There is a topic not often discussed as part of the opioid epidemic, and that’s how to treat pain in cancer patients when they have a history of opioid addiction or dependence or are opioid-tolerant.
According to doctors, there are usually three groups of people to consider. One group consists of people who have cancer, but it’s well-treated and is viewed as a chronic disease. In these instances, health care providers need to offer safer, long-term pain management approaches. The second group is cancer survivors who are still being monitored and need to be successfully transitioned off opioids. The third group is the people with an active disease who have a history of opioid addiction or dependence.
In these situations, opioid alternatives may be needed. However, out of a sense of compassion, health care providers are often not speaking to patients about this issue when they’re already grappling with a cancer diagnosis.
Approaches to Cancer Pain Treatment
For advanced pain management related to cancer, whether that pain stemmed from cancer itself or the treatment, opioids were typically the first-line treatment. However, given what we now know about these drugs, some medical experts are looking at opioid alternatives. Alternatives to opioid treatment being explored by doctors include varying options such as injecting steroids, stimulating the spinal cord and prescribing opioid alternatives that combat pain but aren’t addictive.
Opioid Alternatives to Reduce Long-Term Impact
Along with the aforementioned approaches, there are other opioid pain alternatives in use for some patients. The specific opioid pain alternatives depend on the type of pain, where the pain is and the patient.
Current Opioid Alternatives in Use
As well as steroids and stimulation of certain nerves, one other option that can be used is the administration of a radiofrequency probe that has a heating element. This can change how sensations are sent through the body, and it can provide pain relief for up to two years. The procedure is essentially like cutting off the communication line of pain to the rest of the body.
When it comes to pain that’s not cancer-related, there are other approaches being looked at that can be considered alternatives to opioid pain relievers. For example, there was a recent study that was published in the journal Addiction, and it was managed by a team from the VA Center for Clinical Management Research and the University of Michigan Addiction Center.
The approach is called ImPAT, which stands for Improving Pain During Addiction Treatment. Fifty-five participating veterans saw noticeable benefits according to study results. The approach combines behavioral therapy and social support to provide pain management without the use of medication.
Currently being explored are techniques using electrical signals and spinal cord stimulation. Another option is a pain pump, which can allow for pain medication to be delivered directly to the spinal cord, which can offer relief without some of the side effects of oral pain medications.
Other potential alternative opioid treatments aside from injections or nerve blocks can include acupuncture and physical therapy. Relief may also come from massages and learning relaxation or biofeedback techniques.
Discussing Safe Pain Management After Addiction
When someone is in addiction recovery, it’s nearly inevitable they will be at a point in their life when they need pain management. That makes it important that patients be willing to openly discuss alternatives to opioids for pain. As a patient, if you are in recovery, you should let your physician know that you’d like to explore legal opioid alternatives and that you are open to different options. At the same time, don’t be afraid to let your health care provider know the extent of your pain and if you need alternatives to opioids for severe pain.
Many times, people may feel afraid of the stigma, or they don’t want to open up about their addiction history, but it’s important to have open communication with health care providers.
Griffith, Dorsey. “Finding non-opioid alternatives for cancer pain.” University of California, August 7, 2019. Accessed September 11, 2019.
Gavin, Kara. “The ImPAT Approach: Treating Pain Without Opioids.” University of Michigan Health Lab, July 27, 2016. Accessed September 11, 2019.
American Society of Anesthesiologists. “Non-Opioid Treatment.” Accessed September 11, 2019.