Rx for Change: Alternatives for Chronic Pain
Taken from the January/February 2018 issue of the Women's Health Activist Newsletter.
First of all, drop the idea that opioids are the best treatment for chronic pain. Except for end-of-life care, opioids should not generally be used for chronic pain. Not only are they dangerous and addictive, but opioids also actually increase pain over time; by increasing sensitivity to pain, they worsen the problem they are supposed to solve. And, don’t be fooled that tramadol isn’t an opioid. Many physicians don’t know that it is an opioid, but it is. It’s weaker than other opioids but it is still an opioid and it’s still addictive.
Manage your expectations, as well as your pain. The goal is not to be entirely pain-free – an impossibility in many chronic pain cases — but to manage pain so that it doesn’t interfere with work, sleep, and/or recreation.
Use non-steroidal analgesics; over-the-counter analgesics include ibuprofen, naprosyn, aspirin, and acetaminophen. Prescription versions include diclofenac, ketoprofen, indomethacin and celecoxib.
Exercise! Even if you don’t want to. Numerous studies show that exercise, on land or in the water, improves multi-site pain and pain from osteoarthritis of the hip and knee.   (Exercise doesn’t seem to do much for arthritis in the hands.) Pilates, and yoga have been studied for low back pain and found to be effective; yoga was found to be as effective as physical therapy for pain and function. There’s no good evidence that any particular type of exercise is better than another type. The best kind of exercise is the kind you will do, so develop or rediscover a love of swimming, walking, dancing, or whatever else (literally) moves you.
Consider cannabinoids. A systematic review of 28 studies of various cannabis preparations in more than 2,000 patients found that cannabis generally improved chronic pain, especially neuropathic pain. If medical cannabis is legal in your state, find a knowledgeable health care provider to help you navigate the different formulations.
For low back pain or neck pain, consider spinal manipulative therapy (osteopathic or chiropractic treatment). Studies show that it improves pain and function for both conditions. And, while physicians have had concerns that spinal manipulative therapy could increase the risk of stroke, a recent study shows that isn’t the case. 
Systematic reviews have shown that acupuncture is effective for pain that is associated with fibromyalgia, temporomandibular disorder (TMD), herpes zoster, endometriosis and post-stroke shoulder pain. Acupuncture has been found to improve some kinds of cancer-related pain, as well.
In addition, Transcutaneous Electrical Nerve Stimulation (TENS) treatments help neuropathic pain, and cognitive behavioral therapy can help improve mood.
Ginger extract may be as effective as over-the-counter analgesics for pain if you like the taste of ginger, try drinking ginger tea or eating candied ginger. If you don't like the taste, take ginger in capsules (1-4 grams a day.)
For arthritis, S-adenosyl methionine (SAM-e) can help with pain and function; the usual dose is 300 mg three times a day. Glucosamine (500 mg three times a day) and chondroitin (400 mg three times a day) are popular supplements for arthritis. There is stronger evidence for the benefits of chondroitin than for glucosamine, and their main effect may be on preventing further cartilage loss rather than treating pain.
There are many treatments to try instead of using opioids, and combining modalities can be helpful; obviously, it is fine to combine say, ibuprofen, ginger, acupuncture, and exercise.
Charlea T. Massion, MD, is a practicing physician in Santa Cruz County specializing in hospice and palliative care. Charlea brought her passion for improving women’s health along with 40+ years of health care experience to the NWHN as a member of the board for 8 years. She also co-founded the American College of Women’s Health Physicians.
Adriane Fugh-Berman, MD, is a former NWHN Board Chair whose research presents a critical analysis of the marketing of prescription drugs. Adriane educates prescribers on pharmaceutical marketing practices as Director of the PharmedOUT program, and created the Health in the Public Interest program at Georgetown University School of Medicine where she trains a new generation of consumer advocates.
Read more from Charlea T. Massion and Adriane Fugh-Berman.
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