It is outside the scope of the DHS Opioid Prescribing Improvement Program to provide specific recommendations about non-pharmacologic and non-opioid treatment modalities. The following resources provide a thorough examination and/or overview of the evidence base for non-opioid and non-pharmacologic treatment approaches.
Non-opioid analgesics and adjuvant analgesics are equally or more effective than opioid analgesics for most pain types, with potentially less risk of harm to the patient. Appropriate prescribing of non-opioid and adjuvant analgesics will depend on the patient’s diagnosis, symptoms, pain type, comorbid conditions and overall risk for adverse drug events. Non-opioid medications used to treat pain include non-opioid analgesics, nonsteroidal anti-inflammatory drugs (NSAIDS), selected anticonvulsants and selected antidepressants.
Non-pharmacological therapies include, but are not limited to, physical modalities, behavioral approaches, interventional approaches and patient education. Examples include:
Emerging research suggests that patient education about the neurobiology and neurophysiology of pain reduces pain, disability, anxiety and stress associated with the pain experience (Louw, 2011). This type of education—often referred to as therapeutic neuroscience education (TNE)—typically includes an educational session or sessions describing the neurobiology or neurophysiology of pain and pain processing by the nervous system. The aim of this type of pain education is to teach patients to re-conceptualize their pain as the nervous system’s interpretation of the threat of injury, rather than an accurate measure of the degree of injury in their tissues.
The complexities of pain—and specifically chronic pain--requires a multidisciplinary approach to pain management, tailored to the patient’s individual needs and circumstances. Providers should use the biopsychosocial assessment completed during initial visits to guide decision-making about what treatment modalities may be beneficial to the patient.
The ability to treat chronic pain patients using a multidisciplinary approach may be limited due to the provider’s geographic location or practice setting. Clinicians with limited access to specialists and other health care providers should explore telemedicine options for providing multidisciplinary care.
Multi-modal therapy addresses the various biopsychosocial factors that influence the pain experience. Treatment modalities should include those appropriate for the pain diagnosis, as well as comprehensive psychosocial support. Treatment may include, but is not limited to:
