The non-opioid therapies that can be used to relieve pain

Opioids are derived from opium poppy plant seeds. These derivatives, when administered attach to specialized receptors in our nervous system providing pain relief. Chronic pain is frequently treated with opioids. Despite their effectiveness in acute pain states, their long-term side effects prevent their use in chronic pain. Current evidence shows that when used chronically, it is not only less effective but can cause significant harm.

Chronic pain is a major health challenge for Australia. The management of pain in Australia remains inadequate, despite the efforts of health practitioners, consumer organizations, and in recent years, State health authorities.

One in five Australians will suffer persistent pain in their lifetime yet up to 80% living with this debilitating condition are missing out on treatment that could improve their health and quality of life. Access Economics in 2007 estimated that persistent pain costs the Australian economy $34 billion per annum, is Australia’s third most costly health problem and as the population ages, the numbers and costs are increasing.

Chronic pain, opioid use, and alternative treatments are discussed in this article.

Chronic pain is a multifaceted problem

The treatment of chronic pain can be challenging. There are several reasons for this.

One in five Australians are affected by it

There is a range of different categories of pain, including acute, chronic, neuropathic, and cancer-related pain. Living with and managing persistent pain requires reliable and up-to-date medical treatment (including allied health and pharmaceutical assistance). It also needs self-management capability, utilizing lifestyle information, activity, and support. A combination of these measures can restore function and quality of life to individuals whose main disability is pain. In Australia, approximately 19% of the population is currently affected by moderate to severe chronic pain. 33% of these sufferers had pain with a high disability that was moderate to severely limiting. Overall, it has a considerable impact on quality of life, resulting in significant suffering and disability. While in many cases it is accepted that a cure is unlikely, the impact on quality of life, mood and function can be greatly reduced by early and best practice measures.

Treatment Can Be Difficult

About 20% of people who visit a healthcare provider for pain will be prescribed opioid medications.

Chronic pain management Sydney, Studies show that people who avoid physical activity and take medications have twice the disability rate as those who exercise and maintain a positive outlook. Opioids commonly prescribed include:

  • Oxycodone (Endone, Targin)
  • Fentanyl patches
  • Hydromorphone
  • Morphine (MS Contin)
  • Buprenorphine (Nospan, Temgesic)
  • Codeine

Temporary Effects of Opioids

While opioids temporarily relieve pain, they also produce a feeling of well-being. The brain’s pleasure centers are stimulated by these drugs. In chronic pain, opioids build up a tolerance in the brain, requiring higher doses in order to achieve the same effects.  Opioids slow the brain’s production of pleasure chemicals over time.

When opioid use is stopped, withdrawal symptoms can occur, including anxiety, tremors, diarrhea, and muscle cramps. In order to avoid these negative side effects, people may continue taking drugs. As a result, a vicious cycle is created.

Opioids alternatives

Chronic pain can be effectively managed with non-opioid medications, therapies, lifestyle behavioral changes, and interventional pain management techniques.

A list of non-opioid medications

With the help of a pain specialist in Sydney, chronic pain can be effectively treated with a wide range of non-opioid medications. There are some potential side effects associated with these medications, although they are generally safer than opioids.

Here are some examples:

  • Advil (ibuprofen) and Aleve (naproxen) are nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Acetaminophen (Panadol)
  • Inhibitors of COX-2 (Celecoxib)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants
  • Neurontin (gabapentin) and Lyrica (pregabalin) are anticonvulsants
  • Atypical opioids (Palexia)

Interventional Pain Management

Living with pain can have a large effect on the ability to enjoy life and this results in physical and psychological dysfunction. The field of interventional pain management is focused on identifying a patient’s source of pain and targeting therapy to those sources. Targeted therapy helps provide high-quality pain relief and allows patients to cope better with their pain.

“Interventional pain management utilizes advanced diagnostic medical imaging and targeted injections to identify the source of pain and treat chronic pain with better precision.”

Most patients attending a pain clinic would have had conservative management. Interventional pain management is a field of pain management that is applied prior to surgery or when conservative medical management has not succeeded to provide pain relief.

