12 OPIOID ALTERNATIVES

12 OPIOID ALTERNATIVES BEING PUSHED ON PAIN PATIENTS... INSTEAD OF THE OPIOID PRESCRIPTION THAT ONCE MANAGED THEIR PAIN

1.   RADIOFREQUENCY ABLATION

INFO & BENEFITS:   Radio-frequency ablation disrupts nerve conduction, specifically interrupting the conduction of pain signals. In turn, this may reduce pain, and other related symptoms. Approximately 70 percent of patients will get a good block of the intended nerve. This should help relieve that part of the pain that the blocked nerve controls. Sometimes after a nerve is blocked, it becomes clear that there is pain from the other areas as well* (*In other words wrong spot, another injection, another time)

OUTCOME:   The nerves are usually blocked for 6-9 months, although it may last as short as 3 months or as long at 18 months or longer.

SUCCESS RATE:  about 30% to 50% of patients that undergo this procedure for low back pain experience significant pain relief for up to two years. Out of the remaining 50-70%, about 50% of those patients will get some pain relief for a shorter period.

DISADVANTAGES/RISKS:   Nerves regenerate over time, causing the alleviated pain to return.

The nerves to be ablated may be near blood vessels or other nerves that can be potentially damaged.

COST*:   Cervical--  $ 4,000.00      Lumbar or Thoracic--  $ 4,650.00

Links:  http://www.medcentral.org/Main/RadiofrequencyAblation.aspx

 2.   NERVE BLOCK AKA EPIDURAL INJECTION (BANDAID?)

INFO & BENEFITS:   An epidural steroid injection (ESI) treats inflammation associated with back pain, as well as related pain in the neck, legs, or arms. An epidural procedure delivers powerful anti-inflammatory medicine directly into the epidural space. The steroid (cortisone) will usually begin working within 1-3 days, but in some cases it can take up to a week to feel the benefits. Although steroids do not change the underlying condition, they can break the cycle of pain and inflammation, allowing the body to compensate for the condition.

OUTCOME:   Although steroids do not change the underlying condition, they can break the cycle of pain and inflammation, allowing the body to compensate for the condition. While the effects of an epidural steroid injection tend to be temporary (lasting from a week to up to a year)

SUCCESS RATE:  50% of patients receive some pain relief as a result of lumbar epidural steroid injections. Depending on the study these rates are highly debatable. Some state 80-90% however that was in comparison to Placebo. It is very important that you research and know what type of steroid is being injected. See Dr. Oz’s In-Depth Investigation of Epidural Steroid Injections, be sure to read, do some research, and judge for yourself.

http://www.doctoroz.com/article/depth-investigation-epidural-steroid-injections?page=1

http://nationalpainreport.com/study-finds-nerve-blocks-risky-8823030.html

http://nationalpainreport.com/the-dark-side-of-epidurals-8816252.html

DISADVANTAGES/RISKS:   Steroid injections do not change the underlying condition. Most doctors limit patients to two or three injections per year, as having injections too often may weaken spinal bones or nearby muscles. Receiving higher doses of the steroids in these injections may cause similar problems. Overall we suggest you do your homework, be choosy, and do not get too many or you may be causing more damage.

COST*:   Epidural Injection* Cervical, Lumbar, or Thoracic, w/ general anesthesia $2,750 - $ 3,550, Sacroiliac (SI) Joint* $ 1,850-$ 2,650, Facet Injection* Cervical, Lumbar, or Thoracic with general anesthesia $3,050.00

* You can expect to pay about $800.00 less for local anesthesia vs. general

LINKS: http://www.spine-health.com/treatment/injections/epidural-steroid-injection-pain-relief-success-rates

https://www.epainassist.com/pain-management/intrathecal-pain-pump-the-cost-of-surgery-and-refill

 3.   SPINAL STIMULATOR or INTRATHECAL PAIN PUMP:

INFO & BENEFITS:   (aka neurostimulators or drug pumps) These devices are meant for chronic pain or severe spasticity that isn't responding to medication, or the side effects. The implantable device may help to manage nerve or chronic pain, and restore one’s ability to do everyday activities.

