Q&A: Finding Pain Relief Amid the Opioid Crisis

When I read that 20% of U.S. adults had chronic pain, I wasn’t surprised. I consider myself an active, healthy person. But, pretty much every day, something hurts. I joke that I’ve graduated from physical therapy so many times that I should have two PhDs.

The same study, published in the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly report, also found that 8% of adults have high-impact chronic pain. This means their pain limits their ability to work or do daily activities. The study notes that these groups are more likely to have high-impact chronic pain:

• Women
• Older adults
• Adults who have had jobs but don’t currently work
• Adults who live in poverty
• People in rural areas
• Adults with public health insurance

However, many well-known prescription painkillers are highly addictive opioids. Healthcare providers must carefully weigh the benefits and risks of these drugs before prescribing them for pain. 

Q&A: Treating Chronic Pain

UVA Health’s pain management experts helped us answer these common questions about pain relief and opioids.

What is chronic pain?

“Chronic pain is pain that lasts beyond what is typically expected,” explains Lynn Kohan, MD. “It can be difficult to treat, but there is always hope.”

This is different from acute pain, which happens because of an injury, surgery, or short-term illness.

What causes chronic pain?

Many of the conditions that cause chronic pain are invisible illnesses. Other people can’t see them, so family members and friends might assume you’re fine or exaggerating. This lack of pain relief support can make you feel worse.

These include:

• Fibromyalgia
• Complex regional pain syndrome
• Osteoarthritis and joint pain
• Peripheral neuropathy
• Back and spine problems
• Headaches
• Abdominal pain
• Cancer

Often, we feel pain in one part of the body, but the source of our pain is somewhere else. For example, people with sciatica often feel pain in their leg. But the cause of this pain is usually in the hips or spine. Healthcare providers call this referred pain.    

Why are we prescribing fewer opioids?

Many painkillers are opioids. These include drugs you’ve probably heard of or taken, like oxycodone, hydrocodone (Vicodin), morphine, codeine, and fentanyl. They’re highly addictive because they release dopamine in your brain, which makes you feel relaxed and happy. Your brain quickly adapts, though, and you need more and more to get that good feeling.

Opioid addiction is a huge problem in the U.S. More than 92,000 people died from drug overdoses in 2020, according to preliminary CDC data. And even for those who survive, “life just falls apart,” explains psychologist Dania Chastain, PhD. The drugs can consume the person’s life.

Signs of opioid addiction include:

• Craving use or feeling strong urges to use
• Being unable to stop using after multiple attempts
• Spending a lot of time, energy, and money using and recovering from that use
• Struggling to meet expectations at home, work, or school
• Conflict with loved ones over use
• Quitting fun or important activities to use
• Using before or while driving, or in other dangerous situations
• Needing to take more to have the desired effect
• Feeling ill or uncomfortable when you’re not using

So does that mean you can’t get opioid painkillers?

No. If you have chronic pain and other options haven't worked, providers might prescribe an opioid painkiller, combined with other treatments.

They’ll have you set goals. Kohan offers examples: “Can you play with your grandchildren now? Can you walk around the block now?” You’ll use the drug for a trial period, carefully noting any benefits and side effects.

Palliative care expert Leslie Blackhall, MD, helps patients manage cancer symptoms and treatment side effects. She often prescribes opioids. But in a 2018 Vim & Vigor story, she explains that she also adheres to strict safety measures, including:

• Screening for addiction risk
• Encouraging patients to openly communicate with their provider
• Teaching patients how to store the drugs securely and stick to the prescribed dose

Providers are also constantly looking at alternatives. Blackhall says she also prescribes buprenorphine in some situations, including for patients at greater risk for addiction or misuse. Buprenorphine is less likely to cause breathing issues than other opioids.

Why does my doctor always ask me to rate my pain?

If you’ve ever seen a doctor for an injury or chronic pain, they may have instructed you to “rate your pain on a scale of 1-10.”

Chastain acknowledges that many people hate this question. “My 8 may be your 2.”

But the goal is to track the pain over time. She and Kohan also assess how well the patient functions and consider context. One person may rate their pain as an 8/10 but meet their goal of walking a mile every day, while another can’t work. 

How can someone with chronic pain find relief, besides taking opioids?

Providers can prescribe non-opioid options. These include:

• Physical therapy
• Joint and spine injections
• Other oral medications
• An intrathecal pump (pain pump), which is implanted under your skin and delivers pain medicine to your spinal cord
• A spinal cord stimulator, which changes the way you feel pain

But over-the-counter options like ibuprofen and acetaminophen (Tylenol) are also often effective in pain relief, especially when added to the rest of your treatment plan, Kohan says. Talk with your provider before taking these.

Cognitive Behavioral Therapy

Besides the above options, your provider may recommend cognitive behavioral therapy. This helps you recognize and stop destructive thoughts and behaviors. It can include:

• Talking to supportive friends and family members
• Challenging negative thoughts and replacing them with positive ones
• Relaxation training

Chastain gives an example: If you’re in pain, you might have trouble sleeping, and consider using opioids to help you sleep. Instead, you can practice better sleep management techniques. Chastain tells patients to view their bedroom as a sanctuary, a place for sleep and perhaps sex, but not watching TV or working. 

How does social support affect pain & opioid use?

“It’s important for us to know what’s going on with the patient,” Chastain says. “We can come up with a list of treatments. But if the patient doesn’t have access, it doesn’t help.”

Kohan lists aquatic therapy as an example. It can be great for treating pain. But not everyone lives near a facility that offers it or has money or insurance to pay for it.

The COVID-19 pandemic coincided with the largest-ever number of opioid overdoses in a year. People are socially isolated, financially stressed, and unable to access support systems like in-person 12-step programs.

Support from family and healthcare providers is critical. Family and friends should:

• Validate symptoms; hearing “This is all in your head” makes someone in pain feel worse.
• Avoid sharing their own medication
• Encourage physical activity if the person’s healthcare provider recommended it for pain relief

When should I get medical help for my chronic pain?

See your primary care provider if your pain is interfering with your quality of life. That could mean that you have trouble with:

• Taking care of family members or yourself
• Working
• Activities you enjoy, such as exercising, crafting, or playing music

How else can I help someone who is using opioids?

Keep Narcan (Naloxone) handy. This nasal spray can reverse or block an opioid overdose in an emergency. In the Charlottesville area, you can get Narcan for free through:

• Local health departments — contact the Blue Ridge Health District at 434.972.6269
• Region Ten, after completing a free training