By Dr. Mercola
In the 1940s, opioid-based narcotics like opium and heroin were popular drugs of abuse, which lead to strict controls being put into place to curb their use. Regulations existed to control who could prescribe opioids and at what doses; breaches to the regulations could lead to a loss of your medical license or criminal prosecution.
Many physicians feared the repercussions, and thus may have under-prescribed such medications, even in cases where they're called for, such as in late-stage cancer pain.1
Decades later, in the 1990s, successful lobbying by pharmaceutical makers led to changes in the opioid regulations, such that doctors couldn't be penalized for prescribing them.
The loosened regulations paved the way for the aggressive treatment of pain, not only in cancer patients and those with terminal diseases, but in virtually anyone with chronic pain. We're now at the opposite end of the spectrum, where opioids are vastly overprescribed and doing far more harm than good.
American Academy of Neurology: Opioids Not for Non-Cancer Chronic Pain
The American Academy of Neurology has released a new position statement on opioids, highlighting the problems of overuse. Since policies changed in the late 1990s, over 100,000 people have died, directly or indirectly, from prescribed opioids in the US.
In the highest-risk group (those between the ages of 35 and 54), deaths from opioids exceed deaths from both firearms and motor vehicle accidents.
The report notes that while such drugs may offer short-term relief for non-cancer chronic pain such as back pain, headaches, migraines, and fibromyalgia, they cause more harm than good over time:2
"Whereas there is evidence for significant short-term pain relief, there is no substantial evidence for maintenance of pain relief or improved function over long periods of time without incurring serious risk of overdose, dependence, or addiction."
Research has shown, for instance, that more than half of people who use opioids for three months will still be using them five years later.3 Meanwhile, a study published in the New England Journal of Medicine found that long-term use of opioids actually does little to relieve chronic pain.4 In some cases, they may even make chronic pain worse. As TIME reported:5
"…the opioids can backfire in excessive doses; in the same way that neurons become over-sensitized to pain and hyper-reactive, high doses of opioids could prime some nerves to respond more intensely to pain signals, rather than helping them to modulate their reaction."
Powerful Opioids Should Be the LAST Resort for Pain… But They're Currently the First
Pain is one of the most common health complaints in the US, but record numbers of Americans are, sadly, becoming drug addicts in an attempt to live pain-free. According to 2010 data, there were enough narcotic painkillers being prescribed in the US to medicate every single adult, around the clock, for a month.6
By 2012, a whopping 259 million prescriptions for opioids and other narcotic painkillers were written in the US, which equates to 82.5 prescriptions for every 100 Americans.7 And those narcotics are responsible for 46 deaths each and every day...
Americans use the most opioids of any nation—twice the amount used by Canadians, who come in second place in terms of prescriptions.8 The problem has become noticeable enough that even US officials now warn that narcotic painkillers are a driving force in the rise of substance abuse and lethal overdoses.
Preliminary research presented at the 2014 meeting of the American Academy of Pain Medicine in Phoenix, Arizona also found that 12.6 percent of all primary care visits made by Americans between 2002 and 2009 involved prescriptions for sedatives and/or narcotic painkillers (opioids).9 The study also found:
- The number of prescriptions for sedative drugs rose by 12.5 percent a year
- Patients receiving a narcotic painkiller were 4.2 times more likely to receive a second prescription for a sedative
- The number of joint prescriptions of opioids and sedatives also increased by 12 percent a year in that time frame
- Prescription sedatives and narcotic painkillers are responsible for at least 30 percent of narcotic painkiller-related deaths
- Besides deaths caused by overdose, other risks associated with sedative use include falls in the elderly, emergency room visits, and drug dependence
Would You Take Heroin? Opioids Are Indistinguishable to Your Brain
You're probably aware that heroin is very addictive… but did you know that prescription opioids are virtually identical as far as your brain is concerned?
As explained by Dr. Wilson Compton, deputy director of the US National Institute on Drug Abuse, heroin, morphine, hydrocodone, and oxycodone "are all classified as opioids because they exert their effect by attaching to the opioid receptor found in our brain and spinal cord."10 For instance, hydrocodone, a prescription opiate, is synthetic heroin.
