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Richard JumanRichard Juman, PsyD, of TeamHealth, likes to refer to two studies that should help physicians move away from prescribing opioids. The point is that opioids are not particularly effective for chronic pain.

“There were two recent studies, one compared acetaminophen and ibuprofen, Tylenol and Advil really, to opioid combinations, and that study focused on acute pain, post-surgery. It showed the nonopioids equally effective to opioids,” he says.

A second study looked at chronic pain and compared opioid patches such as Vicodin, fentanyl, and oxycodone, with again Tylenol and Advil, and the results were very comparable in their effects, Juman says.

Taken into account the efficacy of the opioids, there are many alternative pharmacological treatments for pain, like antidepressants, anticonvulsives, nonopioid pain medications, and medical cannabis, he says.
And there are the standard drugs Suboxone and methadone to wean people off opioids.

Beyond drug options, there are nonpharmacologic, evidence-based interventions for pain management. Juman says these include physical therapy, different types of psychotherapy, relaxation techniques, acupuncture, and yoga, among a host of others.

“All strategies should be included in every pain management situation. The basic problem is that they are not,” Juman says. “Or, at least opioids should not be a first-line treatment. The default response to pain in the United States became an opioid. We have 5 percent of world’s population, but use 80 percent of the prescribed opioids in the world.”