In Pain? There are Alternatives to Opioids

Joints, bones, tendons, ligaments and nerves work together to move us through the world, but overuse or injury to these amazing body parts can hamper our mobility — and cause teeth-gritting pain. Fortunately, orthopedic pain is a manageable problem when treated with suitable therapies.

Clinicians divide pain into two broad categories: acute and chronic. Acute pain — usually caused by injury or trauma, including surgery — lasts for a short time and disappears once the damage is treated or healed. 

Most of the time, pain signals that the body is in distress.

Chronic pain is ongoing and sometimes lasts even after an injury has healed.

According to the U.S. Centers for Disease Control and Prevention, more than 51 million people – over 20% of U.S. adults – suffer chronic pain. Of those, 17 million – about 7% – have high-impact chronic pain.

Kristopher J. Paultre, M.D., a family medicine and primary care sports medicine specialist with the University of Miami Sports Medicine Institute, sees both acute and chronic pain cases in his practice. His patients range from young, active athletes suffering from an overuse injury to older folks whose pain is caused by the wear and tear over time.

“There are four main [pain] sites I see most often,” he says. “Shoulder, knee, hip and back.”

By the time patients end up in his office, they desperately want relief from pain that affects their daily lives, often making it difficult to do even minimal activities. 

“Most have tried over-the-counter pain medications and already have seen their primary who has referred them.”  

There are several pain management options, none involving the class of narcotic painkillers known as opioids.

(More than 2 million people in the U.S. are addicted to opioids, and the problem is so serious that the Department of Health and Human Services declared opioid abuse a public health emergency in 2017.)

Dr. Paultre’s go-to-first step is prescribing physical therapy for his patients, but even PT is sometimes insufficient. Here are other alternatives he recommends:

• Steroid shots. These injections use a corticosteroid medication plus a local anesthetic to help tame the pain and inflammation in a specific body part. The med is injected into an affected joint, muscle or tendon sheath. These shots help treat various conditions, from bursitis to tendonitis to back pain. They are also very effective for different types of arthritis.

There are, of course, potential side effects with repeated use, including cartilage damage, temporary weakening of tendons and ligaments, and impaired bone remodeling at the injection site. That’s why Dr. Paultre limits injections to no more than once every three months. “Steroids are one of the most powerful drugs we have, and they work remarkably well,” he says.

• PRP. Platelet-rich plasma is created by withdrawing vials of a patient’s own blood, centrifuging this blood to concentrate platelets, and then injecting the resulting product into the pain area. PRP can be used alone or together with other therapies, and it’s considered a good option for patients who have not found relief with steroid shots. However, “we’re still in the early stages of regenerative medicine and actively studying more about it,” Dr. Paultre warns. Another caveat: most insurances don’t cover PRP shots.

That said, Dr. Paultre has found these injections to be effective for chronic pain resulting from osteoarthritis as well as overuse and acute injuries in tendons, muscles, and ligaments. Scientists believe that the bio-proteins, or hormones known as growth factors found in both the plasma and platelets, help speed up the healing process by repairing the damaged tissue and bringing down inflammation. Another plus: The risk of an adverse reaction is much lower than with other shots, including steroid shots, because PRP injections contain a patient’s own cells.

• Hyaluronic acid injections. These injections are a good alternative when steroid shots have failed to ease the pain, and many insurances cover them, at least partially. They are composed of a “gel” – hyaluronic acid – that can bind and thicken the normal joint fluid, therefore serving as a lubricant. These shots are used mostly in osteoarthritis cases, specifically in the knee. Some clinicians believe that injected hyaluronic acid can decrease the inflammation of cartilage cells and provide a protective sheath. But like other shots, the number of injections should be limited. What’s more, relief may take several weeks after the injection, and it is only temporary, lasting from several months to a year.
• Nerve blocks. Though not as common as other therapies, such as steroid shots, nerve blocks have a lot going in their favor. They provide almost immediate relief and can be used in many forms to manage pain, not only from the spine but also pain that affects the neck, buttocks and limbs. Nerve blocks, though, work only in certain circumstances. For example, if the pain is not related to a single or small group of nerves, the treatment won’t work. Side effects include itching, rash, soreness at the site of injection and bleeding.
• Nerve Ablation. Rather than simply blocking a nerve or a set of nerves, ablation actually destroys the nerve or nerves in the pain area, thus providing relief from chronic pain. The therapy is done under a local anesthetic and involves a needle that uses chemicals, radiofrequency or a laser to kill the nerves. Ablation is usually used when other treatments haven’t worked. The destroyed nerve can grow back, requiring a second procedure.

Ana Veciana-Suarez is a regular contributor to the University of Miami Health System. She is a renowned journalist and author who has worked at The Miami Herald, The Miami News, and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow @AnaVeciana on Twitter.

Tags: Dr. Kristopher Paultre, pain relief, prp treatment, reducing inflammation