OUTCOME:   Provide pain relief around the clock with less side effects. They decrease the need for oral pain medications, and improve quality of life

SUCCESS RATE:  If you are selected and can get through the entire process studies show approximately 50% reduction in chronic pain. Multiple types of opioid medications are available for the device. Many report a much better quality of life however don’t get too excited until you read all the information and the links at the bottom.

http://professional.medtronic.com/pt/neuro/scs/eff/data-clinical-outcomes/index.htm#.WNY2kjvsLIU

DISADVANTAGES/RISKS:  PRICE! Very costly! The process is absolutely tedious. Two surgeries one minor for trial (outpatient) the other more involved for the insertion. There is a 1 in 20 chance of death from overdose. After researching you will probably be scared and should be, the stories from patient complications are nothing short of a nightmare… while awake. Complications are not uncommon. The pumps do not last forever so you can expect to go through this multiple times. There is only one company that makes the pumps and there are very few if any long term studies.

COST*:   The newer devices can cost $20,000. That is just the device. One report showed over two years the expense would run $60-85,000.00

http://www.medtronic.com/us-en/patients/treatments-therapies/drug-pump-chronic-pain/getting-a-device/drug-pumps-questions-answers.html#question8

http://www.healthcentral.com/chronic-pain/c/915283/142528/intrathecal/

http://nationalpainreport.com/medtronic-pain-pump-blamed-for-14-deaths-8820647.html

https://www.epainassist.com/pain-management/intrathecal-pain-pump-trial-and-its-contraindications

https://www.epainassist.com/opioid-treatment/interventional-treatment/pump-implant-pain-medications

https://www.ncbi.nlm.nih.gov/pubmed/9932882

https://www.ncbi.nlm.nih.gov/pubmed/9083712

4.   ACUPUNCTURE:

INFO & BENEFITS:   Acupuncture involves the insertion of extremely fine needles into the skin at specific "acupoints." This may relieve pain by releasing endorphins, the body's natural pain-killing chemicals, and by affecting the part of the brain that governs serotonin, a brain chemical involved with mood. No drugs. Natural. Many pain management offices are now including this option within their own practice.

OUTCOME:   Varies widely. I remember years ago doctors and surgeons alike would dismiss any discussions or thoughts of using an acupuncturist and chiropractor. Today, we often wonder if the new acupuncture option at pain management is money driven. The procedure is now FDA approved.

SUCCESS RATE:  Success stories vary, some say it helps others say it doesn’t do a thing. Studies are the same with nothing concrete.

DISADVANTAGES/RISKS:  Although FDA approved, some states do not have any licensing requirements for acupuncturist so do your homework. Many patients will need to pay out of pocket. Ouch, for chronic pain 12-20 sessions are generally recommended.

COST*:   Generally $60.-$120.00 per treatment. Not covered by Medicare and many insurances

LINKS:             http://www.health.harvard.edu/healthbeat/relieving-pain-with-acupuncture

https://www.painscience.com/articles/acupuncture-for-pain.php

https://acupuncturenowfoundation.org/2016/03/one-two-three-four-how-many-sessions-more/

5.   CHIROPRACTIC CARE:

INFO & BENEFITS:   Chiropractors use hands-on spinal manipulation and other alternative treatments, the theory being that proper alignment of the body's musculoskeletal structure, particularly the spine, will enable the body to heal itself without surgery or medication. Years ago Surgeons would dismiss any thoughts or questions regarding a chiropractic care. I personally received my first diagnosis of scoliosis and leg length inequality at 17 from a chiropractor. Doctors and the schools missed this so

OUTCOME:   Considered a safe, effective treatment for acute low back pain, the type of sudden injury that results from moving furniture or getting tackled.  Many have also had success in relieving headaches. Many get relief but once things get severe there is only so much they can do to help. They can help keep your pain minimal especially those with basic pains.

