Noninvasive Non-Drug Pain Management
Noninvasive Non-Drug Pain Management: An Alternative for Treatment By: Tajuan Conway
A Seminar Paper
Presented to
The Graduate Faculty
University of Wisconsin-Platteville ______
In Partial Fulfillment of the
Requirement for the Degree
Masters of Science in Education
Adult Education
Approved by: Dr. Karen Stinson
Dr. Karen Stinson November 4, 2020
Signature of advisor Date Approved
Noninvasive Non-Drug Pain Management
Acknowledgments
I would like to acknowledge everyone who played a role in my academic
accomplishments. First, I would like to thank my parents Cleovers and Harriet Conway who
instilled in me the abilities of hard work, commitment, and compassion. Secondly, I am grateful
for my sons Deshae and Dwayne Zanders who empower me with love, inspiration, and
understanding. My family deserves much of the credit for my accomplishments with their
unconditional support. Without your encouragement, I could never have reached this milestone
in my life. Lastly, to my beautiful granddaughter Amelia Zanders, because much of your life I
had to sacrifice my time with you for school, but your patience has kept me motivated to reach
my goals.
I would like to acknowledge the UW Platteville academic staff, Damira Grady for her
advisement at the beginning of my research. Your feedback steered me in the right direction for
my topic and created the foundation of my paper. Finally, I would like to express my gratitude
to my seminar advisor Dr. Karen Stinson who took a sincere interest in my work. Your guidance
and positive feedback throughout the finalization process have been so uplifting. Your heartfelt
words have inspired me to consider publishing my work. Above all my faith in God has given
me strength, resilience, and endurance to accomplish my academic endeavor.
Noninvasive Non-Drug Pain Management
An Alternative for Treatment
.______.
University of Wisconsin-Platteville
.______.
by
Tajuan Conway
2020
Noninvasive Non-Drug Pain Management 2
Abstract
Chronic pain is a condition that impacts many individuals not only in our community but around
the world. It is a serious problem that negatively impacts the quality of life for many people and
their families. Prescription opioids are one solution to manage chronic pain but, unfortunately
opioids are highly addictive. According to 2018 data, misuse of opioids kills 128 people in the
United States each year. The focal point of the literature review was to examine healthier,
nonpharmacological alternatives to manage chronic pain and reduce the use of opioids. Research
has supported the use of physical activity, acupuncture, laser, cognitive behavioral therapy
(CBT), diet/vitamins, mind and body practices (yoga & meditation) as some of the best methods
for nonpharmacological pain management. Opioid abuse has continued to impact not only the
individual with pain, but families and society as well. The result of the findings may lead to a
change in managing chronic pain that will strengthen the quality of life for individuals, families
and society.
Keywords: noninvasive, medical treatment, opioid, epidemic,
Noninvasive Non-Drug Pain Management 3
Chronic pain substantially impacts physical and mental functioning, productivity, quality
of life, and family relationships and has been one of the leading causes of disability. A
monumental public health challenge, chronic pain affects millions of adults in the United States,
with a conservative annual cost in personal and health system expenditures estimated at $560
billion to $635 billion. (Skelly, Chou, Dettori, Turner, Friedly, Rundell, Rongwei, Brodt,
Wasson, Kantner & Ferguson, 2020).
Narcotic medications are prescribed every day to individuals who are seeking pain
management. Opioids are considered one of the most effective drugs to use for pain and
suffering; however, some people may encounter serious negative consequences if they become
addicted to opioids. The ongoing abuse of narcotic medications has been on the rise for many
years. According to the Center for Disease Control (CDC), in 2017, more than 70,000 people
died from drug overdoses, making it a leading cause of injury-related death in the United States
(Center for Disease Control & Prevention, 2017). Of those drug overdoses that lead to death,
almost 68% involved a prescription or illicit opioid (CDC, 2017). Drug overdose deaths have
continued to increase in the United States at an alarming rate with 2018 data showing that every
day, 128 people in the United States die after overdosing on opioids (National Institute on Drug
Abuse, 2020). What should be done to address the opioid epidemic in the United States?
Statement of the Problem
The problem to be addressed is “How can dependence on narcotic medications be
decreased among people seeking care for pain management?” Is noninvasive, non-drug pain
management a viable option for patients?
Noninvasive Non-Drug Pain Management 4
Significance of the Study
The costs associated with chronic pain incurs an annual cost of $874 billion by the United
States population (Mohiuddin, 2019). Prescription opioids have often been prescribed as a way
of treating chronic pain, however, opioids are highly addictive when used long-term. According
to the Center for Disease Control (CDC) the opioid epidemic has affected thousands of patients
each year and countless more family members of the addicted individual (Center for Disease
Control, 2020). Society has also been negatively impacted because of the staggering cost of
medical care due to opioid addiction at 2.5 trillion dollars over four years (Council of Economic
Advisers, 2019). The Department of Health and Human Services (HHS) announced a public
health emergency in 2016 (Health & Human Services, 2016). According to the Substance Abuse
and Mental Health Services Administration (SAMHSA), since 2017, HHS has disbursed more
than $2 billion in grants to fight the opioid crisis, more than any previous year (Substance Abuse
& Mental Health Services, 2018). According to the research, if patients received appropriate
non-drug medical attention for pain, then there would be many fewer addicted persons. The
opioid epidemic has impacted many individuals especially those who are prescribed opioids for
pain management. Opioid medication given over a longer period of time has led to addiction,
overdoses and deaths.
Purpose of the Study
The purpose of this research was to examine healthier ways to provide pain management
with noninvasive, non-drug pain management as an alternative for pharmaceutical treatment. A
review of the literature was performed from the last 5 years to link past pain management
treatments with current non-pharmaceutical options.
Noninvasive Non-Drug Pain Management 5
Definition of Terms
Acute Pain: pain that usually starts suddenly and has a known cause, like an injury or surgery. It
normally gets better as your body heals and generally pain lasts less than three months (Center of
Disease Control, 2020).
Chronic pain: pain that lasts 3 months or more and can be caused by a disease or condition,
injury, medical treatment, inflammation, or an unknown reason (CDC, 2020).
Misuse: the use of illegal drugs and/or the use of prescription drugs in a manner other than as
directed by a doctor, such as use in greater amounts, more often, or longer than told to take a
drug or using someone else’s prescription (CDC, 2020).
Narcotic drugs: originally referred to any substance that dulled the senses and relieved pain.
Some people use the term to refer to all illegal drugs but technically, it refers only to opioids.
Opioid is now the preferred term to avoid confusion (CDC, 2020).
Non-pharmacological pain management: the management of pain without medications
(Mohiuddin, 2019).
Opiate: refers to substances derived from opium, such as morphine and heroin, while opioids
refer to synthetic and semisynthetic opiates. However, the term opioids is now often used for the
entire family of opiates, including natural, semisynthetic, and synthetic (Food and Drug
Administration, 2020)
Opioid: Natural, synthetic, or semi-synthetic chemicals that interact with opioid receptors on
nerve cells in the body and brain and reduce the intensity of pain signals and feelings of pain.
This class of drugs includes the illegal drug heroin, synthetic opioids such as fentanyl, and pain
Noninvasive Non-Drug Pain Management 6
medications available legally by prescription, such as oxycodone, hydrocodone, codeine,
morphine, and many others (CDC, 2020).
Pain management: may involve the use of a number of tools—both pharmacologic and
nonpharmacologic—to relieve pain and improve function and quality of life (FDA, 2020).
Pharmacological pain management: drugs used to manage pain (CDC, 2020).
Delimitations of Research
Research was conducted from 2015-2020. Peer-reviewed journals with only articles that
were published within the past 5 years were used. Many references from the National
Academies of Sciences, Engineering, and Medicine were searched to provide independent and
objective analysis. In addition, workshop presentations and discussions from the National
Academies were also reviewed. Search terms included: opioid epidemic, pain management,
pharmacological drugs and non-invasive nonpharmacological techniques with the following
databases: PubMed, Google and National Center for Biotechnology Information -NCBI.
Method of Approach
A brief review of the history of addiction and the opioid epidemic was completed. A
review of literature related to research, studies, and anecdotal evidence of noninvasive medical
treatment for pain management was also conducted. Another review of literature on related
research of alternative medical treatments to treat addiction was also done. Search terms
included: opioid epidemic, pain management, pharmacological drugs and non-invasive
nonpharmacological techniques. These terms were searched with the following databases
PubMed, Google and National Center for Biotechnology Information-NCBI).
The findings were summarized and synthesized in Chapter 2 of this paper. Conclusions
and recommendations are included in Chapter 3.
Noninvasive Non-Drug Pain Management 7
Chapter Two Literature Review
Prescription drugs have been prescribed to individuals daily, but prescription opioids
have come with a high price. The Federal Drug Administration (FDA) described opioids as a
pain killer manufactured in many forms, but primarily misused in a pill or capsule form (FDA,
2020). Opioid overdoses have been one of the leading causes of deaths in our country with
39,999 deaths reported in 2015 (Ruhm, 2018). In addition, Ruhm (2018) reported the United
States opioid deaths are underreported each year by the CDC by 20 to 35% because deaths may
not have been specifically listed as opioid overdose on the death certificate. The CDC reported
67,367 opioid overdose deaths in 2018 and over 450,000 deaths to opioid overdose from 1999 to
2018 (CDC, 2020). Many individuals with chronic pain may not be aware that there are
alternative noninvasive treatments. Even with many federal and state grants to combat the opioid
epidemic (SAMHSA, 2018) and increased awareness through the media of the dangers of the
opioid health crisis, physicians have continued to prescribe these drugs that can lead to addiction
(Ausness, & Sade, 2020).
This paper will include an overview of previous research on the opioid epidemic and then
research noninvasive, non-drug pain management options. The definition and levels of pain will
be reviewed. Then, the history of opioid pain management and noninvasive non-drug pain
management will be compared. Next, the increase over the past two decades in misuse and
addiction of opiates will be examined. The overprescribing of prescription opioids that results
in dependence will be reviewed in relation to the profits of the pharmaceutical companies. The
patient’s consequences of opioid use will also be considered at the personal, family and societal
level. Finally, alternative approaches including nonpharmacological therapies to coping with
pain will be discussed.
Noninvasive Non-Drug Pain Management 8
Defining Pain Levels
Ongoing chronic pain impacts thousands of individuals daily. The concept of pain has
been defined and explained from many dimensions. The International Association for the Study
of Pain defined pain as an unpleasant sensory and emotional experience associated with actual or
potential tissue damage (Mwanza, Gwisai & Munemo, 2019). Acute pain and chronic pain are
defined differently. A normal sensation that alerts you of a possible injury or discomfort has
been defined as an acute pain (CDC, 2020). Acute pain typically gets better as the tissue and
wound heals. Chronic pain however lasts for weeks, months and even years (CDC, 2020).
Chronic pain can stem from physical ailments such as back pain, arthritis, cancer or other serious
conditions not easily or quickly remedied. Chronic pain has also been associated with multiple
comorbidities, including, among others, impaired memory, cognition, and attention; sleep
disturbances; reduced physical functioning; and reduced overall quality of life (Wylde, Dennis,
Beswick, Bruce, Eccleston, Howells, & Peters, 2017). Chronic pain can also lead to more visits
to the doctor, which can increase the probability that the patient will be prescribed
pharmacological pain management.
History of Opioid Use
Based on the belief that patients in serious pain were undertreated and that opioids were
not addictive, opioid prescribing soared in the early 1990s (Dayer, Painter, McCain, King,
Cullen, Foster, 2019). This belief led to an increase in opioid abuse, addiction and overdoses
(Hsu, McCarthy, Stevens & Mukamal, 2017). The National Center for Health Statistics (NCHS)
estimated opioid pain relievers (excluding non-methadone synthetics) directly accounted for
more than 17,500 deaths in 2015, up from approximately 6,160 in 1999 (National Center for
Noninvasive Non-Drug Pain Management 9
Health Statistics, 2016). The past three decades have witnessed a significant increase in the
prescribing of opioids for pain (Dayer, et al., 2019) and a subsequent increase in the misuse of
opioids.
Misuse of Opioids
There are many people who take their prescriptions exactly as prescribed, but there are
others who do not. According to results from the 2017 National Survey on Drug Use and Health,
from the National Institute on Drug Abuse (NIDA) an estimated 2 million Americans misused
prescription pain relievers for the first time within the past year, which averaged approximately
5,480 initiates per day (National Institute on Drug Abuse, 2018). Also, in 2017, 47,000
Americans died as a result of an opioid overdose. The overdose included: prescription opioids,
heroin, and illicitly manufactured fentanyl, a powerful synthetic opioid. That same year, an
estimated 1.7 million people in the United States suffered from substance use disorders related to
prescription opioid pain relievers, and 652,000 suffered from a heroin use disorder (NIDA 2020).
Revised in February 2020, data from 2018 shows that every day, 128 people in the United States
died after overdosing on opioids. The misuse of, and addiction to opioids—including
prescription pain relievers, heroin, and synthetic opioids such as fentanyl—created a serious
national crisis affecting public health as well as social and economic welfare (NIDA, 2020).
Overprescribing of Opioids
Physicians who routinely prescribed opioids or renewed prescriptions for opioids greatly
increased a patient’s risk of developing an addiction (Meisenberg, Grover, Campbell, & Korpon,
2018). Research showed patients taking opioids longer than 90 days, had a much higher risk of
developing a substance use disorder (Allegri, Mennuni, Rulli, Vanacore, Corli, Floriani, De
Simone, Allegri, Govoni, Vecchi, Sandrini, Liccione & Biagioli, 2019). Research has also
Noninvasive Non-Drug Pain Management 10
shown that pharmaceutical companies flooded physician offices with free opioids and funded
workshops and retreats for physicians to encourage doctors to prescribe new opiates, while at the
same time hiding the dangers of the drugs (Schatman, Vasciannie, Kulich, 2019). Recent class
action and personal injury lawsuits against the pharmaceutical companies have exposed the
extent of the problems (Ausness, & Sade, 2020). The class action lawsuits held the
pharmaceutical companies and the overprescribing physicians accountable by awarding millions
in damages to patients and their families. Between 2001 and 2018, the epidemic cost $1 trillion;
and by 2020, cost another $500 billion in lost human productivity and lost lives (Jackson, 2018).
Patient’s Consequences of Opioids
Opioids use has a negative impact on the individual, family and on society (Theisen,
Jacobs, Macleod & Davies, 2018). Opioids are considered even more deadly for high risk youth
(Schrager, Kecojevic, Silva, Jackson, Iverson, Lankenau, & Zacny, 2014).
Individual.
Opioid addiction causes a physical and mental dependence on the drug. A physical
dependence means a person relied on the drug to prevent withdrawal symptoms. Withdrawal
symptoms included nausea, vomiting, diarrhea, insomnia, restless legs, agitation, stomach
cramps, and hot and cold flashes which some individuals reported was like having the flu times
20 or more (Cooper, Johnson, Kirk, Pavlicova, Glass, Vosburg, Sullivan, Manubay, Martinez,
Jones, Saccone & Comer, 2016). Some individuals who become addicted to their pain
medication then transitioned to other substances like heroin (Ruan, Luo, Kaye & Kaye, 2017).
Many individuals made the transition to heroin and other substances because their physicians no
longer would renew their opioid prescription for more pain killers. In addition, heroin was
Noninvasive Non-Drug Pain Management 11
generally cheaper to buy than a prescription medication, leading to individuals going from
opioids to heroin and other “street” drugs that are readily available (Ruan, et al., 2017).
Family Consequences
Children and adolescents who grow up in households with opioid misuse and opiate use
disorders may experience a myriad of adverse consequences, including: increased risk of mental
health problems and drug use; accidental opioid poisoning; increased risk of developing a
substance use disorder; and family dissolution that results from parents’ incarceration, foster care
placement, or loss of parent to an opioid overdose (Winstanley & Stover, 2019). The number of
children in foster case has increased significantly in the past ten years, with opioid addiction and
death by opioids a contributing factor (Growing opioid epidemic forcing more children into
foster care, 2018). Parental drug use may result in child neglect or deficits in parent–child
attachment. In addition, parents with an opioid use disorder are generally much less likely to be
reunified with their children (Terplan, 2018). Tragically, children born to opioid addicted
mothers may have significant health problems as well as more of a likelihood to abuse opioids in
the future (Krisberg, 2017). There is limited research on the consequences of parental opioid
misuse and opiate use disorder on children and adolescent development; the breadth of potential
adverse outcomes has been based on the broader literature of substance abuse disorders among
parents. The parent’s addiction and high rates of relapse may cause instability in children’s lives
that can result in detrimental consequences that extend into adulthood (United States. Congress.
Senate, 2020; Winstanley & Stover, 2019)
Societal Consequences
The CDC has declared a national health emergency because of the opioid epidemic and
the negative affect on people and society (CDC, 2020). The economy has been negatively
Noninvasive Non-Drug Pain Management 12
impacted by the loss of workers and the decrease in the tax base because of the number of people
no longer able to work because they are incarcerated, hospitalized or deceased (United States
Congress, House, 2018, 2017; Wittenberg, Bray, Aden, Gebremariam, Nosyk, & Schackman,
2016; Chou, 2016). Pain management must be done within the context of the broader social
impact according to prominent researchers (National Academies of Sciences, Engineering, and
Medicine: Health and Medicine Division NASEM-HMD (2017, 2019a) .
Nonpharmacological Therapies
Nonpharmacological therapies refer to those treatments that do not include opioids or
other prescription pain killers. The therapies reviewed were exercise/physical therapy;
mind/body practices such as yoga and meditation; acupuncture; and psychological therapies such
as Cognitive Behavioral Therapy as nondrug methods to reduce pain in patients. In addition,
laser and electromagnetic therapies have been recommended as well as specific patient diet and
nutrition education to help manage pain.
Physical activity.
Physical activity has been found to improve general health, increase muscle mass and
reduce weight and disease risk. Physical exercise has been proven to decrease the progression
of chronic illnesses such as cardiovascular disease, type 2 diabetes, and obesity. When physical
exercise was applied to chronic pain conditions, within appropriate parameters (frequency,
duration, and intensity), physical activity significantly improved pain and related symptoms
(Ambrose & Golightly, 2015).
Acupuncture
The World Health Organization has recommended the use of acupuncture for a
substantial number of disease (World Health Organization, 2020). The efficacy of acupuncture
Noninvasive Non-Drug Pain Management 13
has been formally endorsed by the National Institute of Health and recognized by the American
Medical Association (Pak, Micalos, Maria, & Lord, 2015). Acupuncture has been used as a form
of pain management for centuries in China and in many Asian countries, acupuncture has even
been used even as an anesthetic in surgery (Baker & Chang, 2016). Recently, acupuncture has
been widely studied and recommended in the treatment of opioid dependence (Baker & Chang,
2016; Chen, Wang, Wang, Xie, Ren, Yulan & Deborah, 2018; Lee & Jo, 2019).
Mind/body Practices: Yoga and Meditation
Yoga and meditation are ancient healing methods from India (Brown, Rojas & Gouda
2017). Many research studies have indicated that mind body techniques can reduce blood
pressure, aid in recovering from heart attacks and help reduce pain post-surgery (Jacobs, 2016;
Zeidan and Vago, 2016).
A 2016 review found that mindfulness-based interventions effectively reduced pain
intensity, improved functional status, improved pain-related psychological consequences, and
improved quality of life (Khusid & Vythilingam, 2016). Khusid and Vythilingam (2016) also
found patients interested in self-management strategies, were able to effectively use yoga as an
adjunct therapy to improve health-related quality of life to help control their substance use
disorders.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) has been found to be effective in combination with
other pain management techniques to reduce pain and increase health (Guarino, Fong, Marsch,
Acosta, Syckes, Moore, Cruciani, Portenoy, Turk, & Rosenblum, 2018). Cognitive Behavioral
Therapy is defined as a short-term therapy technique that can help people find new ways to
behave by changing their thought patterns (Hilton, Hempel, Ewing, Apaydin, Xenakis,
Noninvasive Non-Drug Pain Management 14
Newberry, Colaiaco, Maher, Shanman, Sorbero & Maglione, 2016). Cognitive Behavioral
Therapy has used psychological principles to change behaviors, thoughts, and feelings of
individuals with chronic pain to help patient’s experience less distress (Boschen, Robinson,
Campbell, Muir, Oey, Janes, Fashler, & Katz, 2016). The patient was encouraged through
Cognitive Behavioral Therapy to conceptualize pain as manageable, and to move from a passive
to active role in pain control, thereby developing adaptive behavioral and cognitive responses to
pain (Boschen et al., 2018). Other researchers studied cognitive-motivational influences on
health behavior change in adults with chronic pain and found that consistent focused therapy can
help reduce and manage pain without the use of pain medications (Anderson, Hurley, Staud, &
Robinson, 2016).
Laser
Laser was another form of therapy proposed as an alternative to prescription pain
medication. For over forty years, low level laser (light) therapy (LLLT) and LED (light emitting
diode) therapy (also known as photobiomodulation) has been shown to reduce inflammation and
edema, induce analgesia, and promote healing in a range of musculoskeletal pathologies (Cotler,
Chow, Hamblin & Carroll, 2015). White, Elvir, Ofelia, Galeas, and Cao, (2017) studied the use
of electroanalgesia and lasers to reduce pain initially and with repeated use to reduce the need for
pain medications. Other researchers found more than 4000 studies on pub.med.gov pertaining to
the use of light therapy and concluded the majority of laboratory and clinical studies have
demonstrated that LLLT has a positive effect on acute and chronic musculoskeletal pain (Cotler, et
al., 2015).
Noninvasive Non-Drug Pain Management 15
Diet, vitamins
Several research studies focused on diet and the use of vitamins to counteract chronic
pain. One study focused on how zinc ions interfered with opioid dependence/addiction and
analgesia, to determine if zinc supplementation in opioid-users should be recommended
(Ciubotariu, Ghiciuc & Lupușoru 2015). They found specific vitamins use was effective in
helping reduce pain, in the control group, and therefore the patient needed fewer opioids and for
a shorter period of time, therefore, helping reduce addiction. Other researchers studied diet and
vitamins in persons with other chronic pain issues such as arthritis, post-surgery pain, cancer and
other serious chronic pain situations (Ciubotariu, et al., 2015). Accumulating evidence indicated
that vitamin C can exhibit analgesic properties in some clinical conditions, particularly if the
patient was deficient initially in those substances, thus potentially mitigating suffering and
improving patient quality of life (Carr & McCall, 2017).
Comparisons of Pharmacological to Nonpharmacological
What are the benefits of noninvasive nonpharmacological therapies compared to
pharmacological therapy? There has been an increased interest in nonpharmacological therapies.
due to the negative impact of pharmacological therapy to include opioid addiction (National
Academies of Sciences, Engineering, and Medicine: Health and Medicine Division NASEM-
HMD (2020). The Centers for Disease Control and Prevention (CDC) in 2016 recommended
nonpharmacological therapy and nonopioid pharmacological therapy for chronic pain (Dowell,
Haegerich & Chou, 2016). The literature also stated another driver for emphasizing
nonpharmacological approaches has been the evolution in the understanding of chronic pain
from a biomedical to a biopsychosocial model (Ahmadvand, Gatchel, Brownstein, & Nissen,
2018). Historically, biopsychological models of pain management were used with children
Noninvasive Non-Drug Pain Management 16
because surgeons wanted to reduce the amount of prescription medications that a child needed to
take over an extended period of time (Vetter, McGwin, Bridgewater, Madan-Swain, Ascherman,
& Evers, 2013). The research has now turned to finding a balance with pain management and
the use of opioids and nonpharmacological approaches (National Academies of Sciences,
Engineering, and Medicine: Health and Medicine Division NASEM-HMD, 2017).
Summary
The current literature review yielded multiple resources on chronic pain, the opioid
epidemic and alternative nonpharmacological treatment options (Hsu, et al., 2017; Winstanley &
Stover, 2019 ). Pain treatment with opiates has been abused and misused which has negatively
impacted the quality of life for many individuals causing overdoses and deaths (Center for
Disease Control & Prevention, 2017; National Institute on Drug Abuse, 2020). Evidence from
researchers suggests the best way to manage chronic pain would be to include
nonpharmacological approaches whenever possible (Becker, Dorflinger, Edmond, Islam, Heapy
& Fraenkel, 2017; Rieder, 2018). A review of the literature provided evidence that noninvasive
nonpharmacological methods can be effective pain management treatments when matched to the
patient’s needs (Ahmadvand, et al., 2018). Chapter 3 includes the conclusions of my findings
and recommendations.
Noninvasive Non-Drug Pain Management 17
Chapter Three: Conclusions and Recommendations
The opioid has been a health emergency plaguing our country with significant negative
consequences for decades. The review of literature supported the use of nonpharmacological
techniques as a supplement to pharmacological pain management, but these techniques were
found to not have been utilized extensively in the health care profession (Rieder, 2018) .
Researchers found there are barriers about nonpharmacological treatment from patients as well
as providers. Skepticism about the efficacy for Nonpharmacological Methods – NPMs, by both
patients and providers was identified as a barrier, including patient and provider beliefs that
NPMs are not effective, that NPMs will fail, or that NPMs are substandard treatment (i.e., as
compared to medications) (Becker et al., 2017). Patient perception that medications are more
effective were identified as one of the most important barriers reported by providers (Becker, et al.,
2017).
Based on these conclusions, it is recommended that further study be conducted on
nonpharmacological methods for the treatment of pain. Research on which nonalternative
treatment would be most effective with each unique chronic condition could provide more in-
depth answers for physicians and patients.
In addition, physicians need more education on the dangers of opioid prescriptions
(Gupta, Lindstrom & Shevatekar, 2020; Stulberg, Schäfer, Shallcross, Lambert, Huang, Holl,
Bilimoria, & Johnson, 2019). Academic detailing, could be provided for physicians about
treatment strategies using pharmacological as well as nonpharmacological methods to further the
doctor’s education (Becker et al., 2017). The use of motivational interviewing strategies as well
as other pain communication strategies such as validation, are also needed to help providers
more effectively engage with patients with chronic pain (Becker et al., 2017). The challenge in
Noninvasive Non-Drug Pain Management 18
implementation, however, is that writing a prescription for a pain medication, is much quicker
and easier than discussing nonpharmacological methods with a patient. In addition, the
nonpharmacological method requires the patient to take an active role in their pain management
and requires monitoring and encouragement of the patient.
Another way of managing opioid over-prescription are with online records that monitor
each prescription to prevent patients from going to multiple doctors to get pain medication
(Zivin, White, Chao, Christensen, Horner, Petersen, Hobbs, Capreol, Halbritter, & Jones, 2019).
Mandatory use laws for prescription drug monitoring programs (PDMPs) are recommended that
require prescribers to review patient prescription history of controlled substances prior to
prescribing opioids. The PDMPs have emerged as promising strategies to address the epidemic
(Strickler, Zhang, Halpin, Bohnert, Baldwin, & Kreiner, 2019). Physicians efforts to talk with
their patients about the addictiveness of prescription painkillers—or other topics addressed in the
course of these discussions—may yield positive behavioral consequences that reduce
opportunities for painkiller abuse (Hero, McMurtry, Caitlin, Benson, John & Blendon, Robert,
2016).
Patient education and youth education is also recommended as a way to reduce opioid
overuse (Compton, Jones, Baldwin, Harding, Blanco & Wargo, 2019). One program to provide
information on the dangers of opioid use is Operation Prevention. The program has been
designed for middle and high school students, educators and parents, to educate students about
the science behind drug addiction and its impact, with resources that help initiate lifesaving
conversations in the home and classroom. (Operation Prevention, 2016).
Some state and federal legislators are also planning to continue the lawsuits against the
pharmaceutical companies and the doctors who overprescribed medications in the past, and for
Noninvasive Non-Drug Pain Management 19
some who are still overprescribing today (Ausness, & Sade, 2020). More recently, a broad
coalition of legislators, attorneys, academics, commentators, and doctors have argued that drug
manufacturers should share a significant portion of the blame for the opioid epidemic because
they intentionally or recklessly encouraged over-prescriptions, enshrouded the true risks of
addiction, and targeted vulnerable populations (Michalski, 2019). Currently, over 1900 cases
with over 2400 plaintiffs are in front of a single judge in the Northern District of Ohio
(Michalski, 2019) with similar other states also considering legal action.
The opioid epidemic tragically has destroyed thousands of lives over the past several
decades (Ruhm, 2018). Physicians and the pharmaceutical companies have now been held
accountable for past misuse of prescription opioids (Ausness, & Sade, 2020; Schatman, et al.,
2019) but it has still not been enough to stop the addiction. Many physicians are still prescribing
opioids for pain management (Allegri, et al., 2019; Meisenberg, et al., 2018), therefore the opioid
abuse and addiction continue. Researchers have provided alternatives to chronic pain
management (Ahmadvand, et al., 2018; Becker, et al., 2017; Dowell, Haegerich & Chou, 2016;
Rieder, 2018). The researched nonpharmacological methods have the potential for reducing
acute pain, increasing quality of life, and reducing the opioid epidemic.
Noninvasive Non-Drug Pain Management 20
References
Ahmadvand, A., Gatchel, R., Brownstein, J. & Nissen, L. (2018). The biopsychological model-
digital approach to health and disease: Call for a paradigm expansion. Journal of
Medical Internet Research, 20(5), 1-189.
Allegri, N., Mennuni, S., Rulli, E., Vanacore, N., Corli, O., Floriani, I., De Simone, I., Allegri,
M., Govoni, S., Vecchi, T., Sandrini, G., Liccione, D., & Biagioli, E. (2019). Systematic
review and meta-analysis on neuropsychological effects of long-term use of opioids in
patients with chronic noncancer pain. Pain Practice, 19(3), 328-343.
Ambrose K. R., & Golightly Y. M. (2015). Physical exercise as non-pharmacological treatment
of chronic pain: Why and when. Best Practice & Research: Clinical Rheumatology
9(11),120‐130. doi:10.1016/j.berh.2015.04.022.
American Psychological Association, (2010), 6th Edition, Washington, D.C.
Anderson, R. J., Hurley, R. W., Staud, R. & Robinson, M. E. (2016). Cognitive-motivational
influences on health behavior change in adults with chronic pain. Pain Medicine, 17 (6),
1079-1093.
Ausness, R. C. & Sade, R. M. (2020). Is litigation the way to combat the opioid crisis?
The Journal of Law, Medicine & Ethics, 48 (2), 293-306.
Baker, T. E. & Chang, G. (2016). The use of auricular acupuncture in opioid disorder: A
systematic literature review: The use of auricular acupuncture in opioid use disorder.
The American Journal on Addictions, 25 (8), 592-602.
Noninvasive Non-Drug Pain Management 21
Becker, W. C., Dorflinger, L., Edmond, S. N., Islam, L., Heapy, A. A., & Fraenkel, L. (2017).
Barriers and facilitators to use of non-pharmacological treatments in chronic pain. BMC
Family Practice. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359906/.
Boschen, K. A., Robinson, E., Campbell, K. A., Muir, S., Oey, E., Janes, K., Fashler, S. R., &
Katz, J. (2016). Results from 10 years of a CBT pain self-management outpatient
program for complex chronic conditions. Pain Research and Management.
https://link.gale.com/apps/doc/A507186338/PPPC?u=platteville&sid=PPPC&xid=21df79
7b.
Brown, M., Rojas, E. & Gouda, S. (2017). A Mind-body approach to pediatric pain management.
Children 4 (6), 50.
Carr, A. C., & McCall, C. (2017). The role of vitamin C in the treatment of pain: New insights.
Journal of translational medicine, 15(1),77. https://doi.org/10.1186/s12967-017-1179-7.
Centers for Disease Control and Prevention (CDC) (2017). Response to the opioid overdose
epidemic. https://www.cdc.gov/opioids/index.html.
Centers for Disease Control and Prevention (CDC) (2020). Commonly used terms.
https://www.cdc.gov/drugoverdose/opioids/terms.html.
Chen, Z., Wang, Y., Wang, R., Xie, J., Ren, Yulan K. & Deborah, A. (2018). Effect of
acupuncture for treating opioid use disorder in adults: A systematic review and meta-
analysis. Evidence-based Complementary and Alternative Medicine, Vol.2018, p.1-15.
Ciubotariu, D.; Ghiciuc, C. M.; Lupușoru, C. E. (2015). Zinc involvement in opioid addiction
and analgesia – should zinc supplementation be recommended for opioid-treated persons?
Substance Abuse Treatment, Prevention, and Policy. 10 (1), 1-17.
Noninvasive Non-Drug Pain Management 22
Compton, W. M. Jones, C. M., Baldwin, G. T., Harding, F. M., Blanco, C., Wargo, E. M. (2019).
Targeting youth to prevent later substance abuse disorder: An underutilized response to
the US opioid crisis. American Journal of Public Health, 109 (S3), S185-S189.
Cooper, Z. D., Johnson, Kirk. K. W., Pavlicova, M., Glass, A., Vosburg, S. K., Sullivan, M. A.,
Manubay, J. M., Martinez, D. M. Jones, J. D., Saccone, P. & Comer, S. D. (2016). The
effects of ibudilast, a glial activation inhibitor, on opioid withdrawal symptoms in opioid-
dependent volunteers. Addiction Biology, 21 (4), 895-903.
Cotler, H. B., Chow, R. T., Hamblin, M. R., & Carroll, J. (2015). The use of Low Level Laser
Therapy (LLLT) for musculoskeletal pain. MOJ orthopedics & Rheumatology, 2(5),
00068. https://doi.org/10.15406/mojor.2015.02.00068.
Council of Economic Advisers, (2019). The full cost of the opioid crisis: $2.5 trillion over four
years. https://www.whitehouse.gov/articles/full-cost-opioid-crisis-2-5-trillion-four-years.
Dayer, L. E., Painter, J. T; McCain, K., King, J., Cullen, J., Foster, H. R. (2019). A recent history
of opioid use in the US: Three decades of change. Substance Use & Misuse, 54 (2), 331-
339.
Dowell, D., Haegerich, T. M. & Chou, R. (2016). CDC Guidelines for prescribing opioids for
chronic pain- United States. JAMA: The Journal of the American Medical Association,
315 (15), 1624-1645.
Federal Drug Administration- FDA (2020).
https://www.drugabuse.gov/publications/drugfacts/prescription-opioids.
Food and Drug Administration (2020). https://www.fda.gov/drugs/information-drug-
class/opioid-medications.
Noninvasive Non-Drug Pain Management 23
Growing opioid epidemic forcing more children into foster care, Pharma Law Weekly,
2018-01-23, p.62.
Guarino, H., Fong, C., Marsch, L., Acosta, M., Syckes, C., Moore, S., Cruciani, R., Portenoy, R.,
Turk, D. & Rosenblum, A. (2018). Web-based cognitive therapy for chronic pain patients
with aberrant drug-related behavior: Outcomes from a randomized controlled trial. Pain
Medicine, 19 (12), 2423-2437.
Gupta, A., Lindstrom, S., & Shevatekar, G. (2020). Reducing Opioid Overprescribing by
Educating, Monitoring and Collaborating with Clinicians: A Quality Improvement Study.
Curēus 12 (4), 7778.
Health and Human Services - HHS (2016). https://www.hhs.gov/opioids/about-the-
epidemic/index.html.
Hero, J. O., McMurtry, C., Benson, J. & Blendon, R. (2016). Discussing opioid risks with
patients to reduce misuse and abuse: Evidence from two surveys. Annals of Family
Medicine, 14(6), 575–577. https://doi.org/10.1370/afm.1994.
Hilton, L., Hempel, S., Ewing, B. A., Apaydin, E., ; Xenakis, L., Newberry, S., Colaiaco, B.,
Maher, A. R., Shanman, Roberta M., Sorbero, M. E. & Maglione, M. A. (2016).
Annals of behavioral medicine, 51 (2), 199-213.
Hsu, D. J., McCarthy, E. P., Stevens, J. P. & Mukamal, K. J. (2017). Hospitalization, costs and
outcomes associated with heroin and prescription opioid overdoses in the United States
2001-2012. Addiction, 112 (9), 1558-1564.
Jackson, L. (2018). Opioids, justice and mercy: Courts are on the front lines of a lethal crisis.
ABA Journal, 104(6), 36.
https://link.gale.com/apps/doc/A553402475/LT?u=platteville&sid=LT&xid=a09fdc55.
Noninvasive Non-Drug Pain Management 24
Jacobs, J. A. (2016). As opioid prescribing guidelines tighten, mindfulness, meditation holds
promise for pain relief. JAMA: The Journal of the American Medical Association, 315
(22), 2385.
Khusid, M. A., & Vythilingam, M. (2016). The emerging role of mindfulness meditation as
effective self-management strategy, Part 2: Clinical implications for chronic pain,
substance misuse, and insomnia. Military Medicine, 181(9), 969–975.
https://doi.org/10.7205/MILMED-D-14-00678.
Krisberg, K. (2017). Prevention driving health response to opioid epidemic; CDC prescribing
guide shifting approach for safer prescribing can help prevent addiction to opioids.
The Nation's health, 47 (5), 1.
Lee, S. & Jo, D. (2019). Acupuncture for reduction of opioid consumption in chronic pain:
A systematic review and meta-analysis protocol. Medicine, 98 (51), 18237.
Meisenberg, B. R., Grover, J., Campbell, C. & Korpon, D. (2018). Assessment of opioid
prescribing practices before and after implementation of a health system intervention to
reduce opioid overprescribing. Journal of American Medical Association Network Open,
1 (5), 182908.
Michalski, R. (2019). MDL immunity: Lessons from the national prescription opiate litigation.
American University Law Review, 69(1), 175-251. https://search-
proquest.com.ezproxy.uwplatt.edu/docview/2333624043?accountid=9253.
Mohiuddin, Abdul Kader. (2019). Non-drug pain management: Opportunities to explore.
American Journal of Biomedical Science and Research,
https://biomedgrid.com/ebooks/non-drug-pain-management-opportunities-to-explore.pdf.
Noninvasive Non-Drug Pain Management 25
Mwanza, E., Gwisai, R. D., & Munemo, C. (2019). Knowledge on nonpharmacological methods
of pain management among nurses at Bindura Hospital, Zimbabwe. Pain Research and
Treatment, https://doi.org/10.1155/2019/2703579.
National Academies of Sciences, Engineering, and Medicine: Health and Medicine Division
NASEM-HMD (2017). Pain management and the opioid epidemic: Balancing societal
and individual benefits and risks of prescription opioid use. Washington (DC): National
Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK458655/.
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division -
NASEM-HMD (2019a). Pain management for people with serious illness in the context
of the opioid use disorder epidemic: Proceedings of a Workshop. Roundtable on quality
care for people with serious illness, Washington (DC): National Academies Press (US).
https://www.ncbi.nlm.nih.gov/books/NBK544140/ doi: 10.17226/25435.
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division
NASEM-HMD (2019b). The role of nonpharmacological approaches to pain
management: Proceedings of a workshop. Washington (DC): National Academies Press
(US); 2019 from: https://www.ncbi.nlm.nih.gov/books/NBK541702/ doi:
10.17226/25406.
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division
(2020). Opportunities to improve opioid use disorder and infectious disease services:
integrating responses to a dual epidemic. Washington (DC): National Academies Press
(US). https://www.ncbi.nlm.nih.gov/books/NBK555809/ doi: 10.17226/25626.
National Center for Health Statistics, 2016). https://www.ncbi.nlm.nih.gov/books/NBK458655/.
Noninvasive Non-Drug Pain Management 26
National Institute on Drug Abuse. (2018, December 13). Misuse of prescription drugs.
https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs .
National Institute on Drug Abuse. (2020, April 17). Opioid Overdose Crisis.
https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis.
Operation Prevention (2016). https://www.operationprevention.com/opioid-and-prescription-
drugs.
Pak, S. C., Micalos, P. S., Maria, S. J., & Lord, B. (2015). Nonpharmacological interventions for
pain management in paramedicine and the emergency setting: A review of the literature.
Evidence-based complementary and alternative medicine, eCAM, 873039. Retrieved
https://doi.org/10.1155/2015/873039.
Rieder, T. N. (2018). There’s never just one side to the story: Why America must stop swinging
the opioid pendulum, Narrative Inquiry in Bioethics, 8(3), 225-231.
Ruan, X., Luo, J. J., Kaye, A. M. & Kaye, A. D. (2017). Non-medical use of prescription opioids
is associated with heroin initiation among United States veterans. Addiction, 112 (4),
727-728.
Ruhm, C. J. (2018). Corrected United States opioid-involved drug poisoning deaths and
mortality rates 1999-2015. Addiction,113 (7), 1339-1344.
Schatman, M. E., Vasciannie, A., & Kulich, R.J. (2019). Opioid moderatism and the imperative
of approaochment in pain medicine. Journal of Pain Research, 12, 649-657.
Schrager, S. M., Kecojevic, A., Silva, K., Jackson, B. Jennifer; Iverson, E., Lankenau, S. E. &
Zacny, J. (2014). Correlates and consequences of opioid misuse among high-risk young
adults. Journal of Addiction, 1-8.
Noninvasive Non-Drug Pain Management 27
Skelly, A.C., Chou, R., Dettori, J. R., Turner, J. A., Friedly, J. L., Rundell, S. D., Rongwei F.
Brodt, E. D., Wasson, N., Kantner, S., & Ferguson, A. J. R. (2020). Noninvasive
nonpharmacological treatment for chronic pain: A systematic review and update.
Comparative Effectiveness Review, No. 227. Retrieved June 18, 2020 at
https://www.ncbi.nlm.nih.gov/books/NBK556229.
Strickler, G. K., Zhang, K., Halpin, J. F., Bohnert, A. S. B., Baldwin, G. T., & Kreiner, P. W.
(2019). Effects of mandatory prescription drug monitoring program (PDMP) use laws on
prescriber registration and use and on risky prescribing. Drug and Alcohol Dependence,
199, 1–9. https://doi-org.ezproxy.uwplatt.edu/10.1016/j.drugalcdep.2019.02.010.
Stulberg, J. J., Schäfer, W., Shallcross, M. L., Lambert, B. L., Huang, R., Holl, J. L., Bilimoria,
K. Y., & Johnson, J. K. (2019). Evaluating the implementation and effectiveness of a
multi-component intervention to reduce post-surgical opioid prescribing: study protocol
of a mixed-methods design. BMJ open, 9(6), e030404. https://doi.org/10.1136/bmjopen-
2019-030404.
Substance Abuse and Mental Health Services Administration- SAMHSA (2018)
https://www.ncbi.nlm.nih.gov/books/NBK538436/.
Terplan, M. (2018). Are children places in foster care too often in response to the opioid crisis?
The CQ researcher, 28(26), 625.
Theisen, K., Jacobs, B., Macleod, L. & Davies, B. (2018). The United States opioid epidemic: A
review of the surgeon’s contribution to it and health policy initiatives.
BJU International, 2018-11,122 (5), 754-759.
Noninvasive Non-Drug Pain Management 28
United States. Public Health Service. Office of the Surgeon General (2018). Facing addiction in
America: The Surgeon General's spotlight on opioids. U.S. Department of Health and
Human Services. https://addiction.surgeongeneral.gov/sites/default/files/Spotlight-on-
Opioids_09192018.pdf.
United States Congress, House (2017). The Crisis Next Door: President Donald J. Trump is
Confronting an Opioid Crisis More Severe Than Original Expectations
https://www.whitehouse.gov/briefings-statements/crisis-next-door-president-donald-j-
trump-confronting-opioid-crisis-severe-original-expectations/.
United States Congress (2018). A Year of Historic Action to Combat the Opioid Crisis,
https://www.whitehouse.gov/articles/year-historic-action-combat-opioid-crisis/.
Vetter, T. R., McGwin, G., Bridgewater, C. L., Madan-Swain, A., Ascherman, L. & Evers, S.
(2013). Validation and clinical application of a biopsychosocial model of pain intensity
and functional disability in patients with a pediatric chronic pain condition referred to a
subspecialty clinic. Pain Research and Treatment, 2013, 143292-12.
White, P. F., Elvir L., Ofelia L., Galeas, L., & Cao, X. (2017). Use of electroanalgesia and laser
therapies as alternatives to opioids for acute and chronic pain management, F1000
Research, 6, 2161.
Winstanley, E. L., & Stover, A. N. (2019). The impact of the opioid epidemic on children and
Adolescents. Clinical therapeutics, 41(9), 1655–1662.
https://doi.org/10.1016/j.clinthera.2019.06.003.
Wittenberg, E., Bray, J. W., Aden, B., Gebremariam, A., Nosyk, B., & Schackman, B. R.(2016).
Measuring benefits of opioid misuse treatment for economic evaluation: Health-related
Noninvasive Non-Drug Pain Management 29
quality of life of opioid-dependent individuals and their spouses assessed by a sample of
the United States population. Addiction, 2016-04, 111 (4), 675-684.
World Health Organization-WHO (2020). https://www.who.int/bulletin/volumes/88/12/10-
076737/en/.
Wylde, V., Dennis, J., Beswick, A. D., Bruce, J., Eccleston, C., Howells, N. & Peters, T. J.
(2017). Systematic review of management of chronic pain after surgery. British Journal
of Surgery, 104 (10), 1293-1306.
Zeidan, F., & Vago, D. R. (2016). Mindfulness: meditation-based pain relief: A mechanistic
account. Annals of the New York Academy of Sciences, 1373 (1), 114-127.
Zivin, K. White, J. O., Chao, S., Christensen, A. L., Horner, L., Petersen, D. M. Hobbs, M. R.,
Capreol, G., Halbritter, K. A. & Jones, C. M. (2019). Implementing electronic health
record default settings to reduce opioid overprescribing: A pilot study. Pain Medicine, 20
(1), 103-112.