Managing Chronic Pain With And Without Opioids

For many people, coping with pain is a daily way of life. Injuries or conditions such as arthritis or fibromyalgia can cause pain that lasts for years. And unfortunately, many who experience chronic pain feel that their treatment options are limited.

Chronic pain is very difficult for a person to cope with, says Kayvan Ariani, MD, an anesthesiologist and pain medicine specialist at AdventHealth. It is very tempting after months or even years of chronic pain to lose hope.

The good news, he says, is that often times, a balanced, multimodal treatment plan can lead to improvement in pain experience, patient function and satisfaction with life.

Partnering with a pain physician can be helpful in terms of reviewing the potential causes of your pain and looking at a wide array of treatment options, Dr. Ariani says. I encourage you to be open-minded when discussing a treatment plan with your pain physician and maximize the use of low-risk options if you're suffering from chronic pain.

What is the first step?

The most important intervention for a patient experiencing chronic daily pain is to be evaluated by a board-certified pain physician, explains Dr. Ariani. The first steps in assessing a patient's pain complaints includes:

• Reviewing the patient's history
• Performing a physical exam
• Reviewing diagnostic studies such as X-rays, CT scans, MRI scans or lab work

Fully evaluating a patient with chronic pain can be complex. Chronic pain is an experience that can have both physical and emotional factors that contribute to the patient's pain experience and lead to functional decline. An experienced pain physician can assess factors that may be contributing to a patients pain experience and then develop a multimodal treatment plan that can improve the patient's pain and optimize functionality.

What treatments are available?

In some cases, the treatment may be a straightforward procedure, such as an injection. Injections may be helpful in terms of both diagnosis and treatment of pain conditions. In other cases, a multimodal treatment plan may be recommended.

A multimodal treatment plan may include a combination of the following treatments:

• analgesic medications
• injection/interventional therapy
• physical therapy/rehabilitative care.

Certain patients may benefit from referral to a pain psychologist, he elaborates. A pain psychologist may help patients learn techniques such as biofeedback, relaxation, imagery and diaphragmatic breathing that can be helpful in gaining some control over their pain. Working with a pain psychologist may also allow them to develop more constructive thoughts and healthy behaviors in relation to their pain. In addition, a pain psychologist can assess them for issues such as anxiety and depression that can develop over time in patients who experience chronic daily pain.

Next steps in treating a patient with chronic pain:

• A multidisciplinary team of providers (pain physician, physical therapist, pain psychologist) communicate their assessments of the patient to one another.
• Then, a coordinated and optimized treatment plan can be tailored specifically for the patient.
• Ultimately, this unique assessment for each patient allows application of the proper tools to improve a patients pain experience and optimize the patient's functionality.

What are the alternatives to opiates in treating chronic pain?

There are many alternatives. Injection therapy can have a therapeutic impact in terms of interrupting the pain cycle in a patient and/or providing an anti-inflammatory effect. Other interventional techniques, in the appropriate patient candidate, may significantly improve pain experience and functionality.

Both passive and active physical therapy tools used by the physical therapist can help manage the patient's pain and return to normal functioning.

In the analgesic arena, there are non-opiate medications that can be prescribed to help avoid or minimize the need for opiates. A pain physician can assess your pain and determine appropriate medications that may be helpful for you while minimizing risk. In some cases, opiate therapy can be a reasonable tool to enhance functionality if you have chronic pain.

It's important to understand that there's a risk of physical dependence and opiate tolerance with opiate therapy. In some cases, these risks are outweighed by significant pain relief and improvement in a patients quality of life. Using the lowest possible dose can help avoid side effects.

What are some tips to facing chronic pain without medication?

It's important to have a broad, balanced, multi-modal approach to managing chronic pain. Proper sleep and nutrition as well as an appropriate level of physical activity are important foundational tools in managing chronic pain. Maximizing your use of low-risk foundational tools will enhance the effects of specific treatments provided by your pain management team.