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Ask the Expert: What pain management alternatives to opioids are available?

Ask the Expert: What pain management alternatives to opioids are available?

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What pain management alternatives to opioids are available?

Increased prescription of opioids has led to widespread misuse of prescription and non-prescription opioids. In 2017, the U.S. Department of Health and Human Services health department declared the opioid crisis a public health emergency and announced strategies to combat this national issue.

Millions of Americans are in pain. Whether it’s chronic headaches or back pain, recovering from surgery, sports injuries or accidents, millions of prescriptions are written for pain medications — many of them powerful opioids that can cause side effects and lead to addiction. But there are many non-opioid treatments available for pain, including prescription and over-the-counter medications, injections, physical therapy and pain psychology.

Non-opioid medicationsNon-opioid prescription medications can be prescribed for muscle pain, nerve pain, bone pain and inflammation, as well as other causes of pain. Muscle relaxants can help ease tight muscles and spasms in the back and neck, while nerve pain medications like gabapentin and duloxetine will calm down the burning or tingling sensation from irritated nerves. Non-steroidal anti-inflammatory medications — available both through a prescription strength or over the counter — can help with inflammation and aching bone pain.

Other interventionsCertain types of pain respond well to injections. Injections are done at an outpatient clinic, are generally well tolerated and can be used alone or in conjunction with other treatment options. At UVa Health, we may utilize cutting-edge techniques that involve inserting a needle next to the nerve that is responsible for the pain, then burn the nerve by using electric current created by radio waves. This may help with back and neck pain, and results can last up to a year. Steroid injections in the back and neck also can help with pain that may go down the arm and leg.

Pain that doesn’t respond to other treatment options may respond to a therapy known as spinal cord stimulation. This cutting-edge technique uses a pacemaker-like device that replaces the pain with a more tolerable sensation, typically a tingling or massage-like feeling. The physician implants the device in the lower back, attaching it to tiny wires that are in the spinal canal. When patients feel pain, they can use a remote control to send signals to the painful area. This technique can help with back pain as well as pain going down the arms or legs. New forms of SCS show promise in relieving pain without tingling.

Physical therapyA physical therapist or physician who specializes in physical medicine and rehabilitation may be able to create a program that helps improve your ability to function and decreases your pain. It is very important for patients to participate in physical therapy not only to help improve their symptoms but to preserve and maintain function going forward.

Pain psychologyOur expert pain psychologists at UVa Health work with patients on developing coping mechanisms to deal with their pain as well as reduce pain levels. They are skilled in techniques such as cognitive behavioral therapy, biofeedback, mindfulness and self-hypnosis.

There are many other options that we can explore together. Our goal at the UVa Health Pain Management Center is to create a custom treatment plan for you to reduce your pain, improve your functionality and get you back to the things you enjoy.

For more information about the UVa Health Pain Management Center, visit

Dr. Anna Irwin is an anesthesiologist and board-certified pain management specialist at UVa Health.

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