There are several different interventions and procedures that are used for chronic pain management. The best way to approach pain will vary depending on your symptoms and diagnostics. Many patients have found interventional pain treatment is most effective as an alternative to surgical interventions.

Diagnostic Injections

Diagnostic injections are performed by the pain specialist to identify the source of pain and assist in targeting treatment.

“Interventional pain management utilizes advanced diagnostic medical imaging and targeted injections to identify the source of pain and treat chronic pain with better precision.”

Diagnostic injections are intended to help your doctor determine what part of the body is causing the pain you are experiencing. The part that is causing the pain is sometimes referred to as the pain generator. Diagnostic injections are used by your doctor to determine the pain generator by a process of elimination.

Head and Neck, Shoulder and Upper Limb pain, Lower back pain, Chest pain, abdominal pain, pelvic pain, and knee pain.

Interventional pain management utilizes advanced diagnostic medical imaging and targeted injections to identify the source of pain and treat chronic pain with better precision.”

PRF – Pulsed Radio Frequency Ablation

What is pulsed radiofrequency (PRF)?

Pulsed Radiofrequency therapy is a pain management Sydney intervention to provide long-term pain relief when the pain relief from nerve blocks has lasted only for a short period. PRF is the next step in the treatment protocol after a diagnostic nerve injection. It is unique in that PRF does not destroy the nerve completely but resets the pain nerve to reduce pain and provide longer-term relief.

PRF is offered to patients with chronic pain originating from nerves.

What’s involved in the provision of PRF?

The radio frequency machine produces an intermittent (pulsed) electrical current through a needle that stimulates the nerve. The process should not be painful. It is a treatment that uses radio waves to control pain. A rapidly changing electric current is applied using a needle to a specific nerve which is causing problems. This causes changes to the nerve which can provide pain relief by preventing pain signals from reaching the spinal cord. Other signals from this nerve are not blocked.

During the procedure, you will also be given a local anesthetic and steroid injection to help relieve short-term pain following the PRF.

What are the benefits?

PRF treatment can give long-lasting pain relief for between three to 18 months but everyone experiences the effects in a different way.

Radiofrequency Ablation (RFA)

Radiofrequency ablation (RFA), also called radiofrequency neurotomy, uses radio waves to create a current that heats a small area of nerve tissue. The heat destroys that area of the nerve, stopping it from sending pain signals to your brain. Radiofrequency ablation can provide lasting relief for people with chronic pain, especially in the lower back, neck, and arthritic joints.

The goals of radiofrequency ablation are to:

  • Stop or reduce pain.
  • Improve function.
  • Reduce the number of pain medications taken.
  • Avoid or delay surgery.

Radiofrequency ablation is used to treat:

 What happens during an RFA?

The procedure is performed in the operation theatre. You will be sedated and local anesthesia will be used to numb your skin. The doctor will then insert a small needle near the medial branch nerve. Fluoroscopy, a type of x-ray, will be used to ensure the safe and proper position of the needle. Once the doctor is sure the needle is correctly placed, the medicine will be injected. Radiofrequency energy will then be used to disrupt the medial branch nerve. This is often repeated at more than one level of the spine.

What happens after an RFA?

You will be monitored up to monitored closely in the recovery room for 30 minutes after the injection. When you are ready to leave, the staff will give you discharge instructions. You will need to keep a pain diary. It is important to maintain a diary to help the doctor ascertain the success of the RFA.

You may feel sore for one to four days. It may be due to muscle and nerve irritation. Your back may feel numb or itchy for a couple of weeks. Maximum pain relief normally comes in two to three weeks but can take as long as six to eight weeks.


Neuromodulation is a rapidly developing area in neurosciences that involves the use of electricity or medications, targeting specific areas of the brain, spinal cord, or other parts of the nervous system, with the aim of relieving pain and or improving function. Neuromodulation can be classified into their major categories:

  1. Spinal Cord Stimulation
  2. Dorsal root Ganglion Stimulation
  3. Peripheral Nerve Stimulation
  4. Sacral Neuromodulation

One of the most common neuromodulation techniques is Spinal Cord Stimulation. This popularity has increased, not only because of its ability to reduce pain but also to help patients wean and cease potentially dangerous medications especially opioids (e.g. Morphine).

