In response to the 100,000 opioid overdose-related deaths in the past decade, along with the increasing rise in heroin use and deaths associated with initial opioid pain-killer addiction, federal regulations came into effect this week to tighten controls on medicines containing hydrocodone. Hydrocodone is a synthetic opioid, and is one of the active ingredients found in several prescription pain-killers, including Vicodin, Norco and Lortab. (Drugs containing natural opiates like codeine are not included under the new regulations.)

Opioids manipulated the way that the brain processes pain signals. They work on the reward system in a way that can result in feelings of euphoria, accounting for much of the medicines' addictive potential.

The new guidelines essentially require physicians to consciously renew their decision to prescribe opioids to a patient on a more regular basis. The changes now in place include:

  • Prescriptions are limited to a 30-day supply
  • No refills – new prescription required each month
  • Only doctors can write prescriptions, and these must be handwritten on paper rather than faxed or called in

While there are potential loopholes to these regulations – doctors may post-date prescriptions to provide a 90-day supply, and emergency prescriptions in case of injury may be called in – pharmacies are not required to honor such exceptions.

Pros and Cons

Opponents point out that people who legitimately use these medications to improve quality of life and alleviate debilitating pain may have difficulty obtaining medication under the new guidelines, particularly if they have mobility or transportation issues. They argue that the regulations are specifically unrelated to people with pain caused by cancer and other life-threatening conditions, and that a few bad apples, essentially, are spoiling it for the whole bunch.

Proponents, however, point out that these drugs are prescribed en masse to people with non-cancer pain caused by conditions like fibromyalgia, chronic back pain and headache for which long-term use of the drugs has not been proven effective; the American Academy of Neurology cites research that shows half of patients who use opioid pain-killers for three months end up still using them five years later.

See more on the new regulations and arguments for and against at http://psychologyofpain.blogspot.com/2014/10/after-new-federal-rules-popular.html .

Alternative Pain Management

It's important for people with chronic pain to beef up their supply of non-narcotic pain management methods. The following should be considered:

Ibuprofen / NSAIDs: These anti-inflammatory medications may help manage non-cancer pain, and are available both over-the-counter and by prescription. It should be noted that these medications are not without risk; they can lead to gastrointestinal problems, cardiovascular risk and kidney problems. Heavy or prolonged used should be pursued with caution (if at all), and patients who drink alcohol should be especially wary.

Cognitive Behavioral Therapy: This form of psychotherapy has time and again proved useful in managing pain and disability. In sessions, patients work to identify maladjusted thoughts, attitudes and beliefs about pain, replacing them with more accurate and constructive cognitions.

Exercise: Exercise is beneficial to overall well-being, and often for pain management specifically. Along with strengthening muscles and improving the circulation of oxygen- and nutrient-rich blood to the body's tissues, exercise releases endorphins that act as natural pain-killers. For those who are afraid of pain caused by movement, graduated exercise – in which the intensity of physical activity is gradually increased under the guidance of a physical therapist – can be immensely beneficial.

Myofascial Release: Some cases of chronic back pain, fibromyalgia and migraine can be helped by a form of massage called myofascial release. This is especially helpful to patients whose pain is related to chronic muscle tension.

Acupuncture: The body of research in support of acupuncture's effectiveness in treating pain for many conditions is ever-growing.

Relaxation Techniques: Anxiety and stress have an amplifying effect on physical pain. Meditation, breathing techniques, guided imagery and other forms of relaxation training can help mitigate pain.

Pain patients who may be affected by the new regulations of opioid medication are not left without resources for chronic pain management. Many of the alternative options above may be covered by health insurance. Discuss the possibility of expanding your pain management repertoire with a specialist, doctor or physical therapist.