It is not for everyone, people who have osteoporosis, spinal cord compression, or inflammatory arthritis, or who take blood-thinning medications should not undergo spinal manipulation.

SUCCESS RATE:  Success for those with acute pain shows a good amount of happy patients. Acute meaning pain from getting tackled or from a of sudden injury that results from moving furniture   Because there’s such a broad range of reasons one may see a chiropractor here are some of the medical research and studies regarding the therapeutic benefits of chiropractic.

https://draxe.com/10-researched-benefits-chiropractic-adjustments/

Unfortunately that’s not great news for those patients with lifelong chronic pain.

DISADVANTAGES/RISKS:  Not covered by many insurances and those that do have a cap. It is not for everyone.

COST*:   $30-$200.00- with the average session being about $65.00

LINKS:             http://www.webmd.com/pain-management/guide/chiropractic-pain-relief#1

https://draxe.com/10-researched-benefits-chiropractic-adjustments/

 6.   PHYSICAL THERAPY

INFO & BENEFITS:   The goals of physical therapy are to decrease pain, increase function, and teach the patient a maintenance program to prevent future problems. ... Passive physical therapy (modalities), which includes things done to the patient, such as heat application, ice packs and electrical stimulation.

OUTCOME:   You will learn how to properly do exercises and what at home treatments will help with the pain you are having and relieve that pain. After a surgery physical therapy is used to get you moving again.

SUCCESS RATE:   It really depends on the patient’s issue, on average 50% is a safe estimate. Here’s an interesting and recent article.

www.thegoodbody.com/physical-therapy-statistics-and-facts/

DISADVANTAGES/RISKS:  Some patients spend a lot of time doing therapy when they really should have had an MRI and surgery first. Many insurances are very picky about the order doctors are dealing with pain, requiring this before that and so on, which can be very frustrating to patients in a lot of pain.

COST*:   Most insurances will cover some physical therapy and HMOs are required to cover it. http://www.thegoodbody.com/physical-therapy-statistics-and-facts/

LINKS: http://www.spine-health.com/treatment/physical-therapy/physical-therapy-low-back-pain-relief

7.   NSAIDS ASPIRIN & IBUPROPHEN

INFO & BENEFITS:   OTC, Non-steroidal anti-inflammatory drugs, known as NSAIDs, are more than just pain relievers. They also reduce inflammation and lower fevers. A recent study published in Lancet found that NSAIDs are effective in relieving pain, but prevent blood from clotting. So using them can put patients at an increased risk for heart attack and stroke, as well as gastrointestinal problems and ulcers.

OUTCOME & DISADVANTAGES/RISKS:  Many of the pain patients I spoke to consider this option “laughable” and feel insulted at the provider’s suggestion. I agree, these patients are very familiar with these OTC drugs and will never get nearly the amount of pain relief needed. They may not have a stomach left if they tried. Patients do use this when needed for certain types of pain but not for chronic pain.

COST*:   Minimal, OTC, out of pocket

 8.   ACETAMINOPHEN:

INFO & BENEFITS:   OTC, The generic version of Tylenol is easily obtained over the counter and is often used for patients who don't take NSAIDs because of stomach irritation or worries about heart attacks. Like NSAIDs, acetaminophen is useful in relieving pain, but more than 4000 mg should not be taken in 24 hours or acute liver failure may occur.

OUTCOME & DISADVANTAGES/RISKS:  Many of the pain patients I spoke to consider this option “laughable” and feel insulted at the provider’s suggestion. I agree, these patients are very familiar with these OTC drugs and will never get nearly the amount of pain relief needed. They may not have a stomach left if they tried. Patients do use this when needed for certain types of pain but not for chronic pain.

COST*:   Minimal, OTC, out of pocket

9.   ANTICONVULSANTS:

INFO & BENEFITS:   Anticonvulsant medications are effective in treating neuropathic pain conditions, which can cause burning and shooting sensations, according to the American Chronic Pain Association. Gabapentin (Neurontin) has been shown to be effective in high dosages, according to the American Academy of Family Physicians, but can cause dizziness, headache, diarrhea and confusion. Although anticonvulsants are not habit-forming, the American Chronic Pain Association advises against abrupt discontinued use. The medication is intended to be taken every day, whether or not the patient is experiencing pain.

