After undergoing surgery or surviving an accident, it’s routine to receive a prescription for opioids – a class of drugs that includes painkillers like oxycodone (OxyContin®) and hydrocodone (Vicodin®). While opioids are effective at managing pain, they come with a slew of pesky side effects like drowsiness and constipation. They are also quite addictive: Taking opioids for as little as five days can lead to drug dependency and addiction. In fact, 75% of heroin users in treatment state that their opioid addiction began with a legal prescription for painkillers. People undergoing surgery – even minor, outpatient surgery and elective procedures – are therefore at increased risk of opioid dependency, and should avoid opioids altogether if they can.
While generally safer than opioids, over-the-counter (OTC) pain medications also carry risks. Ibuprofen can be hard on the kidneys, and, like aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), can quickly cause a stomach ulcer. Acetaminophen (also known as Paracetamol, and sold in the U.S. under the brand name Tylenol®,) can also be brutal to the liver: Acetaminophen overuse is the #1 cause of acute liver injury and acute liver failure in the so-called developed world, and the risk is higher in women.
Thankfully, there are other ways to control pain besides these drugs. Here are some of the approaches to pain that I often share with my patients:
The mineral magnesium can also help alleviate pain, in part by helping the muscles properly relax. This calming effect occurs not only in the skeletal muscles (like the biceps and hamstrings), but also in the tiny muscles lining the blood vessels. This is why magnesium can also help lower blood pressure and improve heart health. Magnesium also plays essential roles in nerve transmission and protects the nerves from excessive excitation (excitotoxicity). Practically, what this means is that magnesium can have a calming effect, take the edge off of the anxiety and distress associated with pain, and support healthy sleep.
Nervines are a class of herbal medicines that support the nervous system and are generally calming. Nervines can help relieve muscle tension, ease anxiety, and support restful sleep, and can be taken in the form of teas (tisanes), tinctures, or capsules. Gentler nervines include skullcap (Scutellaria), milky oats (Avena sativa), catnip (Nepeta), lavender (Lavandula) and chamomile (Matricaria chamomilla). Stronger nervines, or relaxants, include valerian (Valeriana), passionflower (Passiflora), and hops (Humulus). Particularly hard-hitting nervines for reducing pain are known as anodynes, and include kava kava (Piper methysticum), which is an ace-in-the-hole herbal muscle relaxant with almost drug-like calming and sedating effects; Jamaican Dogwood (Piscidia); and California poppy (Eschscholtizia). Nervines are often combined together in lovely formulas sold in the health food store.
Vitamin C has been shown in clinical trials to alleviate pain, thanks to its anti-inflammatory, antioxidant, and opiate-receptor supporting activity. Taking just 2 grams of vitamin C one hour before surgery has been shown to reduce the need for opioid pain meds post-op. [Ditto for intravenous (IV).] Vitamin C also supports wound healing and collagen synthesis, which is also handy for healing from surgery or injury.
Mitragyna speciosa (also known as kratom) is a tree in the coffee family native to Southeast Asia. The herb contains many alkaloids, including mitragynine and 7-hydroxymitragynine, partial agonists of the μ (mu) opioid receptor – the same receptor upon which opioids like oxycodone and heroin act. Kratom is a highly effective, plant-based alternative to harder-hitting pharmaceutical opioids. It’s important to remember, however, that even natural opioids can be addictive, especially with regular use – so don’t take kratom for every little headache and “boo-boo,” try to limit the number of days you use it, and do not drive a car or operate heavy machinery while under its effects.
Numerous studies have demonstrated the pain-relieving effects of Cannabis (also known as marijuana) in a variety of contexts, mainly through its effects on the endo-cannabinoid system (ECS). Endo-cannabinoid proteins and receptors are found throughout the brain and nervous system of mammals, and have many biological functions, including the regulation of pain sensation, mood, memory, and aspects of the immune response. Unfortunately, the chronic use of opioid medications have been shown to deplete the ECS, thereby increasing pain perception and driving a vicious cycle of drug dependency. Thankfully, cannabis may help offset the damage caused by opioids and rejuvenate the ECS, thereby reducing pain.
Of the many cannabinoids found in the cannabis plant, cannabidiol (CBD) is the most researched for its medicinal value. Unlike tetrahydrocannabinol (THC), CBD is non-psychoactive (meaning it doesn’t get you high) and is also legal to sell in the United States. CBD may be smoked, ingested, dissolved rectally, and/or applied topically to reduce pain and inflammation, and is generally safe.
While CBD has great effects on its own, it seems to work better as a pain remedy when combined with a small amount of tetrahydrocannabinol (THC). The interaction between CBD and THC’s phytocannabinoids and terpenes – also known as “the entourage effect” – makes a winning combination for pain relief.
Applying cold to a painful area can help not only to numb the pain, but also to reduce the heat and swelling associated with inflammation. Applying cold to a body part can also slow down bleeding, as it causes vasoconstriction (the narrowing of blood vessels). In fact, the use of ice packs has been shown to reduce post-operative pain and narcotic use and to speed up recovery. Submerging the affect body part into a bucket of ice water may work even better than applying ice alone, because water is an excellent conductor of temperature. In fact, an entire branch of medicine known as hydrotherapy, or balneotherapy is dedicated to the application of hot and cold water to the body for healing purposes. A general rule of thumb for cold applications is to wrap ice packs in towels and apply them for no more than 20 minutes at a time.
There is no shortage of studies showing that acupuncture can help with pain. By gently supporting the body’s healing response, acupuncture stimulates the body’s production of beta-endorphin, serotonin, and other substances that help us heal. It has also been shown to reduce the need for pain medication, as well as to reduce post-operative nausea and vomiting. While some people fear the insertion of the acupuncture needles, people typically tolerate the treatment well and report feeling very relaxed during and after their sessions.
After surgery, many people want Vicodin®, not herbal tea. But pain is a means by which the body communicates, reminding us to take it easy as we convalesce. While a little medication can help us sleep and keep us from suffering as we heal, numbing our ability to feel pain entirely may tempt us to overexert ourselves, thus undermining the healing process. Sometimes, rest and patience are the best of medicines, and pain can guide us.
Although our bodies feel pain in response to physical stimuli (say, a broken bone), the perception and response to pain is largely mediated by the nervous system and brain. Numerous studies have demonstrated the power of meditation and other mindfulness practices to ease the nervous system, thereby reducing acute and chronic pain. Meditation reduces stress hormone levels and ease inflammation, two factors that play into pain. (A relaxed brain registers less pain than a stressed one.) Mindfulness practices can also support the release of endorphins, our body’s own natural pain relievers.
You’ve got options!
Although opioids and NSAIDs are routinely recommended by conventional healthcare practitioners, they are by no means the only strategies we have for treating pain. While the strategies listed above are generally considered safe, it’s always a good idea to check with your healthcare provider before making any changes to your (or your child’s) treatment plan, especially if you are pregnant, nursing a child, or medically fragile.
Dr. Erica Zelfand is a licensed family physician trained in naturopathic and functional medicine and specializing in integrative mental health. She is also a medical writer, teacher, and international speaker, and offers courses on the medical applications of psychedelic medicine. To learn about Dr. Z, follow her on Twitter and Facebook, join her mailing list, and visit DrZelfand.com.