) are good for injuries to muscles and tendons, and can often work for headaches as well. They work by reducing inflammation at the site of an injury or irritation. Acetaminophen (Tylenol) does not reduce inflammation, but reduces pain by changing brain chemistry in ways that are still poorly understood. These medications are not addictive and can be safe for long-term use in some situations, but it is important to talk with a doctor if you want to use them for more than a week or two because they can cause organ damage in some people. It is also important for people who take these medicines for headaches to be aware of a phenomenon called “rebound headaches,” which are headaches caused by taking headache medicine too frequently.
Another great anti-inflammatory medicine? An ice pack! Sometimes Mom really does know best. Ice, wrapped in cloth and applied for 5-10 minutes at a time, is great for soothing bumps and bruises, sore backs, and even headaches.
The use of steroid anti-inflammatory medications, such as cortisone or prednisone, is another example of using our bodies’ own healing mechanisms in order to get relief from pain. Like NSAIDS, they are non-addictive. Unfortunately, they can have very serious side-effects if used in large doses or for long periods of time. Sometimes they can be injected at a site where you are experiencing pain, such as in a joint or at the root of a nerve that is irritated. This can be gentler on your body than taking the drugs by mouth, because the effect is strongest only at the spot where the drug is really needed, instead of throughout your entire body. Getting many injections in the same spot can cause weakening of important structural tissues, but sometimes steroids can “put out the fire” and result in long-term relief from just one or two injections. Ask your primary care doctor or a chronic pain specialist if this is an option for you.
Some people prefer to avoid taking medicines, or need additional help with pain on top of using medicines. There are many available options, some of which have scientific evidence supporting their use, and some which do not. You can try these gentle therapies on your own, or consult a naturopathic physician for guidance.
One example of an alternative therapy with some scientific evidence behind it is turmeric. This herb, commonly used as a food seasoning in some parts of the world, can be taken in larger amounts to provide some anti-inflammatory and possibly anti-cancer benefits. You can incorporate it into foods (the best option) or take it in pill form. Other foods with possible anti-inflammatory effects include those which are high in omega-3 fatty acids such as fish (especially salmon and sardines), walnuts, flaxseed (oil or ground seeds), chia seeds, tofu, and green leafy vegetables (especially brussels sprouts, kale, and purslane).
Always remember that anything you are taking as a supplement in larger quantities than would normally be found in food is really a drug. Like all drugs, supplements have the potential to interact with other medicines, or to cause side-effects, and it is always good to let your doctor know if you are taking any herbs or other supplements.
Another option for pain control is acupuncture, which is the use of very thin (and nearly painless…really!) needles inserted in specific points in your body by a trained acupuncture specialist. While the scientific data on acupuncture is mixed, it has been used for a very long time in Chinese medicine to improve health, and many people do find it helpful for pain relief. It is a safe thing to try, and will not interfere with other therapies or medicines.
When we are in pain, we often do not feel like exercising. However, gentle and appropriate exercise has been scientifically shown to help with many kinds of pain, and it is very important for mental and physical health. Physical therapy is a type of exercise that is prescribed by a trained medical professional, and tailored specifically to your type of pain or injury. It is often used to strengthen muscles or correct harmful movement patterns, in order to reduce pain over time and hopefully prevent new injuries. It requires some dedication and patience, but if given a chance, is very often one of the most helpful things for people who have pain related to muscles or joints. It requires a lot more work than taking a pill, but it can fix the root of the problem instead of just temporarily covering it up with potentially harmful substances!
Some other types of exercise which good for health and gentle for people who have chronic pain (or who want to prevent it) are tai chi, yoga, and swimming. All of these types of exercise are good for strength and coordination, and are a wonderful way to release endorphins, our natural painkillers. Tai chi and yoga can also help us develop mindfulness, as discussed below, which is very helpful in reducing the suffering that can go along with pain. They can also be a source of community-building and emotional support.
In the “what is pain?” section, we talked a little about the difference between pain and suffering. If we can learn to separate the two, it is possible to feel pain without having so much anxiety and sadness attached to it. With this skill, we free ourselves to continue to live meaningful and happy lives even if we still have some pain. There are many ways to improve your ability to cope with pain, and this is even more important – absolutely crucial, actually — if you are also having depression or anxiety, which very often go along with pain. Some types of therapy that may be helpful include cognitive behavioral therapy, dialectical behavior therapy, and mindfulness-based cognitive therapy. These therapies are provided by trained professionals, either in one-on-one sessions or in groups, and some sessions are likely to be covered by your medical insurance.
Mindfulness is an awareness of what is happening in the current moment, and it has been scientifically shown to reduce pain and suffering. It sounds so simple, and in a way it is, but it is also a skill which requires learning and practice. You can learn mindfulness on your own or with others, and if you like, it can be part of a spiritual practice. Meditation is a core mindfulness activity which can be learned from books, classes, or online resources. Physical exercises such as yoga and tai chi can serve as mindfulness practices. It is good to start small and be patient with yourself as you begin to incorporate more mindfulness in your life. Like most healthy things, it can become a pleasant habit, but it takes time…and it’s worth it!
healing by helping
Sometimes pain comes to us, and stays with us, and seems to fill up all of our empty space to the point that it can take over our lives. Part of coping with chronic pain is trying to give it less space in our lives, and take back the feeling of control that pain sometimes takes away from us. Think of volunteering as pain control for your spirit. Finding a way to give back to your community and bring comfort to others who are suffering in whatever way can actually reduce your suffering. This is especially important if pain has caused disability or has taken away your livelihood. The need to love and care for one another is part of who we are as human beings, and we are able to give that even if we are experiencing pain or lack some physical abilities. Everybody can contribute. Some ideas for volunteering include church-based activities, support for veterans, political activism, visiting at nursing homes, spending time with animals at shelters, fostering children or animals…there are so many ways to help! Choose something that is meaningful to you, and the love that you give will come back to heal you.