Pain, Pain Management, and Non-Narcotic Pain Management
Pain can impact each person in different ways impacting overall wellbeing and quality of life.
- Acute Pain (lasting less than one month): Acute pain happens suddenly, usually because of an injury, surgery, or illness. It’s your body’s natural alarm system. This kind of pain normally goes away once the cause is treated, or the body heals. If it’s not properly managed, it can sometimes lead to longer-lasting pain.
- Sub-Acute (lasting one to three months): Sometimes pain continues even after the main injury or illness has improved. This ongoing pain is called post-acute pain and can turn into chronic pain if it lasts over three months.
- Chronic Pain (lasting longer than three months): Chronic pain lasts for more than 3 months. It can happen because of a long-term health problem, an old injury, inflammation, and/or a host of complex reasons that can be difficult to narrow down to a single cause. Chronic pain can affect the whole person (physical, mental, emotional, social, and spiritual) and may need ongoing care and support.
Why Non-Narcotic Pain Management Matters
Opioid Medication risk considerations:
- Dependence: Your body can get used to opioids over time. This means you might start to need the medicine just to feel normal. If you stop suddenly, you could feel sick or have withdrawal symptoms.
- Tolerance: After using opioids for a while, the same dose may not work as well. You might need higher doses to get the same pain relief, which increases the risk of side effects and overdose.
- Overdose: Taking too much of an opioid can slow or stop your breathing. This can be life-threatening.
- Increased sensitivity to pain (Hyperalgesia): Sometimes, long-term opioid use can actually make your body more sensitive to pain, so you feel more pain instead of less.
Non-Narcotic Pain Management Options
Nonopioid therapies are significantly effective for many common types of acute, sub-acute, and chronic pain and should be considered first-line treatments. Addressing pain early with nonopioid therapies can prevent chronic pain.
- Medications: Over-the-counter (acetaminophen, NSAIDs), prescription non-opioids (antidepressants, anticonvulsants, topical treatments).
- Therapies: Physical therapy, occupational therapy, exercise, cognitive behavioral therapy, mindfulness.
- Complementary approaches: Acupuncture, massage, chiropractic care, yoga, TENS units.
- Lifestyle: Sleep, nutrition, activity pacing, stress reduction.
MDH-Supported Projects
The 2019 Minnesota legislative session included several primary prevention strategies as part of a comprehensive approach to addressing the opioid epidemic in the state. One of these strategies allocated $1.25 million to fund studies evaluating non-narcotic pain management treatment in Minnesota. Of the total, $250,000 is funding one statewide mapping study to better understand where non-narcotic pain management is available and what barriers exist to accessing this type of care. The other $1 million dollars was awarded to five demonstration projects across the state to better understand what non-narcotic pain management and wellness services are being used, for and among whom, and their effectiveness.
The grantees who received funding included:
Health Partners Institute: Expanded access to the “Manage My Pain with Yoga” program. The curriculum weaves mindfulness-based stress reduction into yoga practice and encourages participants to use these skills both on and off their yoga mats to improve their overall quality of life.
Hennepin Healthcare:
- Began the “Growing Resilience in Chronic Pain Project”, which is a cohort-based group medical visit model. Several strategies employed in this project are unique to this effort. Strategies include addressing pain during didactic learning through weekly themed topics, active learning in mind-body integration including breathing techniques, mindful meditation, and guided imagery, movement-practice such as yoga and tai-chi, group socialization to grow community (e.g. shared experience in pain management), and a food or snack example each week to illustrate simple, affordable, anti-inflammatory food options.
- NOPAIN MN: The Non-Opioid Pain Alleviation Information Network (NOPAIN MN) is a collaborative initiative of Hennepin Healthcare and the Minnesota Department of Health. Together, these partners created Minnesota's first statewide, public resource connecting residents with trusted, evidence-based, drug-free options for managing pain. Studies related to this work can be found below.
- Mapping Evidence-Based Non-Opioid and Non-Pharmacological Pain Management Modalities Across Minnesota: The Non-Opioid Pain Alleviation Information Network Project.
- Continuum Model of Determinants Across Socioecological Nested Health Care Partners: Patient, Clinician, and Administrator Perspectives on Complementary and Integrative Health Care for Nonpharmacological Pain Management.
Innovations for Aging’s Juniper Program: Started the “Living Well with Chronic Pain”program. Participants in this six-session class learned non-pharmacological, self-management skills for lessening chronic pain. Topics in the class include dealing with frustration, fatigue and isolation; appropriate exercise for maintaining and improving strength, flexibility and endurance; appropriate use of medications; and communicating effectively with family, friends, and health professionals. Participants benefit from connecting and socializing with others with similar experiences.
