Chronic pain management has fundamentally shifted away from opioids toward a diverse toolkit of safer, evidence-based treatments that help patients regain function without the addiction risks. According to pain specialists, approximately 80% of chronic pain patients struggle with back or neck pain, yet most can find relief through physical therapy, behavioral strategies, topical medications, and advanced nerve stimulation techniques rather than prescription opioids. What Causes Most Chronic Pain? Back and neck pain dominate pain management practices, with back pain standing as the leading cause of disability globally. Dr. Rob Theiss, a physician at Iredell Pain Management, explained that the most common culprits are straightforward: "Most commonly as we age, there is arthritis that affects our joints. The other common cause is pinched nerves". Beyond these two primary causes, pain specialists encounter diverse conditions ranging from fibromyalgia to neuropathy, each requiring a tailored approach based on the patient's medical history, pain source, and individual tolerance. How Has Pain Treatment Changed Since the Opioid Crisis? The landscape of pain management has transformed dramatically over the past few decades, largely in response to the opioid epidemic. Healthcare providers now acknowledge their role in the crisis and have fundamentally rethought how they approach pain relief. "All parties in the healthcare industry, including doctors, have to own up to the role we had, along with pharmaceuticals, in the opioid epidemic. Well-intentioned people thought 'hey, these are a big breakthrough, you can take a pill and everything feels better.' It's like smoking cigarettes in our grandparent's generation and it spiraled out of control," explained Dr. Theiss. Dr. Rob Theiss, Physician at Iredell Pain Management Today, pain specialists view opioids as just one tool among many, reserved for specific situations rather than first-line treatment. "I think of myself as a carpenter. I've got tools in my toolbox, and opioids are just one tool of many in my toolbox. I reach for them when I feel like they're necessary, but for most people, they aren't," Dr. Theiss stated. Dr. Rob Theiss, Physician at Iredell Pain Management This measured approach means patients receive thoughtful, individualized care that prioritizes safer options first. Steps to Explore Non-Opioid Pain Management Options Pain specialists organize treatment into distinct categories, each offering specific benefits for different types of chronic pain. Here's how doctors approach building a personalized pain management plan: - Therapy-Based Approaches: Physical, occupational, and behavioral therapy form the foundation of most pain management plans. These therapies improve function and equip patients with long-term coping strategies they can use outside the doctor's office, particularly for conditions like fibromyalgia where pain processing pathways are overactive. - Non-Opioid Medications: Anti-inflammatory drugs, muscle relaxers, neuropathic pain medicines, and topical creams offer effective relief with fewer systemic side effects. Topical treatments absorb less than 10% into the bloodstream, meaning patients can use them safely for weeks, months, or even years without significant adverse effects. - Advanced Nerve Stimulation: Transcutaneous electrical nerve stimulation (TENS) units use mild electrical currents to reduce pain, while newer implantable peripheral nerve stimulation devices can target specific nerves for up to 60 days, dulling pain signals at their source. - Targeted Injections: Steroid injections and specialized treatments designed to address arthritis pain in the back provide localized relief without systemic medication exposure. Behavioral pain psychology deserves special attention, as many patients are surprised by its effectiveness. Dr. Theiss explained that for patients with long-standing pain, whether fibromyalgia or other chronic conditions, the nervous system's pain processing pathways become damaged over time. "These patients have their pain processing nerve pathways ramped up and there's a lot of coping that comes with that. In general, patients that have had pain for 15, 20, 25 years, fibromyalgia or not, these processing pathways are damaged. Behavioral pain psychologists teach patients strategies to live a functional and quality life, not because we think it's in your head but because you have very valid pain and we need to find a way to work through that on a long-term basis," he noted. Dr. Rob Theiss, Physician at Iredell Pain Management Why Should You Talk to Your Doctor About Pain Management? If you're experiencing acute or chronic pain, the first step is consulting your primary care provider about a referral to a pain management specialist. Pain specialists maintain collaborative relationships with other healthcare professionals to determine the best course of action for each patient, whether that involves therapies, surgery, or other treatments. The key is finding an approach tailored to your specific condition, medical history, and goals for quality of life. With the expanding toolkit of non-opioid options now available, most people can find effective relief without the risks associated with opioid dependence.