Spinal Cord Stimulation (SCS)

What is Spinal Cord Stimulation (SCS)?

Spinal cord stimulation also called neurostimulation accounts for over 90% of neuromodulation therapies. A small device called a pulse generator is implanted underneath the skin, it delivers small amounts of electricity to specific parts of the spinal cord via epidural lead-containing electrodes. The system is controlled by a handheld device. The electricity changes the way pain messages are sent and processed by the brain. The implanted pulse generator is similar to a pacemaker used for heart disorders; we sometimes refer it to as a pacemaker for pain.

What conditions respond to Spinal Cord Stimulation?

Spinal cord stimulation is indicated for a number of conditions, some of the well know conditions that respond to SCS are as follow;

  1. Failed Back Surgery Syndrome
  2. Chronic Back and Neck Pain
  3. Complex Regional Pain Syndrome
  4. Peripheral Neuropathy
  5. Refractory Angina

Regenerative Therapy

Regenerative medicine is a relatively new branch of medicine that deals with replacing, augmenting, or modifying human cells, tissues or organs with the aim to restore or establish normal function. In pain management clinics, a few innovative techniques have shown promising results in reducing and relieving chronic pain. These techniques are unique in that, not only are they minimally invasive techniques but also have no major drawbacks as the substance’s uses are either inert like hyaluronic acid, or extract from one’s own blood (PRP and Stem cells).

Platelet Rich Plasma (PRP) Injections

What are PRP injections?

In recent years there have been rapid developments in the use of growth factors for accelerated healing of an injury. PRP therapy offers a promising solution to accelerate the healing of tendon injuries naturally without subjecting the patient to significant risk.

Blood is made of red blood cells, white blood cells, plasma, and platelets. Platelets were initially known to be responsible for blood clotting. However, they are now known to release growth factors, which promote the healing processes.

Growth factors are released from the platelets which are found in the bloodstream and influence the biological processes necessary for the repair of soft tissues such as tendons or ligaments following acute traumatic or overuse injuries.

Initially, autologous (originating from the patient) whole blood was injected to promote healing in damaged tissues. However, PRP injections provide a much higher concentration of growth factors which are required within the body to promote tissue healing. PRP is blood plasma with concentrated platelets. The concentrated platelets found in the PRP contain huge reservoirs of bioactive proteins, including growth factors that are vital to initiate and accelerate tissue repair and regeneration.

These bioactive proteins initiate connective tissue healing and repair, promote the development of new blood vessels, and stimulate the wound-healing process

Hyaluronic Acid Injections

What is hyaluronic acid?

Hyaluronic acid (brand names Synvisc, Osteoartz, Euflexxa) is used to treat osteoarthritis, a condition that affects the joints. It is most commonly used to treat osteoarthritis of the knee.

In a normal joint, a layer of cartilage covers the ends of the bones. Cartilage helps the joint move smoothly and cushions the ends of the bones. In osteoarthritis, cartilage breaks down and becomes thin. This leaves the ends of the bones unprotected and the joint loses its ability to move smoothly.

Hyaluronic acid is found naturally in joints and other parts of the body. In the joint, it is found in the cartilage and the synovial fluid that lubricates the joints to keep them working smoothly. In people with osteoarthritis, the hyaluronic acid gets thinner and it is no longer able to protect the joint.

Injections of artificial hyaluronic acid into affected joints may improve protection. Hyaluronic acid injections are usually offered to people with osteoarthritis of the knee if other treatments have not worked or are unsuitable.

Stem Cell Therapy

What is SCT (Stem Cell therapy)?

Stem cell therapy is a promising area for future research in pain medicine utilizing mesenchymal stem cells which have the ability to transform (Pluripotency). Mesenchymal stem cell was initially harvested from bone marrow to treat blood disorders. These cells have now been identified as possible treatment options for patients with chronic pain. The uniqueness is the cells’ ability to transform and also is freely accessible in adipose tissue (fat cells). This makes this therapy safe and minimally invasive.

Which patients are suitable for SCT?

