Pain Control Without Opioids: What Are the Options?

It's a conversation more senior patients and their doctors are having.

Group of seniors discussing medications with a doctor

It seems that every day brings more news about the opioid crisis in America. We see footage of addicts on the street, committing crimes to pay for their next fix. Families are broken apart. Lives are shattered. According to the Centers for Disease Control and Prevention (CDC), 40 people die from opioid overdoses in America each day. The American Society of Anesthesiologists (ASA) reports that these fatalities have increased by 200 percent since the turn of the century.

Much of the media coverage focuses on young addicts and their struggles, but it's important to know that our older population has not been spared. Seniors, too, can become dependent on opioid medications, and the side effects can be severe and deadly.

We now know that for years, well-intentioned doctors contributed to the problem by routinely prescribing opioids. There was a mistaken belief that patients who used these drugs to treat their pain seldom became addicted. However, it is now obvious that this was not true. The ASA warns that opioids "create a feeling of euphoria and make the body believe the drug is necessary for survival," and patients can become addicted after only a few doses. And the ASA warns that opioids can actually increase our sensitivity to pain — a condition called hyperalgesia.

So today, the medical and dental professions are rethinking the use of prescription opioids. The first step: prevent patients from getting started on opioids in the first place.

For starters, reports the ASA, reform is needed when it comes to the routine use of opioids after surgery. Many patients leave the post-surgery recovery room with a prescription for a highly addictive opioid, such as hydrocodone, oxycodone or codeine. A certain percentage of these patients will continue to use these drugs even after they've recovered.

"Nobody needs a prescription for 30 or 50 opioids, and even those who are in major pain and may benefit should only take them for a day or two," said ASA President Dr. James D. Grant. "There are effective alternatives and many people don't need opioids at all or at least should drastically reduce the amount they take."

The ASA recently offered these suggestions for surgical patients:

  • Opioids should be taken only when a patient is in extreme pain, and for the shortest time possible. And don't let unused pills fall into the wrong hands. More than half of people who misuse these prescription medications get them from a friend or relative.
  • Manage your expectations. Soreness and discomfort will most likely improve significantly in a day or two. Just as you wouldn't take an opioid after overdoing it at the gym or after getting your teeth cleaned, recognize they're inappropriate for most post-surgical discomfort and soreness as well.
  • Alternative medications, such as ibuprofen (Motrin), naproxen (Aleve) and acetaminophen (Tylenol), can usually manage pain and soreness effectively.

Relief for chronic pain

Post-surgical pain is an example of acute pain, the kind that happens when we're injured or have a temporary painful condition. What about chronic pain, pain of longer duration resulting from arthritis, heart disease, shingles, lower back trouble, the effects of diabetes or other conditions that are common among older adults?

The CDC recently released new guidelines for the prescription of opioids for pain, stating that unless a patient has active cancer or is receiving palliative care at the end of life, opioids should seldom be the first treatment choice. This is a complicated issue and a work in progress; there are reports of patients who are unable to get the pain relief they need, and doctors worrying about prescribing any opioids due to increased scrutiny. And seniors are the most likely to suffer from chronic pain — yet they are especially vulnerable to the effects of opioid medications.

"Pain is prevalent and often undertreated among older adults," said Prof. Robert Gatchel of the University of Texas at Arlington. Yet opioids are not the answer, he says. "The side effects of opioids, such as nausea and dizziness, can lead to an increased risk and rate of falls and subsequent injury, particularly among the older population. Older adults also are more prone to physical side effects from these drugs, such as liver and kidney problems, and need both careful evaluation and routine testing of organ function for follow-up care."

If you or an older loved one is experiencing chronic pain, have it evaluated by the doctor or a pain specialist. Even seniors who have long taken opioid medications may find that other treatments are more effective and allow them a better quality of life. (Never stop taking a drug without consulting the doctor first.)

Pain specialists today offer treatments that can, in most cases, be just as effective and much safer. To start with, there are the non-opioid medications mentioned above, antidepressants, topical creams, patches and injections. Seniors should take these medications only as recommended. Gatchel says that nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen and naproxen can cause stomach ulcers and organ damage if taken for too long, especially when taken with other medications many seniors take. He says antidepressants also should be used with caution. Acetaminophen can cause liver damage. And studies show many patients take more than the recommended amount of these drugs.

Medications are only the beginning. Other pain management strategies include:

Physical therapy. Hands-on treatments such as massage, ultrasound, hot and cold treatments, biofeedback and electrical stimulation can provide effective pain relief. Physical therapists also train patients to use their bodies in ways that reduce pain, such as improving posture, lifting properly, and building up the muscles to protect painful joints.

Counseling and education. Experts say understanding our pain can go a long way to helping us cope with and overcome it. For example, many patients report that once they understand what's causing their pain and what they can do to best manage their condition, they relax and experience a decreased sensation of pain.

Meditation, yoga and tai chi. Studies have shown these mind-body practices can reduce pain in patients who have arthritis, chronic lower back pain, painful digestive conditions and angina. Mindfulness practices reduce anxiety and increase levels of brain chemicals that provide a sense of well-being.

Managing underlying health conditions. Patients who become dependent on pain medications may be less likely to do all they can to improve the health conditions that are causing the pain. Have regular health appointments, follow the doctor's recommendations, and learn more about your health conditions.

Lifestyle changes. People who are in pain may take to their bed or couch, thereby increasing their pain. Perhaps the top "prescription" for pain is exercise! Under a doctor's supervision, start an exercise program that includes the right types of activities to strengthen muscles, reduce inflammation and improve heart and lung function.

What can family do to help?

Senior woman with caregiver

If a senior loved one is experiencing pain, encourage them to talk to their doctor right away. Pain specialists say that the longer pain goes untreated, the more likely it is to become intractable. "Toughing it out" may allow a pain pattern to persist for a much longer time.

If you're a family caregiver and your loved one is in pain, your support is so important. Especially if your loved one has Alzheimer's disease or other memory loss, following their doctor's instructions can be challenging, and your loved one might not be able to express that they are in pain.

If your family uses in-home care to support your loved one’s well-being, make pain management a top priority. Professional in-home caregivers can provide medication reminders, take your loved one to doctor appointments and physical therapy, prepare nutritious meals that support good health, and provide supervision and support as your loved one exercises.

And did you know that loneliness increases a person's perception of pain? It's a cycle. People who are in pain may withdraw from social interactions — maybe it feels like just too much trouble to visit a friend or tidy the house for a visit. Professional caregivers not only provide the human touch, but also services that help seniors stay connected.

The information in this article is not intended to replace the advice of your healthcare provider. Report painful conditions right away, and take medications only as directed by your doctor.

Right at Home, Inc. is a national organization dedicated to improving the quality of life for those we serve. We fulfill that mission through a dedicated network of locally owned providers of in home care services.