Chronic Pain and Non-Opioid Medications
By Dr. Jessica Badichek, PharmD
More than 25 million Americans suffer from daily chronic pain. Chronic pain has many types of treatments but all too often patients are prescribed opioid medications that are highly addictive. While opioid medications may be effective for acute and various types of cancer pain, they aren’t always the best option for other pain conditions such as neuropathic or chronic musculoskeletal pain. The Centers for Disease Control and Prevention (CDC) Guideline for prescribing opioids for chronic pain recommends nonpharmacologic therapy and nonopioid pharmacologic therapy be initiated prior to trying opioid therapies. These guidelines instruct that opioid medications should only be prescribed if the benefits for pain management outweigh the risks of the opioid medication.
Nonpharmacologic therapy may include aerobic, aquatic or physical therapy for conditions such as osteoarthritis, fibromyalgia or chronic musculoskeletal pain. Non-opioid medications such as acetaminophen, NSAIDs such as ibuprofen or naproxen, antidepressants such as duloxetine (Cymbalta) and other medications such as gabapentin and pregabalin (Lyrica) can often treat pain conditions. These medications are of value because they can offer pain relief specific to particular conditions. For instance, neuropathic pain involves different processes in the body that are best treated with medications such as gabapentin or duloxetine rather than opioid medications that do not target neuropathic pain sources.
Chronic pain can also be treated with topical pain formulations such as topical NSAIDs like diclofenac (Voltaren gel) or compounded formulations such as ketoprofen gel. These topical formulations offer targeted pain relief with a reduced risk of adverse side effects. NSAIDs (non-steroidal anti-inflammatory drugs) can have unwanted adverse effects such as increased risk of gastrointestinal bleeding or cardiac risks when taken orally. Topical formulations are not systemically absorbed; therefore these risks are greatly reduced.
Opioid medications should always be a last resort in treating chronic pain. Although these medications may offer pain relief, the risks associated with opioids often far outweigh the pain relief.
About the Author:
Dr. Jessica Badichek is the Director of Clinical Operations at CompreCareRx. With extensive knowledge of psychiatric therapeutics, substance use disorder therapies and pharmaceutical compounding, she is dedicated to providing optimal clinical care policies that focus on the needs of every individual patient. She has a passion for caring for those suffering from addiction and seeks to provide superior clinical care. She holds a Doctor of Pharmacy degree from Philadelphia College of Pharmacy and is a registered pharmacist.