Why Opioids Aren’t the Best Solution for Back Pain Management
Back pain is one of the top causes of disability and missed work in the United States. When people chronically feel pain and can’t work, they are desperate for solutions. While there are many approaches to back pain treatment, a health care provider may prescribe a drug from the opioid family, a powerful class of pain-relieving drugs. While these medications — including hydrocodone, oxycodone, codeine and morphine, among others — can be effective at pain management, they are not a long-term solution or even the best frontline treatment.
Opioids are addictive, and the misuse of these drugs has created a nationwide epidemic. In 2018, two of every three drug overdose deaths related to opioid use. Health care leaders from coast to coast are seeking ways to combat the opioid crisis through prevention, treatment and recovery initiatives. If opioids aren’t the answer to lower back pain, what is? Understand how these medications work and explore non-opioid pain treatment as you consider how to address your chronic pain.
How Opioids Block Pain
The body naturally produces opioids, including endorphins. Prescription opioids, such as morphine, treat pain by blocking signals sent to the brain. People usually take these drugs orally, but other delivery methods include an IV or a patch. These medications are only available with a prescription, which means you need to visit a doctor. You’ll then need to pick up your medicine at a pharmacy or receive treatment at a hospital.
How do opioids work? The body has opioid receptors in the nerve cells of the spinal cord, brain and other organs. Opioid receptors are responsible for the sensations of pain and pleasure. When you take an opioid, it activates these receptors. The drug kills pain by preventing nerve cell messages that tell the body it is in pain.
In addition to relieving pain, opioids can create feelings of relaxation and happiness. These pleasurable sensations occur due to chemical changes stemming from the interaction between the drug and the body’s opioid receptors. Given how enjoyable these feelings are, opioids have a high potential for abuse.
Many people associate long-term opioid use with addiction. While this is certainly possible, even short-term use of opioids comes with a risk of creating a drug dependency. Opioids can be an answer for acute pain, used for three days or less. When you use these drugs over extended periods, you can develop a tolerance for them. Then, it takes higher doses to produce the same pleasurable effects. Eventually, you can experience intense cravings for opioids when you aren’t using them.
Are Opioids More Effective at Managing Back Pain?
Back pain management without opioids can be effective. Opioids can address acute pain, but they do not solve the issue at its root cause. Additionally, many conditions that cause back pain are chronic, and opioids are not a long-term pain management solution.
Researchers have compared the use of opioids for back pain with non-opioid medications to determine if one approach is superior to the other. One study found no clinically relevant difference between treating back pain in the emergency room with three different opioids and non-opioid medications, including acetaminophen and ibuprofen. Another study came to a similar conclusion: opioids did not demonstrate superior outcomes in pain management for back, hip and knee osteoarthritis pain over 12 months when compared to treatment with non-opioid medications.
Though opioids have potent painkilling effects, that does not mean they are the best solution for managing chronic back pain. Opioids have more risk factors and severe side effects compared to many other approaches to back pain treatment.
What Side Effects Do Opioids Have on the Body?
While opioids can relieve pain and deliver a pleasurable feeling, the “high” is not the only effect these drugs have on the body. In the short term, opioids can have side effects like these.
- Mental fog: When using opioids, you may experience a condition nicknamed “brain fog.” These drugs can make you drowsy and impair your concentration and thought processes, creating that muddled sensation. The drugs may also slow your reflexes.
- Nausea: Research has shown that more than 60% of patients who take opioids will struggle with nausea and vomiting.
- Constipation: Nausea and vomiting are not the only GI symptoms associated with opioid use. These drugs can also cause a lack of fluid in the intestine, leading to constipation.
- Slowed breathing: While mental fog, nausea and constipation can be frustrating and uncomfortable, some side effects of opioids can be life-threatening. When misused, opioids can cause slowed breathing, leading to a condition called hypoxia. This condition happens when the brain is not receiving enough oxygen. Hypoxia can have severe neurological consequences, potentially long-term harm or even death.
Opioid Withdrawal Symptoms
It is possible to become addicted to opioids. When this happens, the body believes it needs the drug and develops a physical dependence on it. If you do not have access to the medication, you may experience withdrawal symptoms. Here are some of the earliest signs of withdrawal.
- Anxiety: In the first stages of withdrawal, people often become very anxious and even irritable.
- Difficulty sleeping: Insomnia and disrupted sleep can accompany the intense physical craving for the drug during withdrawal.
- Sweating: Excessive sweating during the early stages of withdrawal is also common. Flu-like symptoms may accompany this, including muscle cramps and body aches.
Withdrawal can begin between six and 30 hours since you last took an opioid. Withdrawal timeline and symptom severity will depend on the opioid in question. More severe withdrawal symptoms can begin approximately 72 hours since last taking the drug. These symptoms may include the chills and GI symptoms, such as nausea, vomiting and diarrhea. Some withdrawal symptoms can linger for months after ceasing opioid use.
When you are struggling with addiction, quitting opioid use without help can be dangerous. Withdrawal symptoms can be incredibly severe, and the “cold turkey” approach can lead to death. It is safest to quit opioids under medical supervision.
It is possible to overdose on opioids, whether you are struggling with addiction or not. Risk factors for overdose include the following.
