The most important thrust of the question is: “I’d really like to come off the narcotics but I have no idea what else would successfully cover my pain.” THIS is what is facing most people in the midst of chronic pain: they don’t want to become addicted to pain medications, but they can’t function without them.  What effective alternatives are there?

This is a really great question, and it is one of the questions dominating focus, research, debate and policy in pain management today. Narcotics work very, very well: they “turn off” the pain signal, so that you don’t perceive it through your sensory nervous system. This is a delight for the pain patient who is constantly suffering. “A relief from that pain? Heck yeah, sign me up!”

The problem that pain management clinicians and researchers are struggling with is the “activation threshold” of pain. That is, when you dampen the pain signal over time, your system adjusts to that factor, and then the pain threshold lowers, UNLESS you have the medication intervening. Which means you need higher doses of your medication to achieve the same level of relief from pain.

Initially, this means that you can essentially do more with less pain. Yay, right? Not necessarily. What if, even while you feel less pain, you do more damage to the mechanical tissues of your body because you can’t feel the painful feedback your body sends to tell you you’re hurting it? If this happens, it usually results in further injury. For example, let’s say you have a torn muscle in your leg. You numb it with narcotics so that you can run on it. While you don’t feel the pain caused by running on the leg with the torn muscle, this exercise, in this state, almost guarantees extra damage to the torn muscle.

This brings up the crucial factor with which all researchers and clinicians struggle: What is actually causing the pain, both anatomically and physiologically? How did it start? What sustains it? How does one address both anatomy and physiology without making the patient increasingly dependent on medication for relief, or hopefully, recovery?

For this, you need a case director (usually MD/DO) who is well educated and experienced with a BROAD variety of treatment options. These options need to include “alternatives” such as chiropractic, acupuncture, biofeedback and advanced manual therapy. All of these techniques (tools in the therapeutic toolbox, if you will) do have limited studies done regarding their efficacy. The best “director” for your case will be an advanced MD/DO who has been apprised of those studies, and who also has had significant clinical experience with these “tools” and their benefits.

They will know how to best reduce your current medication (possibly in favor of one with lesser side-effects) and also how best to integrate effective “alternative” techniques into your treatment plan and its goals. These goals, often including comfortable and effective resumption of activities of daily living (ADLs) are superimposed with medication dosages in order to determine their therapeutic efficacy.

A good place to start finding a knowledgeable physician to guide your case is with the American Academy of Pain Management. The AAPM is the only institution to currently accredit those in multidisciplinary pain management, and they are committed to an interdisciplinary approach.

If you are merely exploring competent practitioners in alternative methods, PLEASE study their CVs, license, certifications and experience. I would recommend distrusting anyone who says, “Oh, I can cure you; the technique I use is the only one that works.” NO technique is a panacea – NONE. If they can’t discuss the strengths and limitations (almost more important) of their technique, then they are downright dangerous to you.

You need a good guide. That’s what a great pain management doctor does. Go find yourself one! Best of luck.