Everyone experiences pain now and then. But it’s the chronic, long-term pain that last for months or even years that leads many people to rely on opioids. In 2019, over 10.1 million people over the age of 12 misused opioids.¹  About 65% of those who misuse opiates started with a prescription for a chronic pain condition that was well intended but poorly managed. 

Alternative pain management therapies exist that avoid opioid medications. If you experience chronic pain and want to avoid opioid medications, one of the following therapies may work for you based on your diagnosis.  

1. Explore Physical Therapy

Physical therapists (PTs) use a variety of techniques including the McKenzie method (mechanical diagnosis and treatment), massage, manual therapy, stretching, range of motion exercises, patient relaxation, and self-managed exercises to help alleviate and control pain. 

“During treatments, MossRehab PTs explain good and bad moves regarding body mechanics to restore movement, reduce pain, and prevent further injury,” explains Christopher Plastaras, MD, clinical director of Musculoskeletal Spine and Sports Rehabilitation Medicine at MossRehab, and co-director of the Einstein Spine Institute. “Patients also receive instructions on managing pain during flareups and a maintenance exercise program to keep them out of pain.”

2. Face Your Fears
 
People experiencing pain are often fearful of certain movements and can exaggerate the pain experience in their minds. In these instances, PTs use a strategy called pain neuroscience education (PNE) that explains the source and cause of pain while using treatments that gradually introduce patients to their feared activities. With a better understanding of their pain experience, individuals can dispel their fear of movement and change their view on pain. 

For example, a person who equates back pain to climbing the stairs might become fearful of this activity. 
Through the PNE approach, the patient learns about their pain and why it continues.  Once decreasing the patient’s fear of movement, the PT can take a graduated approach to expose the individual to the movement of climbing stairs, starting with little steps.  

3. Distract Yourself from the Pain

Distraction is a pain management technique that masks and reduces pain by focusing attention on something else. Distraction techniques include guided imagery (imagine a relaxing scene), meditation, breathing techniques, music therapy, and something as simple as reading a book or doing a hobby.  

“You can have nociceptive input (sensory nerves that detect pain in response to a stimulus) for pain but not feel its intensity due to a distraction,” says Dr. Plastaras “For example, if you have a throbbing pain in the back, listening to music or talking with someone on a subject other than the pain can shift attention away from the pain intensity to make it easier to manage.”

4. Gain Control Over Your Pain

Understanding your chronic pain, treatment options, and coping skills can reduce anxiety and provide greater control over it. Physiatrists, therapists, psychologists, and other clinicians who serve as part of your care team can answer questions about your condition (What is it? Will I get better?), treatment options (What are the side effects? Is it expensive?), and self-management (What behavior can help now and in the future?). 

For example, a person with degenerative disc disease who learns different factors related to their pain and treatment options such as physical therapy, a heathy diet and medications during flare-ups can become empowered in working towards an individualized solution that helps control it.

5. Consider Medical Marijuana 

Different strains of medical marijuana are becoming mainstream as a safe and effective way to treat chronic pain and other conditions, such as depression and anxiety that are associated with pain. Without the side effects of opioids, medical cannabis has little risk of dependency or overdose when purchased at a regulated dispensary.

“Medical marijuana helps alleviate anxiety and stress that contributes to pain,” says Leonard Kamen, DO, physical medicine and rehabilitation physician and pain specialist at MossRehab Elkins Park. “It also may play a role in bolstering or improving the immune system’s response to pain.”

Pennsylvania identifies 21 diseases eligible for treatment using medical marijuana, including chronic pain, anxiety, cancer, glaucoma, and opioid use disorder. As a medical marijuana practitioner, Dr. Kamen can diagnose a patient and certify a condition for treatment with cannabis. However, he cannot prescribe it, according to Pennsylvania state law.

“It is my job to identify that a person is a candidate for medical marijuana,” says Dr. Kamen. “Once certified, they attend an individual counseling session through dispensaries regulated by the state of Pennsylvania and decide on a strain of marijuana as part of their pain management treatment.”

¹ https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf