Alternatives to opioid usage

By Veita Bland, M.D. / June 10, 2016

In recent months, addiction to opioid medications has been prominently featured in news media. We hear tragic stories of addiction occurring in so many people across the country. There is the tragic story of the high school athlete who initially took pain medications to aid in the care of an injury. He became addicted to the medications and when the rehabilitation for the injury was over, the supply of medication was cut off. He should not have needed them anymore, but he became addicted. Then there is the mother who injured her back bringing groceries home. Pain medication with opioids was an appropriate treatment for the initial injury. However, the mother became addicted to the medications. When her time for rehabilitation was over, her supply was terminated. She was then, like the high school athlete, left addicted with no readily supply of medication.
We see these patients in the office. They state they have pains from an injury and still need medication. You check the internet for their pharmacy record. You note they received pain medication from Dr. A three weeks ago. A prescription for an opioid pain medication was noted from Dr. K one month ago. The pharmacy record shows various doctors giving small amounts of pain meds filled at various pharmacies. Health care providers call that doctor shopping. Trying to find a doctor who will “believe in” your need for the pain medication and become the “one” who will write the prescriptions.

There are several problems with this scenario. How was this problem allowed to manifest? Were we as health care providers so busy that we failed to see this addiction manifesting itself? What about the legitimate person? The one who actually needs opioid pain medications for his/her ongoing pain needs. Especially now, who is willing to write a prescription for pain medications for that person? These are just two of the many complicated questions that need to be answered. There needs to be a better understanding of addiction by health care providers so that we do not unintentionally ruin the life of someone by allowing the addiction to occur.

One way to do this is to try to discern who really needs opioid pain medication and who does not. Pain is indeed a perception by the individual and what may be a little something for me, may be a big something in you. The whole story is much too complicated to do it justice here.

One thing we can do is to use alternative forms of pain medications. For those who are healthy, and there is no fear of cardiac problems, we can use the NSAIDS (nonsteroidal anti-inflammatory drugs). You know them as over the counter medications such as Motrin, Advil and there are prescription strength NSAID medications.

Topical treatment for pain is the new/old frontier. Topical NSAIDS that do not affect the heart are a great choice. They seem to work as well as oral NSAIDS for osteoarthritis, acute sprains and strains. There are drawbacks with their usage. They are not as convenient and they require a prescription. They must be applied correctly and several times a day. Possible cardiac problems and upset stomach are not an issue with topical administration.

Capsaicin, another topical medication that is over the counter, is good for musculoskeletal pain or neuropathic pain (pain caused by damage or disease affecting the somatosensory nervous system). Here though, it may take up to four weeks for effective pain relief to occur.

Lidocaine patches can moderately reduce neuropathic pain.

Another modality would be a TENS device (transcutaneous electrical nerve stimulator). Here, electrical impulses are used to decrease pain perception. They are safe.

Remember, do not place topical medications over damaged or broken skin and do not apply heat over the topical. As always, only use them when you need them.

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Veita Bland is a board certified Greensboro physician and hypertension specialist. Email Dr. Bland at Lideas@blandclinicpa.com.