Medical Alternatives: Non-drug

Addressing Pain Management & Opioid Use/Abuse

Pain Management & Opioid Abuse Strategies:
Medical Alternatives: Non-drug

The CDC Guidelines for Prescribing Opioids for Chronic Pain recommend that opioid therapy only be considered if benefits to both pain and function outweigh the risks. Non-drug alternatives are preferred as the first line of treatment for chronic pain.29

An integrated approach to pain management brings conventional or traditional approaches together with non-drug complementary, non-mainstream practices. This often means use of both pharmacological and non-pharmacological approaches for treatment of conditions such as chronic pain.

Complementary Health Approaches

Overall, more than 30% of adults in the U.S. use complementary health care. The most common approaches used are dietary supplements (fish oil), and mind body practices including deep breathing and yoga, tai chi, and qi gong. While many studies have been done to-date on some natural products, acupuncture, spinal manipulation, yoga and meditation, research is ongoing to reinforce the usefulness and safety of the various complementary health interventions.30

One of the most common health complaints in the U.S. is low back pain (LBP). A recent study showed that over 40% of people with LBP reported using a complementary therapy, the most popular being herbal supplements, chiropractic manipulation and massage. The majority of the LBP population used complementary approaches specifically to treat their back pain and 58% of people who used these therapies perceived a great deal of benefit.31

Plan Design Considerations

To encourage use of complementary therapies, employers need to consider making plan design changes that cover and/or lower copays for non-drug options that are supported by clinical evidence and by state mandated coverage requirements. Examples for non-drug therapeutic options include:1

  • Physical therapy
  • Behavioral health treatment
  • Acupuncture – ancillary to conventional therapy in treatment of nonspecific, non-inflammatory low back pain
  • Chiropractic care
  • Medical massage therapy
    • Rendered by a licensed medical massage therapist
    • Prescription required from health care provider every 12 months
  • Yoga therapy

The value of these interventions can be assessed based on outcome measures that demonstrate improvements in pain and pain-related disability functional status.1