Drug free pain relief
October 13, 2022 9:45 AM   Subscribe

My spouse is in a lot of pain and we could use some advice on alternative avenues of pain relief.

My spouse has bad joints from a couple of careers spent, well, beating up on their joints and wearing crappy shoes on concrete floors. (We are in our 40s and they already have three reconstructions on one joint, one reconstruction on another joint, a replacement on a third, and a procedure scheduled for a fourth in a few weeks). They spend a lot of time in pain.

Unfortunately, we do not live in an area (we are in the United States) where pot is legal, or that would be the obvious answer. We would be less concerned about that, but they are on a (non-pain-relief) controlled substance prescribed by the feds and thus are drug tested every time they visit [federal agency].

Thus, YANOurD, but we're looking for alternatives to pot (apparently Delta 8 has enough THC to make you pop hot or we'd be all over that) and to them bathing in Icy Hot every day. Medical pain management has not proven helpful so far - it took an ER trip and a possible infected joint to get any pain meds before the joint replacement last year. (Spouse is a big POC and doctors are totally uninterested in prescribing pain meds stronger than Tylenol, except for one round right after the joint replacement last year).

Do you have other herbal remedies that work for you? Vitamin regiments? Is medical massage the answer? Other ointments besides the Death By Icy Hot to recommend? Their pain levels are influencing their mental health, so all ideas (that aren't going to trip a drug test, so psychedelics, even if they're legal where you're at, are out) are welcome.
posted by anonymous to Health & Fitness (32 answers total) 22 users marked this as a favorite
A TENS unit is inexpensive and can provide relief. I use mine a lot.

Also are you able to see a pain management specialist?
posted by DarlingBri at 9:53 AM on October 13, 2022

I started on low-dose naltrexone (LDN) a few months ago, and so far, for me, it's been a game-changer. I used to have a fair amount of diffuse pain (especially: knees, lower back, upper back, headaches), which I'd say is 75% gone. I also think it has massively helped my sleep, as well as helped my mood and anxiety levels significantly. It may be more useful for centralized pain rather than peripheral pain - in other words, it may be more useful for pain that is primarily attributable to the brain's amplification of signals in its interpretation of pain, rather than what is actually occurring at the sensory receptors (see Dr. Clauw's work here). However I'm not sure that that doesn't mean it won't provide relief even if your pain is primarily peripheral. It works through interaction with the body's own opioid system:

Naltrexone works by temporarily binding and blocking a mechanism called the MU receptor, which is linked to pain. Blocking the receptor tells our bodies that we aren’t producing enough endorphins (our natural pain relievers), and then releases them.

“Generally, my patients report pain relief greater than 50 percent, that they’re sleeping better, or can return to work,” Dr. Mehta reports. “And some patients end up responding well to doses as low as 0.1 for reasons we don’t yet completely understand. Patients are experiencing good results with low harm in these early studies.”

I'm on 4.5 mg, which is the typical dose, and I've had no side effects except more vivid dreams. I got mine prescribed online by a MD/NP team, and from what you write, I think they very likely would prescribe some for your spouse if they wanted to try it. I pay $35/month including the NP visit to get it prescribed. It is very mild and gentle and kicks in slowly, almost imperceptibly (in my opinion), so I'd determine to give it a good 3-6 months before making a verdict about whether it's working. Feel free to message me with any questions.
posted by ClaireBear at 10:03 AM on October 13, 2022 [7 favorites]

I have had rheumatological issues since my late teens - achy muscles and extremely sore joints. On bad days, nothing really helps except maybe a warm bath. I also use a heat pad every night (it is the only way I can fall asleep). Also consider using a heat wrap (I use one for my neck and shoulders).

Seconding DarlingBri's suggestion for a TENS unit. They do help a lot.

Also, this may be entirely irrelevant so please feel to disregard but my GP suggested I take Vitamin D and B12 supplements (spray supplements). They have helped tremendously with my overall health but also joint pain.
posted by bigyellowtaxi at 10:04 AM on October 13, 2022

another favorable point for a TENS unit, although I've found it helps with muscle pain rather than joint pain. They can be bought for a onetime expense of ~$75.

I believe that kratom is legal in many places that pot isn't, and friends have had good experiences with it. it's usually available the same places that CBD is.

Since you state that "medical pain management has not proven helpful so far", I'm guessing spouse has already tried toradol? it's non-narcotic and clinicians might be more likely to prescribe it. I'm guessing that spouse has gone through physical therapy because of the surgeries? I've had good results going to a physiatrist/ortho surgeon or even a regular GP and stating that I'd like to get evaluated for a referral to PT. Clinicians might take a more favorable view of patients that they can see are definitely trying other paths than opiates, although sometimes they might still think it's long-con drug seeking behavior.