OUTCOME:   Some relief from nerve pain and the unpredictable sensations they cause. Please research this drug prior to long term use and high doses.

SUCCESS RATE:   Rated fairly low for pain on drugs.com 6.5 out of 10 for pain, some patients love it and others are ready to scream and have no relief at all. Neuropathy (nerve pain) gets a 6.3 and restless leg was the highest of these at 6.7 out of 10 when this was written.

DISADVANTAGES/RISKS:  Gabapentin is not approved by the FDA for many of the conditions patients are reporting it is being prescribed for. The drug is only approved to treat a handful of conditions such as Epilepsy, Postherpetic Neuralgia, and

Restless Legs Syndrome. Also nerve pain caused by herpes virus or shingles. Certain brands can treat something the other can’t so be careful with this one and look it up.

https://www.drugs.com/gabapentin.html

COST*:   Should be covered by most insurances.

LINKS:  PLEASE READ THIS ONE         https://www.peoplespharmacy.com/2012/05/26/gabapentin-side-effects/

http://www.medicaldaily.com/gabapentin-side-effects-dangers-label-prescriptions-surprising-side-effects-403998

 10.        ANTIDEPRESSANTS:

An increasing number of providers are suggesting antidepressants for those with chronic pain even if they are not depressed. Many are pointing to Cymbalta. In adults it is used to treat major depressive disorder, general fibromyalgia (a chronic pain disorder), and chronic muscle or joint pain (such as low back pain and osteoarthritis pain). Cymbalta is also used to treat pain caused by nerve damage from diabetic neuropathy. There are a host of side effects, some make it much less appealing. For those fortunate enough to also have the option and access to medical marijuana, you are envied by many and may prefer it as an effective alternative to all the side effects of the antidepressants and nerve issues. Tricyclic antidepressants, such as Amitriptyline, Imipramine and Clomipramine, are particularly effective in treating neuropathic pain. But a study published in Psychiatry (Edgmont) found that tricyclic antidepressants can cause a host of side effects, including weight gain and cardiovascular problems. Cymbalta is FDA approved to treat chronic and musculoskeletal pain.

BENEFITS:   Cymbalta is FDA approved to treat many chronic pain and chronic musculoskeletal pain disorders.

OUTCOME:   Patients vote this a 6.7 out of 10, some are saying risks outweigh the benefits.

SUCCESS RATE:  Overall patients vote this a 6.7 out of 10, the link below breaks them down by condition.  https://www.drugs.com/comments/duloxetine/cymbalta.html

DISADVANTAGES/RISKS:  Very difficult to discontinue, when you do it must be managed by a physician. Cymbalta comes a long list of not so appealing side effects and unfortunately there are very few long term studies.  I found one from patients with over 2500 reviews, you may want to check this out. http://www.askapatient.com/viewrating.asp?drug=21427&name=CYMBALTA

If you are not opposed to Medical Marijuana those that live in approved states may want to read up on it.            https://www.painnewsnetwork.org/stories/2017/2/27/pain-patients-prefer-marijuana-over-opioids

COST*:   Should be covered by most insurances.

LINKS: https://www.drugs.com/cymbalta.html

https://www.bostonglobe.com/metro/2016/09/17/rejecting-opioids-pain-patients-find-relief-with-marijuana/WGJlr7Q5TEh4XDp6N4vZQJ/story.html

https://www.theatlantic.com/health/archive/2017/02/marijuana-cannabinoids-opioids/515358/

http://www.webmd.com/pain-management/news/20151007/medical-marijuana-seems-safe-for-chronic-pain-patients-study-finds#1

11.COGNITIVE BEHAVIORAL THERAPY:

Seeing a mental health counselor (psychotherapist or therapist) because they say “Many people with unrelenting chronic pain can feel hopeless”. Cognitive behavioral therapy can help them practice “acceptance theory," which can lead to changed behaviors and perceptions.

