There are so many options when it comes to treating pain. Opioid medications should not be the default. The trick is to find an option that is effective and has the least side effects.

Coping with Chronic Pain

Acupuncture may help cancer patients with chronic pain.

Diagnosis Life summary:
A study in JAMA Oncology (https://doi.org/10.1001/jamaoncol.2021.0310) looked at 360 cancer survivors with chronic musculoskeletal pain (at least 3 months in duration). Researchers randomized participants to treatment with weekly electroacupuncture, weekly auricular acupuncture, or usual care (analgesic medications, glucocorticoid injections, or physical therapy) over 12 weeks. They measured pain using the 10-point Brief Pain Inventory (BPI). At the end of the study, electroacupuncture improved the BPI score by 1.9 points and auricular acupuncture by 1.6 points when compared to the usual care group. Not only that, people in the acupuncture groups reported better physical function and quality of life than their peers. The benefits persisted after 24 weeks, even though patient did not get more treatments.

Mindfulness training may be an effective way to treat chronic pain.

Diagnosis Life summary:
The opioid epidemic has America on its knees. People are dying at alarming rates. Health care continues to scramble for alternative pain management and ways to treat addiction. A meta-analysis of 21 studies in Evidence Based Mental Health (https://doi.org/10.1136/ebmental-2018-300062) looked to see if mindfulness-based stress reduction (MBSR) training could be an effective option. Researchers compared the effects of mindfulness with controls and found that pain symptoms actually decreased. Not only that, physical functioning and depressive symptoms improved too. It was the best of all worlds! These results are comparable to those achieved with cognitive-based therapies.

Non-opioid treatments may be better for acute surgical pain.

Diagnosis Life summary:
Non-opioid treatments are not only helpful for chronic pain symptoms. They may even be preferred after surgery. A consortium of 70 hospitals across Michigan contributed to a report in JAMA Surgery (https://doi.org/10.1001/jamasurg.2020.5646). Researchers looked at 620 patients who had uncomplicated surgeries, namely gallbladder removal, thyroid removal, and hernia repairs. Half of the patients received opioid-sparing therapy (no opioid medications or a small “just in case” opioid prescription) and the others received standard therapy (a larger opioid prescription). Surveys performed at one and three month intervals showed that all patients were satisfied with their care. More importantly, those in the opioid-sparing group reported less pain overall.

Opioids are not better for pain control than non-opioid medications.

Diagnosis Life summary:
From arthritis to fibromyalgia, millions of people suffer from chronic pain. How can we best treat it, or at least decrease that pain so they can stay active and productive? Let’s look at non-opioid therapies like acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen. A study in JAMA (https://doi.org/10.1001/jama.2018.0899) finds these medications are just as effective as opiates in managing pain over 12 months. In fact, overall functionality was equal across both treatment groups. Pain intensity was better controlled in the non-opioid treatment group. People in the opioid treatment group suffered more medication-related side effects. If we want to decrease unnecessary use of addictive opioid medications, we need to use these simpler regimens first-line.

Topical NSAIDs may be a better choice for musculoskeletal pain.

Diagnosis Life summary:
Many people turn to pills for pain relief but they may be going about it all wrong. The latest recommendations from the American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) turn to topical therapies for treatment of musculoskeletal injuries, at least for the first 4 weeks. Annals of Internal Medicine (https://doi.org/10.7326/M19-3602) published the guidelines based on a meta-analysis of over 200 trials. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) — with or without menthol gel — are recommended as first-line treatment. Oral NSAIDs would be second line therapy with acupressure or transcutaneous electrical nerve stimulation (TENS) in third place. They discouraged opioids and tramadol altogether.