Pain management therapies relying less on opioids

Prescription opioid pills poured out on a counter
In the midst of a deadly opioid crisis, pain management doctors are increasingly turning to other therapies to control cancer-related pain with fewer side effects.

Chronic, sometimes debilitating pain affects millions of Americans—cancer patients among them. For the past couple of decades, powerful narcotics known as opioids have been widely prescribed, but the drugs, while useful in blocking pain, come at a significant cost to patient health, increasing the risk of dependency and abuse. Now, U.S. opioid addiction and overdose deaths have climbed to such unprecedented levels that the federal government has declared a public health emergency, prompting many doctors to re-evaluate the way they treat pain. In cancer care, where an estimated 50 to 70 percent of patients experience uncontrolled pain at some point in their cancer journey, pain management specialists are juggling a careful balance—closely monitoring patients who may benefit from opioid therapy and increasingly relying on alternatives like pain pumps and nerve blocks.

Chronic pain can affect all areas of a person’s quality of life. That’s why interventional therapies to reduce or relieve pain are essential.” - Nathan Neufeld, DO - Chief of the Division of Pain Management at Cancer Treatment Centers of America® (CTCA)

What are opioids?

Opioids—oxycodone, hydrocodone, fentanyl and others—are narcotics prescribed to manage moderate to severe pain. They work by sending signals to the brain that block pain and produce a calming effect. In the 1990s and early 2000s, pharmaceutical companies began aggressively marketing opioids as an efficient way to manage pain. Long-term use may cause a host of side effects, ranging from constipation to hyperalgesia, an increased sensitivity to pain. But the drugs’ addictive properties and long-term consequences for patient safety are the side effects that have concerned the medical community the most, Dr. Neufeld says. That’s why today’s approach to treating cancer-related pain uses opioids more cautiously. Pain management specialists have found that other treatments may control pain with fewer side effects than oral narcotics, Dr. Neufeld says.

Lidocaine, a local anesthetic, for example, may temporarily block pain when injected into a joint or the spine. For longer-term relief, doctors may recommend a neurolytic block, which involves injecting a neurolytic agent near specific nerves. The agent is designed to reduce pain impulses as it flows from the nerves to the brain. Sometimes, Dr. Neufeld says, the nerves regenerate and the pain returns, but the procedure may be repeated as needed.

What are other options?

Some patients may also find relief with a pain pump, a tiny, surgically implanted device that delivers small amounts of medicine to the spinal cord, allowing the dose to be adjusted with a handheld device. This minor surgical procedure may be used for pain in the back, neck, limb, abdominal or pelvis, and for certain types of headaches.

These and other treatment options are often used in conjunction with supportive care therapies, such as physical therapy, mind-body medicine and acupuncture, and may provide a more comprehensive pain management strategy than opioids, says Abed Rahman, MD, MA, Interventional Pain Medicine Physician at our hospital near Chicago.

Because all patients experience pain and respond to treatments differently, strategies for addressing and managing pain must take into account a number of factors specific to them, including their pain tolerance level, their health history, other medical conditions and the source and severity of their pain.

With a record 15.5 million cancer survivors in 2016, effectively managing pain associated with the disease is more important than ever. “The goal is for the patient to control the pain, not the other way around,” says Dr. Rahman. “The combination of integrative and conventional pain management strategies offers a more balanced approach.”