It's no wonder that over the past five years alone, heroin deaths have also increased by 45 percent -- an increase that officials blame on the rise of addictive prescription drugs such as Vicodin, OxyContin, Percocet, codeine, and Fentora, again all of which are opioids (derivatives of opium, like heroin).11
Clear Limits Called Upon for Opioid Use
Most studies on opioid use followed patients for only about one month, which is a fraction of the time most patients actually use them. In addition to not being effective and posing a very real risk of death by accidental overdose and addiction, opioids have also been linked to infertility, abnormal immune function, and heart problems.12
The American Academy of Neurology is now calling for clear limits to be set on opioid use, especially for non-cancer pain. Certain states already have warnings in place that require physicians to seek other opinions if a person takes daily opioid doses of 80-120 mg without getting relief.
Still, the pills shouldn't be viewed as a go-to treatment for chronic pain in the first place, as lifestyle changes, cognitive behavioral therapy, and other strategies are often more effective and far safer.
Are You in Severe Pain?
I strongly recommend exhausting all your options before resorting to a narcotic pain reliever, and I'll list a number of alternatives at the end of this article. That being said, if you're in severe pain, I agree that these drugs do have a place, and can be a great benefit when used cautiously and correctly. Chronic unremitting pain that is not relieved can impair your sleep and radically decrease your health.
However, the evidence is very clear that these drugs are being overprescribed, and can easily lead you into addiction and other, more illicit, drug use. I strongly suspect that the overreliance on them as a first line of defense for pain is a major part of this problem. So if you are struggling with severe or chronic pain, my first suggestion would be to see a pain specialist who is familiar with alternative treatments and the underlying causes of pain.
You need a knowledgeable practitioner who can help you attack the pain from multiple angles, giving you both relief and healing. One option that is receiving increasing attention in the US is cannabis. It's the cannabidiol (CBD) in cannabis that has medicinal properties. CBD is an excellent painkiller and has been used successfully to treat a variety of pain disorders.
In states where medicinal marijuana is legal, such as California, you can join a collective, which is a legal entity consisting of a group of patients that can grow and share cannabis medicines with each other. By signing up as a member, you gain the right to grow and share your medicine. I do, however, still recommend working with a health care practitioner who can guide you on the most effective dosage and form of use (cannabis may be inhaled, smoked, vaporized, taken orally, or even applied topically (in oil form).
19 Non-Drug Solutions for Pain Relief
I strongly recommend exhausting other options before you resort to an opioid pain reliever. The health risks associated with these drugs are great, and addiction is a very real concern. Below I list 19 non-drug alternatives for the treatment of pain. These options provide excellent pain relief without any of the health hazards that prescription (and even over-the-counter) painkillers carry. This list is in no way meant to represent the only approaches you can use.
They are, rather, some of the best strategies that I know of. I do understand there are times when pain is so severe that a prescription drug may be necessary. Even in those instances, the options that follow may be used in addition to such drugs, and may allow you to at least reduce your dosage. If you are in pain that is bearable, please try these first, before resorting to prescription painkillers of any kind.
- Medical cannabis has a long history as a natural analgesic, as mentioned.13 At present, 20 US states have legalized cannabis for medical purposes. Its medicinal qualities are due to high amounts (about 10-20 percent) of cannabidiol (CBD), medicinal terpenes, and flavonoids. As discussed in this previous post, varieties of cannabis exist that are very low in tetrahydrocannabinol (THC)—the psychoactive component of marijuana that makes you feel "stoned"—and high in medicinal CBD. The Journal of Pain,14 a publication by the American Pain Society, has a long list of studies on the pain-relieving effects of cannabis.
- Eliminate or radically reduce most grains and sugars from your diet. Avoiding grains and sugars will lower your insulin and leptin levels and decrease insulin and leptin resistance, which is one of the most important reasons why inflammatory prostaglandins are produced. That is why stopping sugar and sweets is so important to controlling your pain and other types of chronic illnesses.
