Managing Long-Term Pain: Alternatives to Opioids

Patient Education Facilitator
Monday, January 22, 2018 - 9:00am

If you’re experiencing chronic (long-term) pain, here are a few things you should know:

  • There is no benefit to living with pain.
  • Everyone’s pain is different. You’re the only one who knows the nature of your pain, and it’s your job to report it to your health care provider. (And no, that’s not the same as complaining.)
  • People become distressed when they feel they can’t manage the changes that cancer has brought to their lives. Studies show that distress, worry or depression can increase pain.

Today many people are concerned about the risks of taking opioid medications on a long-term basis. But if you’re living with chronic pain, what are the alternatives?

In July 2016, the American Society of Clinical Oncology (ASCO) released new clinical guidelines on how to identify and manage pain in adult cancer survivors. They defined “survivor” as someone with a history of cancer who is beyond the acute diagnosis and treatment stage. Noting that about 40% of cancer survivors “continue to experience persistent pain as a result of treatment,” ASCO experts examined the results of 63 clinical trials. They found that all the pain-relief therapies listed below have benefits that outweigh risks. However, for some of the therapies, there was stronger scientific evidence of effectiveness. Those are listed under Strength of Recommendation: Moderate. The others are listed under Strength of Recommendation: Weak. 

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Strength of Recommendation: Moderate

There is significant evidence that these therapies are effective.

  • Physical/rehabilitation medicine: physical, occupational and recreational therapy; heat/cold; ultrasound; and individual exercise programs (walking, cycling, yoga, qigong, tai chi and/or strength, aerobic and resistance training)
  • Psychological support: Cognitive-Behavioral Therapy (CBT), mindfulness, breathing exercises, relaxation, meditation, guided imagery, hypnosis, distraction, support groups/counseling and biofeedback
  • Non-opioid drugs: nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen or naproxen; acetaminophen (Tylenol®); certain antidepressants or anticonvulsants; local anesthetics (numbing); topical analgesics (pain relievers applied to the skin); and medical marijuana
  • Interventional therapies: nerve blocks, kyphoplasty and epidural or intrathecal analgesics

Strength of Recommendation: Weak 

There is little evidence that these therapies are effective.

  • Nerve stimulation (TENS, STIM) therapy: Uses mild electric current to block pain signals to the spinal cord and brain and relax muscles.
  • Integrative therapies: massage, acupuncture and music therapy. (Music therapy can affect stress hormone levels and may have a positive impact on cancer pain, anxiety and quality of life.)

You may also be interested in these therapies:

  • Healing Touch
  • Humor
  • Nutritional support
  • Aromatherapy: Essential oils may offer antibacterial, antiviral, antifungal, calming or energizing effects.
  • Hydrotherapy (water massage)
  • Reflexology: Manual pressure is applied to specific zones of the feet (or sometimes the hands or ears) that practitioners believe correspond to body organs.

Remember — always check with your health care provider before beginning any of these therapies, to make sure they’re safe for you.

For more information: