Treatment & Management

Pain management can be either non-pharmacological, or without the use of medications, or pharmacological, which refers to using over-the-counter or prescription medications.1,2

Treatment for pain depends on the severity and type of pain. For acute pain, common non-pharmacological options include ice or heat packs, rest, and elevation.4 Movement and exercise can also increase circulation and reduce inflammation.5 Over-the-counter medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen or aspirin, or acetaminophen, can relieve pain and inflammation.6 A doctor can also prescribe a higher dose of these depending on the severity of pain or combine it with opioids as done in emergency departments.7

For chronic pain, incorporating practices, such as yoga, tai chi, meditation, and keeping up a routine of exercise can greatly help in pain management.8,9 A physical therapist can offer exercises for specific types of pain such as low-back, neck, and knee pain.10 Other modalities include acupuncture, massage, spinal manipulation, and forms of therapy to manage mental and emotional side effects of chronic pain.11,12 Non-opioid options for chronic pain are similar to those of acute pain, but also include antidepressants, anticonvulsants, and antiemetics.13

Opioids are usually only considered if pain relief hasn’t been effectively managed through non-opioid or non-pharmacological treatments. In fact, non-opioid therapies were found to be more or just as effective as opioids in many cases of acute pain.15 Opioids are considered a “controlled substance” by the US Drug Enforcement Administration (DEA), which means it carries a number of risks with its use.16 Therefore, there are state laws and guidelines around opioid dosage and supply that prescribers and pharmacies have to follow.17

If an opioid is needed for either moderate-to-severe acute or chronic pain, a doctor will only prescribe the lowest dose possible for the shortest amount of time. Although this and other precautions are in place for opioid prescriptions, there is still a risk of opioid misuse or addiction.18

Common prescription opioids are hydrocodone, oxycodone, oxymorphone, morphine, codeine, and fentanyl.18 Opioids can be short-acting for acute or breakthrough pain (for a few hours or up to a few days), or on a longer-term basis.19 They can be prescribed as an immediate-release, where the drug is absorbed quickly into the bloodstream, or extended/long-acting release where there is slower and controlled absorption of the opioid into the bloodstream.20 Your doctor will review all the risks associated with opioids. If you have never taken an opioid before, your doctor may also start you on a trial dose to see if it might be an effective treatment.21

If you have never taken an opioid before, it is best to express all of your concerns to your doctor prior to the treatment. There are a number of side effects of opioid use and contraindications, and if you are taking any medications, it is significant to disclose all of these to your doctor.21 Furthermore, combining pharmacologic with nonpharmacologic strategies, such as psychological, physical and complimentary interventions like massage, music therapy and acupuncture can help control pain more effectively.22

References

  1. Stanford Medicine Health Care. Management of pain without medications. https://stanfordhealthcare.org/medical-conditions/pain/pain/treatments/non-pharmacological-pain-management.html
  2. Amaechi O, et al. Pharmacologic therapy for acute pain. Am Fam Physician. 2021;104:63-72.
  3. Buck A. Pain management during labor: Clinical sciences. https://www.osmosis.org/learn/Pain_management_during_labor:_Clinical_sciences
  4. Kaiser Permanente. Rest, Ice, Compression, and Elevation (RICE). Last updated July 17, 2023. https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.rest-ice-compression-and-elevation-rice.tw4354spec
  5. Merkle SL, et al. The interaction between pain and movement. J Hand Ther. 2020;33:60-66.
  6. org. Institute for Quality and Efficiency in Health Care (IQWiG). Using medication: Learn More – The safe use of over-the-counter painkillers. Last update: August 23, 2021. https://www.ncbi.nlm.nih.gov/books/NBK361006/
  7. Rech MA, et al. Acute pain management in the emergency department: Use of multimodal and non-opioid analgesic treatment strategies. Am J Emerg Med. 2022;58:57-65.
  8. American Osteopathic Association. Study finds yoga and meditation reduce chronic pain. October 1, 2020. https://osteopathic.org/2020/10/01/study-finds-yoga-and-meditation-reduce-chronic-pain/
  9. Harvard Medical School. Tai chi and chronic pain. April 29, 2015. https://www.health.harvard.edu/alternative-and-integrative-health/tai-chi-and-chronic-pain
  10. George SZ, et al. Interventions for the management of acute and chronic low back pain: Revision 2021. J Orthop Sports Phys Ther. 2021;51:CPG1-CPG60.
  11. Standaert CJ, et al. Comparative effectiveness of exercise, acupuncture, and spinal manipulation for low back pain. Spine (Phila Pa 1976). 2011;36(21 suppl):S120-S130.
  12. American Psychological Association. Managing chronic pain: How psychologists can help with pain management. 2013. https://www.apa.org/topics/pain/management
  13. Centers for Disease Control and Prevention (CDC). Nonopioid therapies for pain management. May 2, 2024. https://www.cdc.gov/overdose-prevention/hcp/clinical-care/nonopioid-therapies-for-pain-management.html
  14. Licciardone JC, et al. Osteopathic manipulation in the management of chronic pain: Current perspectives. J Pain Res. 202013:1839-1847.
  15. Dowell D, et al. CDC Clinical Practice Guideline for Prescribing Opioids for Pain United States, 2022. MMWR Recomm Rep. 2022;71:1-95.
  16. Drug Enforcement Administration (DEA). Drug Fact Sheet. April 2020. https://www.dea.gov/sites/default/files/2020-06/Narcotics-2020.pdf
  17. Prescription Drug Abuse Policy System. State Laws Limiting Prescriptions for Opioid Analgesics. December 31, 2019. https://pdaps.org/datasets/opioid-analgesics-prescribing-limits
  18. National Institute on Drug Abuse (NIDA). Prescription opioids drug Facts. June 2021. https://nida.nih.gov/publications/drugfacts/prescription-opioids
  19. Terrie Y. Identifying and Addressing Breakthrough Pain. US Pharmacist. March 17, 2023 https://www.uspharmacist.com/article/identifying-and-addressing-breakthrough-pain
  20. Kraychete DC, et al. Opioid administration and rescue dose: Exploring the effects of opioid combinations. Braz J Anesthesiol. 2023;73:707-710.
  21. Centers for Disease Control and Prevention (CDC). Working together with your doctor to manage your pain. May 7, 2024. https://www.cdc.gov/overdose-prevention/manage-treat-pain/manage-pain-with-doctor.html
  22. Shi Y, Wu W. Multimodal non-invasive non-pharmacological therapies for chronic pain: mechanisms and progress. BMC Med. 2023;21:372.

All URLs accessed August 23, 2024.

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