Safer Options: Alternatives to Opioids for Pain Management and Relief | Center on Addiction

Safer Options: Alternatives to Opioids for Pain Management and Relief

Safer Options: Alternatives to Opioids for Pain Management and Relief


The U.S. now consumes about 80 percent of the world’s opioid pain medication, despite being 5 percent of the world’s population; and the number of opioid prescriptions nearly quadrupled between 1999 and 2014. Painkillers remain the most prescribed class of drugs in America.

While addiction is always a concern with these medications, and opioids are sometimes misused, pain remains a significant problem in this country. Yet those who use opioid medications – even the many who never face addiction – must contend with a number of uncomfortable and even dangerous side effects. Now, some experts are studying and offering alternatives to traditional opioid pain medication in an effort to lessen reliance on them.

Psychological methods like biofeedback and hypnotherapy, along with more mainstream treatments like Cognitive Behavioral Therapy (CBT), may all serve to lessen reliance on opioids for pain and provide alternatives for those who are concerned about the risk of addiction and other health issues.

How Do These Alternative Interventions for Pain Work?

  • Biofeedback is a method in which individuals learn to better control by monitoring body experiences that are usually outside of people’s awareness, like heart rate or blood pressure. In the case of pain, people are taught to look for cues of their discomfort, with the assistance of medical technology, become more aware of their symptoms, and adapt to control them. One study showed biofeedback’s effectiveness at managing chronic pain in the upper body, specifically for carpal tunnel syndrome, reducing pain in up to 86 percent of adult patients in the study.
  • Hypnotic analgesia or hypnotic therapy is another means to help relieve pain without the use of medication. In theory, hypnosis works by making patients aware of the source of their pain, underlying issues that make it worse, and the ways they can better manage it. Some researchers have had a difficult time differentiating hypnosis and biofeedback; in fact, they have been shown to be about equally effective in relieving lower back pain.
  • Cognitive Behavioral Therapy (CBT) is also an effective alternative – sometimes in combination with other treatments, including medication. CBT is a psychological treatment that helps alleviate pain and depression by identifying dysfunctional thoughts or attitudes and developing coping mechanisms. CBT helps those suffering from chronic pain control their perceptions of pain by realistically evaluating the effect of the pain and how long it will last, and learning strategies to adapt to their symptoms rather than catastrophizing or thinking about their pain in a dramatic, extreme, or hopeless manner. This approach, in turn, reduces the focus on pain.

A Hospital Tries Something Different

In Patterson, New Jersey, St. Joseph’s Hospital has initiated measures to decrease opioid prescriptions by instituting a program called ALTO for Alternatives to Opiates Program. The first of its kind in the country, the program is designed for those who, for any reason, choose not to use opioids in managing their pain. ALTO was founded in January 2016 by Dr. Mark Rosenberg, chairman of St. Joseph's Hospital emergency department. After seeing so many individuals struggle with the consequences of opioids, Dr. Rosenberg wanted to give his patients options.

In the first two months of the program Dr. Rosenberg told NPR about 75 percent of the 300 patients in the emergency room left the hospital without opioids. For some, the alternative provided was the safe and short-term administration of nitrous oxide, or laughing gas, to alleviate stress and create a window of time for pain to subside naturally. For others, physical therapy assisted those struggling with pain, helping them learn to strengthen their bodies and actively manage their symptoms.

For concerned families, ALTO’s approach helps ease worries about pain management, the risk of addiction, and the many detrimental side effects of opioid medications.

Are These Options Right For You?

Making decisions about treating pain is difficult, and opioids are an appropriate choice for some. However, the health and addiction risks associated with opioids have to be recognized, and safer alternatives to opioid medications should be further explored. Chronic pain in the U.S. remains a major concern – but so does the overuse of painkillers. These alternative pain measures can be used as a first line of intervention for relieving some forms of non-cancer or non-surgical pain, instead of the current practice of automatically prescribing opioids. This is particularly important for young people who are treated for pain with opioids, since they are at a disproportionately high risk of developing addiction when using addictive substances.

Biofeedback, hypnosis, CBT, physical therapy and other alternatives may help many manage pain without the use of a potentially harmful and addictive substance. For those with both pain and addiction, these options could be imperative. Other health care providers should follow the example set by St. Joseph’s Hospital by offering patients effective alternatives to opioids and reducing America’s reliance on opioid pain medications.

 Max Dorfman, MA

Max is a Science Writer at Center on Addiction


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