Native American Community Clinic (NACC): NACC developed and evaluated a culturally-centered non-narcotic pain management program to help prevent and treat the opioid epidemic, which has significantly and disparately impacted American Indians in Minnesota over the last several years. NACC serves one of the densest urban American Indian communities in the country, and provides culturally-centered and responsive services in a fully-integrated primary care Community Health Center (CHC) setting. Increasing access to traditional and culturally-anchored medicine has always been at the forefront of their mission.
The Nura Chronic Pain Program was a month-long multidisciplinary program for pain patients with the goal of optimizing function and restoring quality of life while minimizing or eliminating the use of opioids. This program provided education, guidance, and counseling to improve physical strength, increase function, and help individuals manage the emotional components of the “chronic pain syndrome”. The program included medication management with the goal of reducing opioids, physical therapy to assist with physical conditioning, and wellness coaching to reduce stress, depression and anxiety, all of which influence chronic pain.
NOPAIN
Established in 2023, the Comprehensive Drug Overdose and Morbidity Prevention Act (Minnesota Statutes 144.0528) authorizes statewide overdose prevention, epidemiology, and evaluation efforts led by the Minnesota Department of Health through integrated strategies. One strategy advances access to evidence-based, non-narcotic pain management by funding NOPAIN (Non-Opioid Pain Alleviation Information Network) MN, a statewide public resource that connects residents with trusted, nonopioid options for managing pain.
NOPAINMN.org is a statewide hub for patients and providers to find safe, effective alternatives to opioids for pain care. MDH funds Hennepin Healthcare to manage and expand the site. Through this collaboration, NOPAINMN.org connects Minnesotans with trusted providers and evidence-based non-narcotic pain management options, supporting safer and more sustainable approaches to pain statewide.
- To be added to the map visit the NOPAIN webpage, scroll to the bottom of the page, and click Request New or Updated Listing.
Buprenorphine – An Alternative to Full-agonist Opioids
Buprenorphine is a medication that offers effective pain control without the risks associated with full-agonist opioids. Buprenorphine can be a safer choice for long term pain than medicines like oxycodone. Oxycodone fully turns on the brain’s pain receptors, which can lead to stronger side effects, higher risk of overdose, and more chance of becoming dependent. Buprenorphine works differently: it only partly turns those receptors on. Buprenorphine still provides pain relief, but it has a natural “limit” that makes dangerous side effects less likely. It also tends to cause less of the “high” feeling, which lowers the risk of misuse. In short, buprenorphine can control pain while reducing some of the risks that come with full-agonists opioids such as oxycodone or morphine.
The following resources are available to clinicians to learn more about using buprenorphine for the treatment of chronic pain.
- Veteran’s Administration (VA) clinical guidance for prescribing Buprenorphine for the Management of Chronic Pain (PDF).
- Stratis Health hosted two webinars on the topic of prescribing buprenorphine for chronic pain:
- Dr. Isaac Marsolek, Buprenorphine for Pain – You Can Too! YouTube Video
- Dr. Lee Radosh, Buprenorphine for Chronic Pain YouTube Video
- Journal articles
Patient and Provider Resources
For patients:
- Safe Storage and Disposal in Minnesota: This resource provides information about safe storage and disposal of prescription medications in Minnesota.
- How to talk to your provider: Definitions, talking points, and guidance for how to talk to your doctor about MOUD.
- Self-management and support programs: Comprehensive webpage for non-opioid pain management resources in Minnesota.
For providers:
- 2022 Clinical Practice Guidelines for Prescribing Opioids for Pain: This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids, for outpatients 18 or older.
- Training: Managing Pain with Opioids | Overdose Prevention | CDC: This resource provides an overview of safely initiating opioid therapy, as well as best practices for opioid selection, determining dosage, and adjusting dosage as necessary.
- Clinician Checklist: Managing Pain with Opioid Therapy: This checklist is for clinicians providing pain care to outpatients 18 or older
- NOPAIN MN: The Non-Opioid Pain Alleviation Information Network (NOPAIN MN) is a collaborative initiative of Hennepin Healthcare and the Minnesota Department of Health. Together, these partners created Minnesota's first statewide, public resource connecting residents with trusted, evidence-based, drug-free options for managing pain.
Equity and Access
It is important to note that access to non-opioid pain therapies can differ across the state. Efforts such as NOPAIN MN aim to increase awareness and access to non-opioid resources across the state. Additional goals of the project include:
▪ Reducing stigma around pain treatment options.
▪ Providing pain management options outside of health care settings.