When used correctly, opioids can help a person control acute or chronic pain, but the risks of these medications are also clear: The addictive painkillers have led to a national health crisis that claimed more than 42,000 lives in 2016. They’re also known to cause nausea, constipation and allergic reactions.
Though opioids can be helpful in some situations, University of Minnesota Health physicians are increasingly turning to other non-opioid therapies for pain relief, such as non-addictive pain medication, Reiki or acupuncture. They’re also employing innovative techniques, including peripheral nerve blocks during surgery or radiofrequency energy, to reduce or eliminate the need for opioids.
To better understand the opioid alternatives that are available for patients, we spoke with Anesthesiologists Jacob Hutchins, MD, and Clarence Shannon, MD, about acute and chronic pain management alternatives. Both see patients as part of the University of Minnesota Health Pain Management program.
“Upfront, we tell our surgery patients they’re going to receive a holistic approach to pain management—not just opioids—called multi-modal analgesia,” said Hutchins, who is the director of the University of Minnesota Health Perioperative and Interventional Pain Service.
Hutchins and his colleagues focus on providing various methods of pain relief during the three phases of surgery: before, during and after.
Upon arrival before their surgery, patients will often receive non-addictive pain medication, like acetaminophen, ibuprofen or gabapentin. Research shows that when given prior to a procedure, surgery patients will require less post-surgery pain medication, which decreases the need for opioids.
During surgery, anesthesiologists often use nerve blocks—or precise injections of a long-lasting local anesthetic—to numb the nerves around the surgical site.
These local nerve blocks decrease the amount of opioids physicians need to use during surgery. In fact, these nerve blocks have all but eliminated the need for opioids during some minor to moderate surgeries, Hutchins said.
After surgery, the pain management teams work with surgeons to prescribe non-opioid pain relievers—further reducing the need for opioids. Opioids still serve an important role in relieving pain during and after major surgeries, such as spinal procedures or organ transplants. However, University of Minnesota Health providers now prescribe smaller amounts of the drugs, decreasing the risk for side effects and misuse.
“Integrative therapies, such as Reiki, aromatherapy or acupuncture, are increasingly common for our patients in a hospital setting,” Hutchins said. “Although we’re still examining the science behind these therapies and their effect on pain pathways in the body, it’s clear they work better for some patients.”
Integrative therapies can also work for patients facing chronic pain. Unlike surgery patients, whose pain may be temporary following a procedure, chronic pain patients experience long-lasting discomfort.
Clarence Shannon, MD, the director of the University of Minnesota Health Chronic Pain Program, often recommends stretching, yoga and massage—or other healthy lifestyle changes—for people experiencing chronic pain.
“We want our patients to take approaches that don’t involve pain medication whenever possible, and we know from research that they work,” he said. These alternatives are especially effective, Shannon said, when they are paired with other non-opioid pain management techniques.
Another technique involves the use of radiofrequency energy. To relieve chronic pain people feel due to arthritis or other conditions, specialists can insert a small needle near the nerves causing the pain. The needle delivers heat to that nerve and interrupts the pain signals to the brain. This may greatly reduce the discomfort a person feels, and relief can last a year or longer.
Spinal cord stimulation is another long-acting pain management therapy. As part of this procedure, pain specialists place a small electrode near the area of the spine associated with pain signals. The electrode delivers stimulation that can cancel out pain signals so they cannot be processed in the brain.
“Everything we do involves multiple techniques and therapies,” Shannon said. “We approach pain from all directions so that we can determine what works best over the long term.”
In rare instances, Shannon said, chronic pain patients may receive opioids. When opioids are used in chronic pain situations, they’re often delivered by a pump programmed to administer a pre-determine dose. The pump allows physicians to prescribe fewer opioids and reduces the potential for misuse.
“On our initial visits with patients, we set clear guidelines. I ask them what activities are hampered by their pain, and we talk about their pain management goals,” Shannon said. “It’s always a process. There’s not usually a single therapy that will be a quick fix – especially not opioids. But we work with our patients to figure out the most effective mix of therapies over time.”