Evaluating your patient’s pain accurately and providing the most appropriate and effective treatment can be among the greatest challenges for healthcare professionals today. 

The opioid epidemic has left many providers reluctant to prescribe addictive pain meds. Therefore, adding more tools to your pain management arsenal gives you opportunities to further tailor your treatment recommendations and promote a better quality of life for those under your care.

Alternative therapies

Complementary therapies and alternative medicine have remained popular for pain management, particularly those with a low-risk profile.

Acupuncture

This ancient Chinese practice involves inserting thin needles into specific points on the body and applying stimulation manually or using heat or electricity. Neuroscience research suggests acupuncture boosts the production of neurotransmitters and endorphins that affect pain perception.

Studies have shown acupuncture to be effective in managing various types of pain, and it’s increasingly being covered by insurance companies accordingly. In one systematic review of 17 studies, acupuncture effectively treated chronic and acute pain of the lower back when compared with “sham” acupuncture in control groups.

Hypnosis

During hypnosis, patients enter a hyper-focused state that’s free from distractions. Once in this meditative state, they focus on manipulating their perceptions about a particular problem or sensation.

Music therapy

Music therapy is conducted in a patient-provider setting where the therapist plays recorded or live music, or the patient actively makes music by singing or playing instruments.

While it may seem like a benign form of treatment, a massive meta-analysis including 97 trials found music therapy effective for reducing pain and its associated emotional distress, as well as for reducing the use of anesthetics and opioids, in the general population.

Medication options

Whether prescription or over-the-counter, non-opioid pain medicines come with their own list of potential side effects and contraindications. Here’s a quick overview of medications most closely tied to effective pain management.

NSAIDs and acetaminophen

NSAIDs, like ibuprofen and naproxen, are widely used for pain management. They work by inhibiting enzymes that produce prostaglandins, substances responsible for inflammation and pain. NSAIDs are particularly effective for conditions involving inflammation, such as arthritis or musculoskeletal injuries.

Acetaminophen, commonly known as Tylenol, is a widely available over-the-counter pain reliever. It works by reducing the production of prostaglandins in the brain. While it's generally safe when used as directed, excessive consumption can lead to liver damage, making it essential to follow dosage guidelines.

Both NSAIDs and acetaminophen may not be appropriate in certain cases. The review article on integrative pain management in cancer states that patients undergoing chemotherapy are not candidates for use of these drugs given associated risks for liver and kidney toxicities. In addition, these fever-reducing medications can make it difficult for clinicians to spot the warning signs of infection, per the Journal of Cancer review.

Serotonin–norepinephrine reuptake inhibitors (SNRIs)

Certain antidepressant medications are often considered for the treatment of chronic pain. They work by altering neurotransmitter levels in the brain, which can affect pain perception. Despite some evidence for the efficacy of antidepressants for the treatment of pain, clinicians should use caution and understand the limitations of these drugs in pain management. Most studies on antidepressants for pain management are inconclusive or fail to show significant improvements.

Anticonvulsants

Medications like gabapentin and pregabalin, originally developed to treat epilepsy, have proven helpful in some populations in managing neuropathic pain that’s resistant to other therapies. Studies suggest that pregabalin is superior to gabapentin in reducing neuropathic cancer pain and the need for morphine.

Scarborough BM, Smith CB. Optimal pain management for patients with cancer in the modern era: Pain management for patients with cancer. CA: A Cancer Journal for Clinicians. 2018;68(3):182–196.

Nonetheless, insurance companies may require attempts with gabapentin before approving coverage for pregabalin.