- Take a high-quality, animal-based omega-3 fat. My personal favorite is krill oil. Omega-3 fats are precursors to mediators of inflammation called prostaglandins. (In fact, that is how anti-inflammatory painkillers work, they manipulate prostaglandins.)
- Optimize your production of vitamin D by getting regular, appropriate sun exposure, which will work through a variety of different mechanisms to reduce your pain.
- Emotional Freedom Technique (EFT) is a drug-free approach for pain management of all kinds. EFT borrows from the principles of acupuncture, in that it helps you balance out your subtle energy system. It helps resolve underlying, often subconscious, negative emotions that may be exacerbating your physical pain. By stimulating (tapping) well-established acupuncture points with your fingertips, you rebalance your energy system, which tends to dissipate pain.
- K-Laser Class 4 Laser Therapy. If you suffer pain from an injury, arthritis, or other inflammation-based pain, I'd strongly encourage you to try out K-Laser therapy. It can be an excellent choice for many painful conditions, including acute injuries. By addressing the underlying cause of the pain, you will no longer need to rely on painkillers. K-Laser is a class 4 infrared laser therapy treatment that helps reduce pain, reduce inflammation, and enhance tissue healing—both in hard and soft tissues, including muscles, ligaments, or even bones.
The infrared wavelengths used in the K-Laser allow for targeting specific areas of your body, and can penetrate deeply into the body to reach areas such as your spine and hip. For more information about this groundbreaking technology, and how it can help heal chronic pain, please listen to my previous interview with Dr. Harrington.
- Chiropractic. Many studies have confirmed that chiropractic management is much safer and less expensive than allopathic medical treatments, especially when used for pain, such as low-back pain. Qualified chiropractic, osteopathic, and naturopathic physicians are reliable, as they have received extensive training in the management of musculoskeletal disorders during their course of graduate healthcare training, which lasts between four to six years. These health experts have comprehensive training in musculoskeletal management.
- Acupuncture can also effectively treat many kinds of pain. Research has discovered a "clear and robust" effect of acupuncture in the treatment of: back, neck, and shoulder pain, osteoarthritis, and headaches.
- Physical and massage therapy has been shown to be as good as surgery for painful conditions such as torn cartilage and arthritis.
- Astaxanthin is one of the most effective fat-soluble antioxidants known. It has very potent anti-inflammatory properties and in many cases works far more effectively than anti-inflammatory drugs. Higher doses are typically required and you may need 8 mg or more per day to achieve this benefit.
- Ginger: This herb has potent anti-inflammatory activity and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice.
- Curcumin: In a study of osteoarthritis patients, those who added 200 mg of curcumin a day to their treatment plan had reduced pain and increased mobility. A past study also found that a turmeric extract composed of curcuminoids blocked inflammatory pathways, effectively preventing the overproduction of a protein that triggers swelling and pain.15
- Boswellia: Also known as boswellin or "Indian frankincense," this herb contains specific active anti-inflammatory ingredients. This is one of my personal favorites as I have seen it work well with many rheumatoid arthritis patients.
- Bromelain: This enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form but eating fresh pineapple, including some of the bromelain-rich stem, may also be helpful.
- Cetyl myristoleate (CMO): This oil, found in fish and dairy butter, acts as a "joint lubricant" and an anti-inflammatory. I have used this for myself to relieve ganglion cysts and a mild annoying carpal tunnel syndrome that pops up when I type too much on non-ergonomic keyboards. I used a topical preparation for this.
- Evening primrose, black currant, and borage oils: These contain the essential fatty acid gamma linolenic acid (GLA), which is useful for treating arthritic pain.
- Cayenne cream: Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting the body's supply of substance P, a chemical component of nerve cells that transmits pain signals to your brain.
- Methods such as yoga, Foundation Training, acupuncture, meditation, hot and cold packs, and other mind-body techniques can also result in astonishing pain relief without any drugs.
- Grounding, or walking barefoot on the earth, may also provide a certain measure of pain relief by combating inflammation.