BENEFITS:  CBT works by enhancing coping skills, increasing confidence and self-efficacy for managing pain and dealing with emotional problems.
SUCCESS RATE:  Minimal at best for pain, but may give some patients a better outlook on how to handle it. Possibly they will meet others or have a support system in place for bad days.

DISADVANTAGES/RISKS:  Cost, and Can be time consuming. Outpatient therapy can last 5-10 months, with one 50 minute session per week. Partial Inpatient 3-4 weeks (daily for 8 hours, then home in evenings)

Inpatient varies from 30-90days depending on diagnosis and if addiction is involved.

The biggest disadvantage is the pain that sent you there.

COST*:   Medicare will only cover a few visits under certain situations and only for certain reasons or disorders. Some addiction is covered but not many basic mental health. You would need to check with your insurance company, some do and some don’t, but most have limitations.

LINKS:             https://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy/

https://www.apa.org/pubs/journals/releases/amp-a0035747.pdf

http://my.clevelandclinic.org/health/articles/chronic-pain-rehabilitation

https://patient.info/health/cognitive-behavioural-therapy-cbt-leaflet

12.        QUELL:

We’re adding this one since maybe some of you haven’t heard of it yet. Quell is a TENS unit worn below the knee that stimulates nerves, blocks pain signals from reaching your brain, and claims drug free relief in as little as 15 minutes. Quell claims to provide intensive nerve stimulation technology and to be 5x more powerful than other leading over-the-counter pain relief devices. It can be customized and automatically adjusts therapy so that you receive optimal pain relief. Quell can be used alone but was designed to be used in conjunction with other therapies. Quell is used for the following… Nerve Pain, Arthritic & Joint Pain, Leg & Foot Pain, Lower Back, and Widespread Pain.

BENEFITS:   No Prescription, 60 day trial period w/ a money back guarantee. 100% drug free.

OUTCOME:   Some patients are getting relief.

SUCCESS RATE:  We’ve included links so you can see if success stories include your condition.

DISADVANTAGES/RISKS:  PRICE, OTC, not covered by Medicare or insurance. Those with severe pain may incur higher monthly costs and may need other therapies to use in conjunction. At this time there were 2-3 of the monthly electrode products out of stock.

COST*:   All costs will be out of pocket, it is over the counter and not covered by insurances. $250.00 for the unit plus monthly maintenance of about $30.00 for electrodes which may increase as you become accustomed to it. There are also other accessories which may increase costs.

LINKS:             https://www.quellrelief.com/

There are a lot of reviews on amazon you can see for yourself here…

https://www.amazon.com/Quell-Wearable-Pain-Relief-Starter/dp/B01GLHM9NG/ref=sr_1_1_a_it?ie=UTF8&qid=1490427495&sr=8-1&keywords=quell+device

Here are some additional links definitely worthwhile reading:

-          http://drugabuse.com/opiate-alternatives-doctors-got-a-brand-new-bag/

-          https://www.painnewsnetwork.org/stories/2016/10/25/unwilling-to-suffer-in-silence-over-cdc-opioid-guidelines

-          https://pricinghealthcare.com/healthServices/

Can Chronic Pain Cause Suicidal Thoughts?

-          https://www.epainassist.com/pain-management/can-chronic-pain-cause-suicidal-thoughts

We hope that you have found some information and answers so that you can make better decisions and so that have access to information other than what may have been discussed or provided to you. Many of these alternatives are being offered to opioid pain patients instead of the opioids that once managed their pain. Many providers are not offering a choice to the patient. So the patient hears “we will not write you any narcotic opioid prescriptions, so now you have these options. We try to show you the basic Benefits, cost and Risks and provide you with links to the information/studies we found online. They will provide full details and/or study results.

www.Opioidpainpatients.com/12-opioid-alternatives-being-pushed-on-pain-patients

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