Alternatives to Opioids for Back Pain
Miotto says that some people with serious pain become too focused on opioids. They come to believe that opioids are the only thing that will help. But sometimes, you need to take a step back.
"If you keep increasing your dose of opioid pain medication but pain is still an 8 or 9 out of 10, it's time to shift gears and try something else," says Miotto. She points out that at high doses, opioid painkillers can actually make your pain worse -- a condition called opiate-induced hyperalgesia.
In addition to NSAIDs and other drug treatments, there are non-drug options for coping with chronic pain. Physical therapy can be invaluable. Miotto notes that treatments like massage, water therapy, and biofeedback can make a big difference with chronic pain. Unfortunately, it can be hard to get insurance to cover these sorts of treatments, Miotto says.
It's also important to treat any other conditions that might be exacerbating your pain. For instance, experts say that many people with chronic pain also struggle with depression and anxiety. "People who feel an increased amount of anxiety also feel an increased amount of pain," says Webster. Even those who don't have diagnosed psychological condition can benefit from support groups or therapy.
Of course, some with chronic pain will bristle at that suggestion. They believe that it implies that the horrible pain they feel is "all in their heads."
But Miotto says that's not the case at all.
"Severe, chronic pain makes life terribly difficult," Miotto tells WebMD. "Therapy is just another helpful tool in getting people to cope better."
Using Opioids Safely
Clearly, there's no simple advice when it comes to balancing the benefits and risks of opioids for back pain. But if you and your doctor decide to use these medicines, here are some tips for taking them safely.
- Follow your doctor's prescription precisely. Never double up a dose. Never take your medicine for any symptom besides pain.
- Find a specialist. Dealing with chronic pain is complicated. Your regular doctor may not be comfortable handing out long-term prescriptions for opioids. So seek out a specialist in pain management or, better yet, a pain management center. This is essential for people who have a past history of substance abuse.
- Don't mix opioids with other drugs. If you already use prescription or over-the counter drugs, supplements, or alternative medicines, make sure your doctor knows about every single one. Ask about the safety of using your opioid painkillers with alcohol.
- Sign a pain agreement. These documents help build trust between a doctor and patient. A patient might promise to use the medication as instructed and, in some cases, agree to regular drug testing. In return, the doctor agrees to prescribe opioid pain relievers as part of the treatment plan.
- Take a screener. Experts now recommend that doctors use screeners -- a short series of questions -- that help them identify people who might be at higher risk of opioid abuse. Like pain agreements, they help build trust between patients and doctors.
- Ask about alternatives. Talk to your doctor about other ways you could reduce your back pain. Might non-opioid medicines help? What about surgery? Or non-traditional treatments like massage or relaxation?
- Get support. Consider seeing a therapist or joining a support group for people with back pain.
- Keep your medication in a safe place. Remember that it's not only the person in pain who's at risk of abusing opioids. So be careful. Don't keep your medicine where other people -- your children, grandchildren, friends, or neighbors -- can get to it.