HWN Suggests

Non-Opioid Pain Medications to Consider for Emergency Department Patients

As recently as 15 years ago, the approach to pain management was a symptomatic one, whereby the symptom of pain was hidden or minimized with a general analgesic such as an opioid or acetaminophen. Additional pain relief was sought by treating the underlying disease under the assumption that the pain would resolve if you did so.

The symptomatic approach has been almost completely replaced by a mechanistic approach. With this approach, the neurobiological mechanism creating the pain is identified and neutralized with a targeted medication. Although far more applicable in managing chronic pain, the mechanistic approach was first seen in acute pain settings. Witness the change from opioids…

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 Could monoclonal antibodies replace opioids for chronic pain?

Although it may seem very futuristic, the Food and Drug Administration has already approved monoclonal antibodies to treat and prevent migraine. These new medications act on a migraine-associated protein called calcitonin gene-related peptide. The project at UC Davis has a different target — specific ion channels in nerve cells known as voltage-gated sodium channels. The channels are like “pores” on the nerve cell.

 Introducing the ALTO Alternatives to Opioids Program

The idea of an “opioid-free ED” was first described by Sergey Motov, MD, FAAEM, of Maimonides Medical Center in Brooklyn, New York, and much of the basis for the ALTOSM program stems from his teachings...

 Manage Pain Without Opioids

One approach is to layer several non-opioid pain medications. Begin by using tried and true NSAIDS. Studies show that naproxen alone achieves the same level of pain control when compared to combinations of naproxen and oxycodone or flexeril. Moreover, a 400-mg dose is thought to be ideal, as the analgesic ceiling is reached at that range. If that doesn’t achieve the desired response, consider adding acetaminophen. The combination of the two has been shown to achieve better control of postoperative and dental pain than either one alone.

 Painkillers without the addiction? The new wave of non-opioid pain relief https://www.theguardian.com/science/2025/apr/05/painkillers-without-the-addiction-the-new-wave-of-non-opioid-pain-relief Pharma firms are developing drugs that avoid the brain’s opioid receptors to minimise the risks of dependence and overdoses, but not all experts are convinced. Journavx selectively blocks a VGSC called Nav1.8 that is predominantly found in pain-sensing neurons in the peripheral nervous system, says David Altshuler, chief scientific officer of Vertex. The drug does not act on the brain the way opioids do and instead acts outside the brain, meaning there is no addiction risk.

Pharma firms are developing drugs that avoid the brain’s opioid receptors to minimise the risks of dependence and overdoses, but not all experts are convinced. Despite all these new pharmaceutical approaches, most experts agree that there is no such thing as a magic bullet for pain. “We’re going to have to treat pain with multiple drugs that act in the peripheral nervous system, in the central nervous system, in the brain and on emotions and cognition, and not just on sensory systems,” Scherrer says. He adds that other types of treatments such as neurostimulation and cognitive behavioural therapy will also play a key role.

 Rub on pain products – what you need to know

Help comes in the form of a new Cochrane overview review that draws together all the current evidence. The overview pulled together results from 13 Cochrane reviews, with 206 individual trials and around 30,700 participants, to assess the benefits and harms of a range of topical (applied to the skin) painkillers for a range of conditions.

Articles of Interest

Alternatives to Opioids for Managing Pain

Multiple classes of non-opioid medications are routinely used to treat pain, including over-the-counter and prescribed non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, steroids, antidepressants, anticonvulsants, and topical medications.

Alternatives to Opioids for Pain Relief

A combination of Tylenol and Advil worked just as well as opioids for relief of pain in the emergency room, a randomized trial has found.

An E.R. Kicks the Habit of Opioids for Pain

Instead of opioids, an E.R. in New Jersey now treats many pain patients with alternatives like laughing gas, trigger-point injections and even a therapy harp.

Deadly Dangers from Drugstore Pain Meds a Painful Surprise

Could your attempts to cope with common headaches, sore knees or backache be putting you at risk for heart attack, stroke and liver disease? Recent research suggests that both ibuprofen and acetominophen -- the two most popular over-the-counter painkillers -- carry some potentially and even deadly risks.

Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain

Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.

Emergency Department Alternatives to Opioids: Adapting and Implementing Proven Therapies in Practice

The continued expansion of ED-ALTO programs across the US may serve as a mechanism with which to reduce opioid utilization and successfully help patients control pain. Although our program is in its early stages of implementation, we believe it is showing early success with respect to reducing opioid utilization.

Non-Opioid Analgesics Role in Pain Management

As opioid prescriptions decline, non-opioid analgesics are increasingly emphasized in a variety of clinical settings as a preferred, safe, and effective first-line therapy for mild to moderate acute and chronic pain.

Non-Opioid Compounds Squelch Pain Without Sedation

A newly identified set of molecules alleviated pain in mice while avoiding the sedating effect that limits the use of opiates, according to a new study led by researchers at UC San Francisco. The molecules act on the same receptor as clonidine and dexmedetomidine – drugs commonly used in hospitals as sedatives – but are chemically unrelated to them and may not be addictive. Clonidine and dexmedetomidine are also both effective pain killers but so sedating that they are rarely used for pain relief outside of the hospital.

Non-opioid pain pill shows promise in clinical trials

But relieving pain by blocking either Nav1.8 or another channel, Nav1.7, has proved difficult. One issue is their structure closely resembles those of other sodium channels, which regulate vital functions in the heart, muscles, and brain. To be safe, a compound needs to target the channel of interest and not accidentally target these other, critical channels.

“I Was a Little Surprised”: Qualitative Insights From Patients Enrolled in a 12-Month Trial Comparing Opioids With Nonopioid Medications for Chronic Musculoskeletal Pain

The SPACE trial, the first randomized controlled trial to compare long-term outcomes of opioid versus nonopioid medications for chronic pain, found no advantage of opioids over 12 months. Moreover, opioids caused significantly more medication-related adverse symptoms than nonopioid medications.