Non-pharmacologic analgesia modalities for pain can be as simple as ice or heat packs, osteopathic manipulative medicine (OMT) or a massage to relieve pain. Other alternative treatments include acupuncture, hypnosis, meditation, tai-chi, and yoga.3,4 Electrical stimulation, biofeedback techniques, psychotherapy, and talk therapy are also methods for patients to cope with and manage pain.5 Other methods for relieving chronic pain include radio waves, spinal cord stimulation, and nerve blocks.6 Many of these and other non-pharmacological options can be used along with prescribed medications, however it is best that the patient consults with their physician on the safety and effectiveness of these alternatives.7
Opioids can be prescribed for both acute and chronic pain, and after surgeries, injuries, or cancer. Opioids for acute pain are used for only a few hours, or up to 3 days, and less commonly up to 5 or 7 days.16 Opioids are also grouped as short-acting, which stay in the bloodstream for a short while, or long-acting, which can be extended-release (ER) or sustained-release (SR), and are prescribed for people with chronic pain.17 Although the rate of opioid prescriptions has been declining, opioids are still a commonly prescribed class of pain medications. In 2022 alone there were more than 130 million opioid prescriptions in the US.5
There are many benefits of opioids for pain management, but they carry serious risks of misuse, addiction, overdose, and death.19 Due to these risks, opioids are considered a controlled substance per the Controlled Substances Act of the US Drug Enforcement Administration (DEA), where regulated drugs are placed into five different categories or schedules.20 Scheduling is determined by a drug’s medical use and potential for misuse, as well as scientific evidence, public health risks, dependence liability, pharmacological effect, and other factors.20 Schedule I Controlled Substances have no currently accepted medical use in the US, and they have a high potential for abuse (eg, heroin).20 Schedule V drugs have the lowest potential of abuse relative to the other categories (eg, limited quantities of narcotics in cough syrups).20 Most opioids fall into schedules II-IV, and most opioids for chronic pain treatment in Schedule II. Each state has different regulations on the dosage and supply limitations for opioids, and physicians must consult local laws prior to prescribing any opioid.21
