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Home > Non-Opioid Therapies

non-opioid therapiesThis section of Pain Treatment Topics focuses on the variety of non-opioid therapies -- both pharmacologic and non-pharmacologic -- from an evidence-based, clinical perspective. This information is not offered as medical advice or treatment recommendations from Pain Treatment Topics. In all cases, professional discretion is advised in the acceptance or application of information in this section. See also, Disclaimer below.

Documents are listed in logical categories by treatment modality and, within those, in the order of their publication dates – most recent at the top. All URL links were valid at the time of posting. Please notify us of any broken links at: Info@Pain-Topics.org.
Researchers: Winnie Dawson, MA, RN, BSN; Stewart B. Leavitt, MA, PhD.

Fee Required Some items listed on this page are from sources not in accord with the Pain Treatment Topics Open Access Policy and require purchase at the source to view the full documents.

 

New = entry added or changed during latest update.

See more... Also see the following sections for additional documents of interest:

  • Non-Opioid/Alternative Therapies Clinical Guidelines: <Click Here>
  • Non-Opioid/Alternative Therapies Systematic Reviews: <Click Here>
  • Non-Opioid Therapies Position/Policy Statements: <Click Here>
  • Non-Opioid/Alternative Therapies CME Courses: <Click Here>

 

General Pain Relief - Nondrug, Complementary, Alternative


A Complementary Approach to Pain Management

Khatta M. Medscape Ob/Gyn & Women’s Health. 2007(May). Accessed June 6, 2007.

HTML See text at: http://www.medscape.com/viewarticle/556408?src=mp

 

Nonpharmacologic and Complementary Approaches to Cancer Pain Management

Menefee JA, et al. Journal of the American Osteopathic Association. 2005(Nov);105(11 Suppl 5):S15-S20. Accessed May 15, 2007.

PDF Download PDF: http://www.jaoa.org/cgi/reprint/105/suppl_5/S15


Complementary and Alternative Medicine Approaches for Pediatric Pain. A Review of the State-of-the-Science

Tsao JCI, et al. Evidence-Based Complementary and Alternative Medicine. 2005(Jun);2(2):149-159. Accessed May 15, 2007.

HTML See text at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1142204

 


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Acupuncture


Meta-Analysis: Acupuncture for Low Back Pain

Manheimer E, White A, Berman B, et al. Annals of Internal Medicine, 2005(Apr);142(8):651-663. Accessed May 16, 2007.

PDF Download PDF: http://www.annals.org/cgi/reprint/142/8/651.pdf


Acupuncture for Shoulder Pain

Green S, Buchbinder R, Hetrick S. Cochrane Database. 2005;2. Accessed May 28, 2007.

HTML See abstract...>


Acupuncture and Dry-Needling for Low Back Pain

Furlan AD, van Tulder MW, Cherkin DC , et al. Cochrane Database. 2005,1. Accessed May 28, 2007.

HTML See abstract...>


Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee

Berman BM, Lao L, Langenberg P, et al. Annals of Internal Medicine. 2004(Dec);141(12):901-910. Accessed May 16, 2007.

PDF Download PDF: http://www.annals.org/cgi/reprint/141/12/901.pdf


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Adjuvant Drugs

 

New Antidepressant Agents for the Treatment of Chronic Pain and Depression

Jann MW, Slade JH; Medscape, 2008 [from Pharmacotherapy. 2007;27(11):1571-1587].  See details...>

 

Perioperative Ketamine for Acute Postoperative Pain

Bell RF, Dahl JB, Moore RA et al. Cochrane Database. 2006;1. Accessed May 28, 2007.

HTML See abstract...>


Systemic Administration of Local Anesthetic Agents to Relieve Neuropathic Pain

Challapalli V, Tremont-Lukats IW, McNicol ED, et al. Cochrane Database. 2005,4. Accessed May 28, 2007.

HTML See abstract...>


Anticonvulsant Drugs for Acute and Chronic Pain

Wiffen P, Collins S, McQuay H, et al. Cochrane Database. 2005;3. Accessed May 28, 2007.

HTML See abstract...>


Antidepressants for neuropathic pain

Saarto T, Wiffen PJ. Cochrane Database. 2005,3. Accessed May 28, 2007.

HTML See abstract...>


Gabapentin for Acute and Chronic Pain

Wiffen PJ, McQuay HJ, Edwards JE, et al. Cochrane Database. 2005,3. Accessed May 28, 2007.