- Opioid misuse: You are at a higher risk of overdose if you are not using opioids as prescribed. Additionally, opioid use without a prescription and medical oversight will increase the risk of overdose.
- Mixing substances: Mixing opioids with other medications, such as painkillers or alcohol, can affect respiratory function and contribute to the risk of an overdose.
- Opioid injection: People don’t always take opioids orally. They can also inject drugs, a common method of heroin use.
- Using opioids after detoxification: Over time, the body builds up a tolerance to opioids, but that tolerance might not be permanent. If someone resumes opioid use after a long period of abstinence — for example, following detoxification and addiction treatment — they are at risk of overdosing.
It is crucial to recognize the signs of overdose, so the opioid user can receive immediate medical help.
- Pale and clammy skin: Someone who is overdosing may have a wan, pasty complexion and damp, sweaty skin.
- Vomiting: Vomiting, or even a slight gurgling sound, can be a sign of opioid overdose.
- Difficulty breathing: Hypoxia is a significant concern related to opioid misuse. If you see someone struggling to breathe or notice their fingers or lips are taking on a blue or purple tinge, these are potential signs of overdose.
- Unconsciousness: Someone who has overdosed on opioids may become limp and lose consciousness entirely.
If you are concerned that someone has overdosed, call 911 immediately. When health professionals arrive, they will likely administer naloxone, which will reverse an overdose’s effects.
How to Manage Back Pain Without Opioids
While opioids may not be the best solution for back pain management, there are many non-opioid treatments for back pain.
- Radiofrequency ablation: Radiofrequency ablation is one of the alternatives to opioids. This minimally invasive procedure uses an electrical current to target specific areas of nerve tissue in the body. RFA helps minimize the pain signals generated in that area of the body by creating lesions on the targeted nerves. This treatment approach can offer patients pain relief for six to 12 months. Approximately 70% of patients who undergo this procedure have some level of pain relief. The side effects associated with RFA are minimal. Discomfort and bruising at the treatment site are common, but these typically resolve on their own shortly after undergoing treatment.
- Medial branch blocks: Your facet joints may cause chronic back pain. In cases like this, you may lean forward without pain, but experience spasms and pain when trying to lean backward. The medial branch nerve runs through the body’s facet joints and helps support your back muscles. A medial branch block can stop this nerve from sending pain signals. This procedure can provide immediate pain relief, depending on the pain’s cause. This procedure is more of a diagnostic tool. With the information a doctor gathers as a result, they can determine next steps.
- Regenerative medicine: Regenerative medicine refers to a group of therapies that can address chronic pain. Regenerative therapies aim to kick-start the body’s innate healing ability. This approach involves a targeted injection at the pain site. A doctor can use platelet-rich plasma taken from your blood and inject it to promote cellular growth and help heal the injury. It can take months to feel the full effects of a PRP injection, and research is ongoing to understand this approach’s efficacy.
- Intrathecal pain pump: An intrathecal pain pump is a device surgically implanted in a patient. This device, often called a pain pump, can treat various chronic pain conditions. The implantation procedure involves placing a catheter in the intrathecal space above the spinal cord, hence the name. The doctor then places the pump between the skin and muscle. The pump delivers pain medication based on a dosage determined by your doctor. You’ll need to get the pump refilled every one to three months, and replace its batteries every three to five years.
- NSAIDs: Nonsteroidal anti-inflammatory drugs are a non-opioid pain management treatment, but you should still use these drugs with caution. Many NSAIDs, such as naproxen and ibuprofen, are available over the counter, making them a go-to approach for fast pain relief. However, NSAIDs, like opioids, are not a long-term solution. If you are experiencing chronic pain that does not resolve, you will likely need to talk to a doctor about other treatment options.
- Topical formulas: Applying topical remedies to the skin can help alleviate back pain. Topical treatments are available in forms such as a gel, ointment, cream, spray or patch. These treatments, such as lidocaine, can help soothe nerve pain. Topical solutions offer steady relief and have a faster onset than medications taken orally. Some topical medications are available over the counter, while more potent formulations are only accessible via prescription. While topical formulas have advantages, they may not be a solution for all back pain. For example, applying a medication to the skin isn’t likely to affect spinal nerve pain.
- Non-drug therapies: Pain management without medication is a viable approach for many different back pain cases. For example, ice and heat can successfully treat acute pain caused by a muscle strain in the back. Other non-drug options include exercise and physical therapy. Low-impact exercises like yoga can strengthen your back and core muscles, preventing future injury. A physical therapist can teach you beneficial movements to stretch different muscles to alleviate pain. They can also recommend exercises to strengthen your muscles and make them more resilient. Physical therapists may use other approaches, like massage, to address pain. Physical therapy has the benefit of minimal side effects, and you can add many of the exercises and techniques you learn to a regular at-home regimen.
Relieve Your Pain at Spine Institute of North America
Everyone’s experience with back pain is different, which is why you need a care plan tailored to your condition. Our team of board-certified spine specialists uses their training to recommend the least invasive, most effective treatment options for common back pain conditions ranging from pinched nerves and sciatica to herniated discs and degenerative disc disease. You deserve answers to help you identify what is causing your pain.
Call us or fill out an online form to schedule your appointment. Our team of doctors is here to help relieve your pain and revive your life.