Prescription painkillers are no longer as accessible as they used to be. For those seeking pain treatment without opioids, alternative therapies are becoming essential.
Chronic pain is a widespread issue in the United States. In 2021, an estimated 20.9% of U.S. adults struggled with chronic pain. That means approximately 51.6 million adults may seek out medical care for pain and experience diminished quality of life without treatment.
Twenty years ago, opioid medications were prescribed to help people manage their chronic pain and live productive lives. However, the addictive nature of opioid painkillers resulted in thousands of over-prescribed patients. This led many doctors to stop prescribing pain medication to patients to reduce the risk of addiction.
Instead of relying on painkillers to treat people suffering, doctors began to look for chronic pain treatment without opioids. This eventually became a very critical step in attempts to slow down the opioid crisis in the country.
Why is my Doctor not Prescribing Pain Medication?
If your doctor declines to prescribe pain medication, you are not alone in wondering why. There are many reasons why medical providers prescribe opioids very rarely nowadays. The most common are the following:
1. Fear of Misuse
Prescription opioid misuse is a significant factor in the nation’s unwavering opioid crisis. Research shows that approximately 21 to 29% of patients misuse the opioids prescribed for chronic pain. Somewhere between 8 and 12% of all patients prescribed painkillers develop an opioid use disorder. About 4 to 6% of people who misuse their prescription end up transitioning to illicit opioids such as fentanyl or heroin.
2. Legal Issues with Opioid Prescriptions
The legal risks of prescribing opioids have undergone a recent transformation. Between medical malpractice suits and wrongful death suits due to overdose, providers have grasped the potential dangers of these medications.
Medical providers now keep a close eye on what they prescribe and the quantity. Many have become more conservative with pain medication to ensure that none of their patients become dependent. The fear of over-prescribing medication and losing their job and licensure are also results in much hesitation.
3. Changing Standards for Pain
Currently, doctors are looking for chronic pain treatment without opioids. Pain management specialists have ramped up research in finding alternatives to opioid painkillers with surprising discoveries. Due to this constant stream of new information, providers have increasingly been tightening their standards for opioid prescriptions. Many physicians are looking to taper their patients off of harmful opioids and move them on to better solutions.
Speak directly with your medical provider about why they have prescribed you certain medications and why they will not prescribe you others. Some additional reasons why your doctor might not prescribe pain medications include:
- Drug-seeking or disruptive behaviors from patients
- The medication is no longer working
- Personal beliefs regarding the efficacy of opioids for chronic pain
- Comorbidities that could be negatively affected by opioid medications
Whatever the reason, your doctor should be transparent with you. You have a right to know why you are taking certain medications over others to help manage your pain.
Guidelines for Opioid Prescriptions in Chronic Pain Patients
There are currently no nationwide federal laws regarding opioid prescription regulations. The Centers for Disease Control and Prevention (CDC) has released prescribing guidelines for opioids, but they are just that — guidelines. Enforceable laws about opioid prescriptions are down to individual states, and many of the laws enacted have become very restrictive.
The CDC and American Academy of Family Physicians (AAFP) created guidelines for prescribing opioids to treat chronic pain in 2016. A summary of these guidelines states the following:
- Non-opioid therapy is preferred for chronic pain treatment.
- Opioids should only be prescribed if the benefits far outweigh the risks to the patient.
- Providers should establish treatment goals with patients that include tapering off opioids.
- The lowest effective dosage of opioids should always be prescribed to patients.
- Before increasing dosages, risk assessments should be taken seriously.
- Clinicians should avoid complications with concurrent medications and opioids.
Unfortunately, there is always a risk that a patient may develop opioid use disorder through the course of their treatment. In these cases, providers should offer medication-assisted treatment with buprenorphine or methadone to help them recover.
Safe Pain Management for Long-Term Opioid Users
It is not recommended for your doctor to refuse to prescribe opioids if you have already been taking them long-term. The HHS published guidelines recommending a highly deliberate approach to reducing opioid intake for patients undergoing long-term treatment.
Adm. Brett P. Giroir, MD, assistant secretary of health at the HHS, remarked,
“If opioids are going to be reduced in a chronic patient, it really needs to be done in a patient-centered, compassionate, guided way.”
Stopping your opioid medication for chronic pain abruptly could cause severe side effects. This can be avoided with a simple taper schedule and incremental decrease in dosage over time.
Opioid Withdrawal Symptoms after Stopping Medication
If your doctor abruptly discontinues your pain medication, you are in danger of going into opioid withdrawal. The signs and symptoms of opioid withdrawal include:
- Anxiety or agitation
- Difficulty sleeping
- Nausea and vomiting
- Abdominal cramps and diarrhea
- Sweating and fever
- Trembling
- Rapid heartbeat
- Changes in blood pressure
- Confusion
- Hallucinations
- Seizures
Although these symptoms are not usually life-threatening, experiencing them alongside the resurgence of your chronic pain can be debilitating. A careful stabilization from the use of opioid pain medication should be individualized for each patient involving the physician:
- Monitoring temperature, blood pressure and pulse.
- Taking urine or blood samples to get a clear picture of all substances in your system.
- Obtaining information that may help optimize stabilization from other health care providers or family members.
- Recommending other types of therapies for pain.
- Prescribing medications that help manage common withdrawal symptoms and ease discomfort.
One of the options in the new HHS guidelines is stabilization, which can be achieved through the use of buprenorphine. Buprenorphine was initially introduced for use in medication-assisted treatment (MAT) for opioid addiction. The HHS recommends this treatment to reduce withdrawal symptoms while also keeping pain at bay.
Is Chronic Pain Treatment without Opioids Possible?
There are alternatives to opioid painkillers for treating chronic pain. Your other options include:
- Seeking a pain management specialist: Many primary care physicians want to help you control your pain. They can refer patients to pain management specialists with in-depth knowledge of new pain solutions and therapies.
- Joining a support group or online community: Support groups are valuable tools that allow you to speak openly about your chronic pain. You can seek insight from others who understand what you are going through. There, you can learn helpful information on what alternative treatments have worked for others. Also, you can share your own tips with members of the chronic pain community.
- Trying out a drug-free method for pain relief: Some people manage their pain with techniques such as exercise, yoga, acupuncture, mindfulness meditation and a nutritious diet. These methods work better at controlling chronic pain for some individuals than others, but they are a helpful asset.
- Staying aware of your patient rights: Your medical provider can deny you a prescription for pain medication. However, you can learn about other treatment options and choose the option best suited to your needs. Speak with your provider about a referral to a pain management specialist or ask what other alternatives are available.
Talk to a Specialist at HCRC About Chronic Pain Treatment without Opioids
Chronic pain is something every medical provider should take seriously. At Health Care Resource Centers, your experiences matter. Our compassionate care team can help you find the tools needed to live your life in as much comfort as possible.
HCRC is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) as a trusted source. We are dedicated to bringing you quality care and resources for opioid addiction-related information. Our programs are also certified on a state and federal level.
If you are seeking to address opioid addiction or switch to pain management with a buprenorphine treatment program, HCRC can help. We offer medication-assisted treatment for opioid addiction at multiple locations across Maine, Connecticut, New Hampshire and Massachusetts. Call (866) 758-7769 for more information on our programs. Or, fill out our contact form online to learn about the next steps.