HTML See abstract...>


Recent Advances in Nonopioid Treatment of Pain

Moyer P, Bennett DS. Medscape Ob/Gyn & Women’s Health. 2005(Apr). Accessed May 28, 2007.

HTML See text at: http://www.medscape.com/viewarticle/502030


Antidepressants and Antiepileptic Drugs for Chronic Non-Cancer Pain

Maizels M, McCarberg B. American Family Physician, 2005(Feb);71(3):483-390. Accessed May 15, 2007.

PDF Download PDF: http://www.aafp.org/afp/20050201/483.pdf



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Biofeedback


Biofeedback as an Adjunctive Treatment Modality in Pain Management

Gatchel RJ. American Pain Society Bulletin, 2004. Accessed May 14, 2007.

HTML See text at: http://www.ampainsoc.org/pub/bulletin/jul04/clin1.htm


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Botulinum Toxin (BOTOX) Injections


Botulinum Toxin Type A For Migraine Headaches

Sidhu S, Ruddock B. Canadian Pharmacists Journal. 2006(Nov-Dec);139(6):30-31. Accessed May 24, 2007.

PDF Download PDF: http://www.pharmacists.ca/content/cpjpdfs/nov_dec06/
FocusonPatientCare_SIdhu.pdf


Botulinum Toxin Type A Therapy For Cervical Dystonia

Costa J, Espirito-Santo C, Borges A et al. Cochrane Database. 2005, 1. Accessed May 24, 2007.

HTML See abstract...>


Botulinum Toxin and the Management of Chronic Headaches

Evers S. Curr Opin Otolaryngol Head Neck Surg. 2004;12(3):197-203. Accessed May 24, 2007.

PDF Download PDF: http://robotics.me.jhu.edu/~rothbaum/Articles to
read/Botulinum toxin and the management of chronic headaches.pdf


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Cold or Heat Therapy

This topic area includes a wide variety of temperature-based treatments. Cold therapy can be used to reduce acute inflammation and relieve muscle spasm. Typically, the application of cold is superficial; an ice pack or cooling fluids are applied to the skin and local tissues. An unrelated treatment, low-level laser therapy, is also called cold laser therapy because it uses a near-infrared laser which is, basically, nonthermal. Heat therapy is most commonly used to increase blood flow and decrease joint stiffness which, in turn, reduces pain and muscle spasms. The application of heat may be superficial (hot packs, paraffin wax baths, hydrotherapy) or deep (diathermy, ultrasound). One example of deep heat therapy is an ablative treatment such as MRgFUS which is a noninvasive thermal ablation technique using high-intensity focused ultrasound.


Superficial Heat or Cold for Low Back Pain

French SD, Cameron M, Walker BF, et al. Cochrane Database. 2006,1. Accessed May 28, 2007.

HTML See abstract...>


A New Look at Heat Treatment for Pain Disorders. Part 2

O’Connor A, et al. American Pain Society Bulletin, 2005. Accessed May 14, 2007.

PDF Download PDF: http://www.ampainsoc.org/pub/bulletin/win05/inno1.htm


A New Look at Heat Treatment for Pain Disorders. Part 1

McCarberg B, et al. American Pain Society Bulletin, 2004. Accessed May 14, 2007.

PDF Download PDF: http://www.ampainsoc.org/pub/bulletin/nov04/inno1.htm


The Use of Heat and Cold in Pain Modulation

Michel T. Pain Relief Connection, 2003. Accessed May 11, 2007.

PDF Download PDF:
http://www.mgh.harvard.edu/painrelief/Pain%20Topics/Heat_Cold.pdf


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Electroanalgesia (incl. CES, MET, PENS, SCS, TENS, & Others)

The practice of electroanalgesia during the past 15 years has expanded, and even the task of identifying the acronyms can be a challenge. As an aid to understanding techniques available, the first article below (White et al, 2001) provides a brief historical review, a description, and a summary of significant trials in each procedure—from the noninvasive TENS to the minimally invasive PENS and the most invasive DBS.


Star Electroanalgesia: Its Role in Acute and Chronic Pain Management

White PF, Li S, Chiu JW. Anesthesia & Analgesia. 2001(Feb);92(2);505-513. Accessed May 21, 2007.

PDF Download PDF: http://www.anesthesia-analgesia.org/cgi/reprint/92/2/505


Transcutaneous Electrical Nerve Stimulation

Kaye V, Brandstater ME. eMedicine from WebMD. Updated Jan 2007. Accessed May 31, 2007.

HTML See text at: http://www.emedicine.com/pmr/topic206.htm


New Electromedical Treatment of Headaches [CES]

Kirsch DL. Practical Pain Management. 2006(Nov/Dec):58-65. Accessed September 10, 2008.

PDF Download PDF:
http://www.alpha-stim.com/repository/assets/pdf/kirsch-headache.pdf

 

New Microcurrent Electrical Therapy (MET): A Tutorial

Kirsch DL. Practical Pain Management. 2006(Oct):59-64. Accessed September 10, 2008.

PDF Download PDF:
http://www.alpha-stim.com/repository/assets/pdf/kirsch-MET.pdf

 

Transcutaneous Electrical Nerve Stimulation (TENS) For the Treatment of Rheumatoid Arthritis in the Hand

Brosseau L, Yonge KA, Robinson V, et al. Cochrane Database. 2006,1. Accessed May 24, 2007.

HTML See abstract...>


Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low-Back Pain

Khadilkar A, Milne S, Brosseau L, et al. Cochrane Database. 2005,3. Accessed May 28, 2007.

HTML See abstract...>


Comparison of Percutaneous Electrical Nerve Stimulation With Transcutaneous Electrical Nerve Stimulation for Long-Term Pain Relief in Patients With Chronic Low Back Pain

Yokoyama M, Sun X, Oku S, et al. Anesthesia & Analgesia. 2004;98(6):1552-1556. Accessed May 31, 2007.

PDF Download PDF: http://www.anesthesia-
analgesia.org/cgi/reprint/98/6/1552.pdf


Spinal Cord Stimulation (SCS) for Chronic Pain

Mailis-Gagnon A, Furlan AD, Sandoval JA, et al. Cochrane Database. 2004,3. Accessed May 28, 2007.

HTML See abstract...>


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Exercise Therapy


Systematic Review: Strategies for Using Exercise Therapy to Improve Outcomes in Chronic Low Back Pain

Hayden JA, et al. Annals of Internal Medicine. 2005(May);142(9):776-785. Accessed May 14, 2007.

PDF Download PDF: http://www.annals.org/cgi/reprint/142/9/776.pdf

 

Exercises for Mechanical Neck Disorders

Kay TM, Gross A, Goldsmith C, et al. Cochrane Database. 2005;3. Accessed May 28, 2007.

HTML See abstract...>


Exercise Prescription for Older Adults With Osteoarthritis Pain: Consensus Practice Recommendations

American Geriatrics Society (AGS), 2001. Accessed May 28, 2007. 

PDF Download PDF: http://www.americangeriatrics.org/products/positionpapers/
oae_guidelines.pdf

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Headache - Drug & Non-Drug Therapies

See more... Also see: Electroanalgesia and BOTOX Injections.

 

Emerging Drugs for Migraine Prophylaxis and Treatment

Bigal ME, Krymchantowski AV. Medscape General Medicine. 2006(May);5(10). Accessed May 28, 2007.

HTML See text at: http://www.medscape.com/viewarticle/528452

 

Selective Serotonin Re-Uptake Inhibitors (SSRIs) for Preventing Migraine and Tension-Type Headaches

Moja PL , Cusi C, Sterzi RR, et al. Cochrane Database. 2005,3. Accessed May 28, 2007.

HTML See abstract...>

 

Non-Invasive Physical Treatments for Chronic/Recurrent Headache

Bronfort G, Nilsson N, Haas M, et al. Cochrane Database. 2004,3. Accessed May 31, 2007.

HTML See abstract...>

 

Oral Sumatriptan for Acute Migraine

McCrory DC , Gray RN. Cochrane Database. 2003,3. Accessed May 28, 2007.

HTML See abstract....>


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Herbal Medicines and Dietary Supplements

 

New VITAMIN D – A ‘New’ Therapy for Chronic Pain

Stewart B. Leavitt, MA, PhD, Pain Treatment Topics, June 2008.