Patients who have failed conservative management may consider this therapy. The results from clinical research is mixed with no strong recommendations. This is an area of ongoing research, SCT is usually considered when pain limits function significantly and other treatments have failed.

Some conditions in which SCT has been studied are

  1. Spinal pain – discogenic pain
  2. Nerve pain
  3. Osteoarthritis
  4. Musculoskeletal pain


Chronic pain can be effectively treated with physical therapy. Additionally, physical therapy can help restore function that has been negatively affected by pain. A physical therapist can provide the best treatment for chronic pain with the help of pain specialists.

Pain can be treated with physical therapy in the following ways:

  • Modalities of heat or cold (heating pad, ice pack)
  • The use of ultrasound (heating soft tissues in the body)
  • Stimulation with electricity (can reduce pain and inflammation, increase circulation, and help contract muscles – TENS therapy)
  • Training for functional mobility (trains muscle groups to move properly)
  • The use of adaptive equipment
  • Graded exercise programs


Hydrotherapy is one of the most effective ways to treat chronic pain conditions, especially for those who suffer from back/joint pain. A qualified therapist (physiotherapist/exercise physiologist) conducts these classes in a warm pool.

Benefits of hydrotherapy for chronic pain:

  1. The warmth of the water increases circulation, which helps to ease the pain as it allows your muscles to relax
  2. The water helps to take the weight off the joints, which helps to relieve pain and increase the range of movement in the joints and improve muscle strength
  3. Hydrotherapy reduces the levels of stress hormones, resulting in reduced pain levels and improved sleep


Mental health and chronic pain

Sydney pain clinic, Chronic pain can affect both the mental and physical health of a person.  Up to 50% of people with chronic pain also suffer from depression. Chronic pain can also lead to feelings of hopelessness and poor quality of life.

By addressing the way chronic pain impacts every aspect of a person’s life, psychotherapy (counseling) provides support for people living with chronic pain at our Sydney clinic.

Acceptance and commitment therapy (ACT) is one type of psychotherapy used to support people with chronic pain. Individuals learn to accept that pain (and other negative experiences and emotions) are part of life, not something that can be suppressed.

Although living with chronic pain, ACT emphasizes commitment to activities that contribute to a positive quality of life, such as relationships, personal growth, and work duties.

Treatments that are complementary

There are also alternative methods of treating chronic pain in pain management clinics. Among them are:

  • Treatment with acupuncture
  • Practicing meditation
  • Yoga practice
  • The Tai Chi method
  • The hypnosis method
  • A biofeedback system
  • Techniques for relaxation

Chronic Pain: Tips for Living with It

To improve your quality of life with chronic pain, follow these tips:

  • Negative self-talk should be avoided.
  • Keep yourself active.
  • Make sure you don’t isolate yourself.
  • Get involved in hobbies.
  • Maintain a healthy diet.
  • Sleep enough.
  • Stress management techniques should be practiced.

In summary

Chronic pain is commonly treated with opioids. As a result of overprescription and misuse of these medications, Australians are experiencing an opioid crisis.

The pain management clinic in Sydney provides non-opioid medications, physical therapy, acupuncture, yoga, massage, exercise, and biofeedback. Chronic pain is often accompanied by mental challenges and stress, which can be treated with psychotherapy.

Questions to Consider Asking Your Doctor

Bring your notes and questions with you to your appointment. Doing so can help you make the most of the time with your doctor and ensure that you leave with the information needed to understand your diagnosis and treatment options.

  • Do you know what’s causing my pain, or is testing necessary to confirm your diagnosis?
  • Can my pain be cured, or should I readjust my expectations to manage my pain?
  • Does my pain have triggers I should avoid (such activities?
  • What kinds of pain treatments may be an option for me?
  • What are the risks, benefits, and side effects of these treatments?
  • What treatment(s) do you recommend I pursue, and why?
  • What level of pain relief should I expect from your recommended course of treatment?
  • Are there any alternative therapies, such as Physiotherapy, Counselling, or Hydrotherapy, that I may explore?
  • Will lifestyle modifications, such as diet or exercise, help reduce my pain?


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