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This New Approach Treats Pain Without Reliance on Opioids

May 27, 2017

Prescription drug addiction has become a crisis in many states across the country. In Florida, Governor Rick Scott recently deemed the opioid crisis a public health emergency.

One of the challenges with opioids is that these drugs are powerful, which makes them effective for treating pain. But the powerful nature of these drugs comes with consequences – including serious adverse effects and the potential for addiction.

As health care providers, we need to find other ways to treat pain that helps patients, but also puts them at lower risk for dependence that may have severe health consequences down the road. This is one of the reasons we’ve begun to use multimodal pain control more widely when treating patients at Orlando Health.

What is Multimodal Pain Control?

Multimodal pain control is a relatively new approach to pain treatment compared to methods hospitals and care providers have traditionally used. We have now expanded this approach to a variety of patients, including those with major traumatic injuries, especially orthopedic injuries and rib fractures.

It involves managing pain with medications that work with multiple, different mechanisms of action, which basically refers to the way these medications produce their intended effects and reduce pain symptoms. It also involves giving these non-opioid medications on a scheduled, around-the-clock basis to prevent the development of severe pain and the need for treatment with opioids.

Multimodal pain control can involve nonsteroidal anti-inflammatory medications like ibuprofen (Advil®) or naproxen (Aleve®), medications like acetaminophen (Tylenol®), and some agents to help with muscle relaxation and neuropathic pain, a type of chronic pain caused by nerve damage or dysfunction.

Multimodal pain control got its start in elective surgery, with the goal helping patients recover from surgery more quickly. It involves the same principals mentioned above, but often starts the multimodal regimen prior to surgery.

The Benefits of Multimodal Pain Control

With multimodal pain control, our overall goal is to avoid side effects commonly associated with opioids, like sedation and respiratory depression (difficulty breathing). Elderly patients are especially sensitive to these side effects; therefore we try to avoid prescribing opioids since it can increase disorientation and confusion, which increases their risk of a fall. In addition, opioids are associated with nausea, vomiting and constipation, so using a different treatment approach has several benefits for pain patients. A lot of the other agents we use for multimodal pain control are also attractive options because a patient is much less likely to become dependent on them.

Multimodal pain management is not a one-size-fits-all approach. Although the non-opioid agents used are relatively safe, all medications have risks so we have to evaluate each patient individually. What makes a person a good candidate for multimodal pain control depends on their age, chronic disease states such as liver or kidney dysfunction and the nature of their injury or the underlying condition that is causing the pain. These characteristics allow us to predict how quickly patients will process and eliminate medications from their system as well as estimate the severity and duration of pain they will experience. It’s now ingrained in us to use multimodal pain control as the first and best option for pain treatment. Luckily, we have many non-opioid options available which allows us to individualize pain regimens.

Multimodal pain control isn’t a perfect solution for every patient. Even with this approach, we will not be able to completely eliminate pain immediately after surgery or traumatic injuries. Involving patients in development of realistic goals for levels of tolerable pain is a crucial component to pain management. In cases of uncontrolled pain, we can increase the dosage of the non-opioid medications we use, since we don’t begin with the maximum dosage of these drugs. Our goal is to really optimize the dosage of the drugs used for multimodal pain management before we prescribe long-acting opioids or increase the dose of opioids. Even when we use opioids, we prescribe a lower dose and try to get patients off them faster.

Multimodal pain control is still in its infancy, so there’s not a lot of literature that says what combinations of medicines work best. This form of pain management might look different at every hospital and differ from patient to patient.

This approach tries to target pain from different pathways, and it can be beneficial for many patients, especially those with chronic pain or people who may have a dependence on opioids. If you think you are an appropriate candidate for this approach, talk to your doctor — though multimodal pain control should already be on your physician’s radar. At Orlando Health, our goal is to help patients achieve better pain control up front and help them return to their regular lives as soon as possible. Multimodal pain management has allowed us to make significant headway toward this goal and positively impact the lives of patients who experience significant pain.


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