Vitamin D – A Neglected ‘Analgesic’ for Musculoskeletal Pain

   > Practitioner Briefing (7 pages)

   > Full Report (50 pages)

Vitamin D: A Champion of Pain Relief

   > Patient Brochure (6-pages)

HTML Page See details and download all 3 papers...>

 

Use of Herbal Therapies to Relieve Pain: A Review of Efficacy and Adverse Effects

Wirth JH, Hudgins JC, Paice JA. Medscape Ob/Gyn & Women’s Health, 2006(Jan). Similarly published in Pain Manage Nurs. 2005(Dec);6(4):145-167. Accessed May 28, 2007.

HTML See text at: http://www.medscape.com/viewarticle/519761


What You Should Know About Your Patients’ Use of Herbal Medicines and Other Dietary Supplements

American Society of Anesthesiologists (ASA), 2003. Accessed May 18, 2007.

PDF Download brochure PDF:
http://www.asahq.org/patientEducation/herbPhysician.pdf


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Interventional Pain Management

Interventional pain management is an emerging medical discipline devoted to the diagnosis and treatment of pain and related disorders. Interventional techniques include minimally invasive procedures, such as percutaneous precision needle placement, with placement of drugs in targeted areas or ablation of targeted nerves; and some surgical techniques, such as laser or endoscopic discectomy, intrathecal infusion pumps and spinal cord stimulators, for the diagnosis and management of chronic, persistent, or intractable pain.


Interventional Techniques: Evidence-Based Practice Guidelines in the Management of Chronic Spinal Pain

Boswell MV, Trescot AM, Datta S, et al. Pain Physician. 2007(Jan);10(1):7-111. Accessed May 28, 2007.

PDF Download PDF:
http://www.painphysicianjournal.com/2007/january/2007;10;7-111.pdf

 

Local Anesthetic Sympathetic Blockade for Complex Regional Pain Syndrome

Cepeda MS, Carr DB, Lau J. Cochrane Database. 2005;4. Accessed May 28, 2007.

HTML See abstract...>


The Evolving Role of Interventional Pain Management in Oncology

Sloan PA. Journal of Supportive Oncology. 2004(Nov-Dec);2(6):491-500,503. Accessed May 15, 2007.

PDF Download PDF:
http://www.supportiveoncology.net/journal/articles/0206491.pdf


Prolotherapy Injections for Chronic Low-Back Pain

Yelland MJ , Del Mar C, Pirozzo S, et al. Cochrane Database. 2004,2. Accessed May 28, 2007.

HTML See abstract...>


Corticosteroid Injections for Shoulder Pain

Buchbinder R, Green S, Youd JM. Cochrane Database. 2003,1. Accessed May 28, 2007.

HTML See abstract...>


Radiofrequency Denervation for Neck and Back Pain

Niemisto L, Kalso E, Malmivaara A, et al. Cochrane Database. 2003,1. Accessed May 28, 2007.

HTML See abstract...>


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NSAIDs & OTC Analgesics

 

Pearls & Perils of OTC Analgesics

NewThe Pharmacist’s Role in the Appropriate Selection of a Nonprescription Product for Pain Relief

US Pharmacist, September 2008. Accessed September 23, 2008.

Go to details and the link to this document...>

 

NSAIDs: Rx Considerations, Concerns, and Cautions

These documents, all released in early 2007, variously discuss the benefits and risks of non-opioid pharmacologic therapies for acute and chronic pain conditions, primarily musculoskeletal in nature.

Caution Recently-noted concerns about gastrointestinal complications and heart attack or stroke associated with these agents also are considered.

Use of Nonsteroidal Antiinflammatory Drugs. An Update for Clinicians. A Scientific Statement From the American Heart Association
Antman EM, et al. Circulation 2007, published online Feb 26, 2007.

Choosing Non-Opioid Analgesics for Osteoarthritis: Clinician's Guide
U.S. Agency for Healthcare Research and Quality; January 2007.

Medication Guide for Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
U.S. Food & Drug Administration, February 2007

Go to details and links to these documents...>

 

See more... Also see: Topical Analgesia <below>

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Nuclear Medicine

Nuclear Medicine is commonly used as a diagnostic tool, but it can also be administered therapeutically to provide pain relief from certain types of bone cancers. Very small amounts of radiopharmaceuticals can treat targeted bone cancer tumors locally without affecting other parts of the body. Radioactive drugs act on the metastatic bone tumor directly to reduce the effects of the cancer and, therefore, the associated pain.


Radiopharmaceutical Therapy for Palliation of Bone Pain From Osseous Metastases

Pandit-Taskar N, et al. Journal of Nuclear Medicine. 2004(Aug);45(8):1358-1365. Accessed May 11, 2007.

PDF Download PDF: http://jnm.snmjournals.org/cgi/reprint/45/8/1358


Radioisotopes for Metastatic Bone Pain

Roqué i Figuls M, Martinez MJ, Alonso-Coello Pl. Cochrane Database. 2003;4. Accessed May 28, 2007.

HTML See abstract...>


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Physical Therapies (incl. Massage, Shockwave Therapy, and Others)

 

Shock Wave Therapy for Lateral Elbow Pain

Buchbinder R, Green SE, Youd JM, et al. Cochrane Database. 2005;4. Accessed May 28, 2007.

HTML See abstract...>


Traction for Low-Back Pain With or Without Sciatica

Clarke JA, van Tulder MW, Blomberg SEI, et al. Cochrane Database. 2005,4. Accessed May 28, 2007.

HTML See abstract...>


Spinal Manipulative Therapy for Low-Back Pain

Assendelft WJJ, Morton SC, Yu Emily I, et al. Cochrane Database. 2004,1. Accessed May 28, 2007.

HTML See abstract...>


Stabilisation Splint Therapy for Temporomandibular Pain Dysfunction Syndrome

Al-Ani MZ, Davies SJ, Gray RJM, et al. Cochrane Database. 2004,1. Accessed May 28, 2007.

HTML See abstract...>


Physiotherapy Interventions for Shoulder Pain

Green S, Buchbinder R, Hetrick S. Cochrane Database. 2003;2. Accessed May 28, 2007.

HTML See abstract...>


Massage for Low-Back Pain

Furlan AD, Brosseau L, Imamura M, et al. Cochrane Database. 2002,2. Accessed May 28, 2007.

HTML See abstract...>


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Psychological Interventions (plus Hypnosis & Music Therapy)


Music for Pain Relief

Cepeda MS, Carr DB, Lau J, et al. Cochrane Database. 2006,2. Accessed May 28, 2007.

HTML See abstract...>

 

Psychological Interventions for Needle-Related Procedural Pain and Distress in Children and Adolescents

Uman LS, Chambers CT , McGrath PJ, et al. Cochrane Database. 2005,1. Accessed May 28, 2007.

HTML See abstract...>


Psychological Interventions for Symptomatic Management of Non-Specific Chest Pain in Patients With Normal Coronary Anatomy

Kisely S, Campbell LA , Skerritt P. Cochrane Database. 2005,1. Accessed May 28, 2007.

HTML See abstract...>

 

Psychological Therapies for the Management of Chronic and Recurrent Pain in Children and Adolescents

Eccleston C, Yorke L, Morley S, et al. Cochrane Database. 2003,1. Accessed May 28, 2007.

HTML See abstract...>


Psychological Therapies for Sickle Cell Disease and Pain

Anie KA, Green J. Cochrane Database. 2002,2. Accessed May 28, 2007.

HTML See abstract...>


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Topical Analgesia


Topical NSAIDs for Acute Pain: A Meta-Analysis

Mason L, Moore RA, Edwards JE, et al. BMC Fam Pract. 2004(May);5(10). Accessed May 28, 2007.

HTML See text at: http://www.pubmedcentral.gov/articlerender.fcgi?
tool=pubmed&pubmedid=15147585


Topical Agents or Dressings for Pain in Venous Leg Ulcers

Briggs M, Nelson EA. Cochrane Database. 2003,1. Accessed May 28, 2007.

HTML See abstract...>


Principles of Office Anesthesia: Part II. Topical Anesthesia

Kundu S, et al. American Family Physician. 2002(Jul);66(1):99-102. Accessed May 15, 2007.

PDF Download PDF: http://www.aafp.org/afp/20020701/99.pdf


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Pain Treatment Topics and its associates do not endorse any medications, products, services, or treatments described, mentioned, or discussed in any of the resources referenced. Nor are any representations made concerning efficacy, appropriateness, or suitability of any such medications, products, services, or treatments.

In view of the possibility of human error or advances in medical knowledge, Pain Treatment Topics and its associates do not warrant the information contained in the above contents is in every respect accurate or complete, and they are not responsible nor liable for any errors or omissions made by the original sources or for results obtained from the use of this information. Also see, Site Policies.

 

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This page was last updated 9/30/08