Alternatives to NSAIDs and Opioids for Pain Relief (Part One)

Following news reports detailing stunning revelations about a growing opioid epidemic in the U.S., Katherine Poehlmann, PhD, provides a timely overview of helpful alternatives for rheumatic disease pain control that are safer, with fewer side-effects.  Stay tuned for Part Two of this series, next month, as Katherine will be covering nutritional approaches to help reverse dependence and addiction to opioid pain relievers and other harmful substances.


Alternatives to NSAIDs and Opioids for Pain Relief (Part One)


Katherine Poehlmann, PhD

The ability to deal with pain varies with the individual. What is minimal for one person may be excruciating for another. The body feels pain when special nerves called nociceptors detect tissue damage, irritating oxides, and low levels of ascorbate, then send signals about the damage along the spinal cord to the brain. The damage can be the result of injury or trauma (physical or emotional), inflammation, dehydration, or immune reactions to pathogenic microbes and the consequent antioxidant vitamin depletion.

Pain may be chronic or may ebb and flow, exacerbated by allergic reactions to microbial, dietary, and environmental toxins and by inflammation in the gut, bladder, organs, glands, mouth, or joints. Increased joint and muscle pain may be the result of thyroid disease or adrenal dysfunction. Stress can amplify pain, manifesting as headaches, rashes, PTSD (post-traumatic stress syndrome), depression, or stomach upset, even ulcers. Stress depletes antioxidants (such as vitamins C and E, selenium, and flavonoids), increasing the need for replenishment through improved nutrition and/or supplements.

The brain maps the pain to the affected region(s) of the body, evaluates severity, then decides what to do about the pain, which can be chronic or acute and can take a variety of forms and severities. When the search for pain relief begins, the first choice is usually NSAIDS (nonsteroidal anti-inflammatory drugs). Sadly, nutritional needs are often ignored.

The cumulative toxic side effects of NSAIDs and other anti-inflammatory drugs can be serious, even lethal. Also, it has been shown that NSAIDs cause osteoarthritis by depleting collagen and accelerating the breakdown of cartilage in joints such as the knee, hip and low back. As cartilage erodes, joint pain increases with bone-on-bone friction. Bone brittleness (osteoporosis or bone scurvy) is increased by low levels of ascorbate (vitamin C) and lysine.

Some pain management experts and rheumatologists are becoming more willing, albeit reluctantly, to prescribe opioids presumed to be a less risky alternative to NSAIDs for treating arthritis pain. This misguided decision trades one kind of harm for another, as discussed in Part Two of this series.

Just as causes and levels of pain vary, effective approaches to reduce pain depend on the individual’s choice based on motivation, knowledge, and ability. The following are some benign alternatives to drugs.

Correcting hormone levels. The goal is to normalize nutrient absorption and metabolism at the cellular level. Those with adrenal (hormone) dysfunction should severely reduce sugars, excess or processed starches, caffeine, alcohol, stimulant drugs, and nicotine from their lifestyle. To rejuvenate the adrenal cortex, one needs extra vitamins (B5, B6. and C), salt, certain minerals (calcium, magnesium, sodium, potassium, phosphorus, iron, iodine, and zinc), and healthy fats. The body needs salt for the efficiency of the heartbeat, to make hydrochloric acid in the stomach, and for the fluid around the cells. Reducing stress is essential.

Self-hypnosis, also called guided imagery. Individuals who are able to master self-hypnosis will discover a very effective (and costless) coping technique for reducing pain and stress. Many scripts, videos, and step-by-step techniques can be found on the Internet. Check your local adult school catalog for classes. Self-hypnosis increases endorphins in the brain, making the pain tolerable by rerouting the signals.

Natural remedies. Some substances that reduce oxides and inflammation are white willow bark (the precursor to aspirin), turmeric (curcumin), Omega-3 fish oil, boswellia, and SAM-e. A certified nutritionist or herbalist can suggest a combination tailored to the individual’s pain relief requirements. Be sure to discuss all medications you are taking to avoid drug interactions. E.g., blood thinners may interact with curcumin and fish oil.

Correcting vitamin/mineral imbalance. A vitamin deficiency or mineral deficiency can enhance pain. Ask your doctor to test for low levels of essential nutrients. Iron is a mineral used to produce red blood cells and transport oxygen throughout the body. Low iron (anemia) leads to oxygen deficiency, and in turn, joint pain and swelling. Difficulties with strength, balance, and pain may indicate a vitamin D deficiency. Insufficient vitamin C leads to subclinical scurvy, linked to rheumatic disease.

Acupuncture, acupressure, chiropractic. These noninvasive methods have been known for centuries. Treatment is usually covered by insurance. Many chiropractors are experts in nutritive healing and pain reduction without drugs. These therapies generate natural endorphins in the brain but they do not treat the underlying tissue disease and inflammation causing the pain.

Distraction therapy. Pain sensations compete for attention in the brain with everything else going on around you. Distraction is a means to deliberately shift the brain’s focus away from pain and stressors. Joining a club and making new friends is uplifting and socially satisfying. Simply walking or swimming with a buddy several times weekly reaps benefits of exercise, oxygen transport, and better circulation in addition to pain distraction. Listen to music. Read a book. Learn a language. Work on puzzles. Adopt a pet. Do community service work. Seek spiritual help though your religious center.

Increased water intake. The human body is about 75% water. As Dr. F. Batmanghelidj describes in his 2008 book Your Body’s Many Cries for Water, Unintentional Chronic Dehydration (UCD) can cause stress, chronic pain, and degenerative diseases including asthma, arthritis, hypertension, angina, adult-onset diabetes, lupus, and multiple sclerosis. Simply increasing water intake can prevent pain from heartburn, colitis, peptic ulcers, migraine headaches, and can moderate conditions like asthma and allergies. Dehydration symptoms are dry mouth, fatigue, dizziness, small amount or dark urine, or decreased frequency of urination. There is no substitute for plain, pure (filtered) water. Liquids containing caffeine or alcohol (tea, coffee, juice, sodas, beer) are not equivalent. They have a diuretic effect, causing the kidneys to eliminate some of the body’s water reserves.

Dietary changes. Discover and eliminate food intolerances (e.g., gluten, dairy, sugar). Correct electrolyte imbalance caused by many factors including poor diet, hormonal dysfunction, too much or too little exercise, certain medications, dehydration, or an underlying chronic disorder. Improved nutrition enhances healing.

Restorative sleep. A 2017 study found that moderate daily repeated sleep loss as a result of extended daytime and nighttime activities leads to a progressive accumulation of sleep debt, leading in turn to increased pain responses, both of which are reduced after normal sleep is restored.

Topical treatments. Mild or moderate arthritis joint pain may respond to a cream or patch containing some combination of capsaicin, salicylates, menthol, eucalyptus oil, oil of wintergreen, camphor, eugenol from cloves, and/or turpentine oil. Be aware that skin irritation or allergic reaction is possible. For arthritis pain relief, some people get good results from DMSO (Dimethyl Sulfoxide) applied as a cream or gel along with methyl salicylate (oil of wintergreen, similar to aspirin). Some patches require a prescription, e.g., certain NSAIDs, lidocaine, and opioids, and have the same toxic side effects as the oral form.

Part Two will discuss effective nutritional protocols by which opioid addiction can be reversed. The use of specific vitamins instead of morphine analogues can reduce the cravings of (and addiction to) tobacco, alcohol, opioids, and other harmful substances.