Expensive-ish, but I'm also a recent convert to float tanks (high ratio epsom salt solution so floating is more effective than in a swimming pool or even the ocean) - sometimes called sensory deprivation tanks. It's quiet and dark but the floating aspect was the most helpful part of it for me, taking the weight off my joints. a lot of the places have memberships that can pay for themselves within 2-3 visits within the same month.
posted by leemleem at 10:15 AM on October 13, 2022

Perhaps consult with a good acupuncturist? Pain management is one area that is very good at, both according to traditional practice and several studies in modern western medicine (some studies also show no effect, but it's incredibly safe and if it will work for them, it would probably be pretty obvious after the first visit).
posted by SaltySalticid at 10:16 AM on October 13, 2022 [4 favorites]

LDN is great, but definitely not before surgery or while taking opiate pain relief! Save it for after that period.

See if there’s a pain doc willing to do lidocaine injections in the joints. It’s not controlled so doctors are more open to it. It tends to only last about a week, but it’s good relief.

What kind of braces and splints have y’all tried? Getting some support to keep the bones from rubbing together is super helpful. Store bought is ok, but insurance will usually pay for ones prescribed by an ortho or surgeon. There are more intense and awesome joint braces out there than are usually known.

MOBILITY AIDS - he needs some mobility aids asap. Wheelchairs are amazing and people in joint pain should feel 100% like they deserve to use one. Walkers with seats. Appropriate crutches (forearm or better). There’s very often a surplus of wheelchairs in a location, so you probably don’t need to buy new. Call your Independent Living Center and see what resources are available. Also check out Facebook marketplace and craigslist.
posted by Bottlecap at 10:25 AM on October 13, 2022 [3 favorites]

Oh, also talk to a doctor about prescription strength lidocaine and if they can put gabapentin and anti-inflammatories in it and DMSO. Costs me about $75 a month, but also the pain relief is worth it. It did take me a long time to get a doctor who had ideas for helping me. And I did better when I came in saying “I don’t want opiates, what other options do you have for me?” Because it got them out of their (stupid stupid) drug seeker mentality.
posted by Bottlecap at 10:29 AM on October 13, 2022 [2 favorites]

Diclofenac gel ointment, to apply topically on areas that hurt, used to be prescription-only in the US, and is now available without a prescription. It's an NSAID, like ibuprofen, but because it doesn't have to go through the digestive system, it's easier on the stomach for some people than oral NSAIDs. The brand-name is Voltaren but generic is also available.
posted by brainwane at 10:36 AM on October 13, 2022 [3 favorites]

Note that OP did not specify their spouse's gender.
posted by obfuscation at 10:36 AM on October 13, 2022 [3 favorites]

I use a high-quality CBD salve, you can also use their tincture topically but I like the way the salve absorbs. I don't want to overpromise the effectiveness but I am routinely shocked that it can completely shut down the kinds of pain that it does. I hyperextended my thumb about six weeks ago and it's hard as hell to heal a dominant thumb sprain but the salve (and a splint because I apparently spend all night shoveling coal or something) is what lets me sleep.

My mother, who has hand-distorting arthritis, also uses it and is also constantly surprised how well it works.
posted by Lyn Never at 10:44 AM on October 13, 2022 [3 favorites]

Consider Mindfulness Meditation for Chronic Pain. I did this for migraines, and while it didn't make the migraine go away, it gave me a sense of control and something to do instead of just be controlled by the pain.
posted by Diddly at 10:47 AM on October 13, 2022 [1 favorite]

I am surprised that there's no mention of cortisone shots in your post. They can't be done with frequency or shortly before an operation, but they're unquestionably a useful tool in the joint relief arsenal.

I know you've asked for "alternative" pain relief, but you've mentioned the reticence of primary physicians not willing to prescribe more than Tylenol (so annoying!) without mentioning a referral to a medical pain clinic. Pain clinics can not only prescribe drugs, but also provide cortisone shots or less common procedures like RF ablations (where the nerves in the troublesome joint are deactivated through electrical stimulation.) Often, PCPs won't prescribe painkillers because they don't view it as their job to manage the treatments on an ongoing basis; a specialist pain clinic performs that role on modern medicine.
posted by eschatfische at 10:55 AM on October 13, 2022 [1 favorite]

Be aware that diclofenec gel is mega toxic to animals and you have to be vigilant that no animals ever lick you or anything it had been on. I don’t use it because I have dogs and a neighborhood cat that I worry about.
posted by Bottlecap at 11:00 AM on October 13, 2022 [9 favorites]

What about a pain phycologist? Dr. Rachel Zoffness has both an online course (with free preview intros) and a book if you want to get more information about the idea before seeking out someone to see or want to try to work through it yourself.
posted by carrioncomfort at 11:11 AM on October 13, 2022

I wanted to second dietary changes - I was going through testing for lupus and rheumatoid arthritis due to joint pain when I inadvertently discovered that eliminating wheat and dairy from my diet and taking an antihistamine daily completely eliminated my joint pain. I don’t specifically recommend the same - rather, I would look into your own inflammation triggers and see if there are any allergy correlations that you may be able to control that will help keep inflammation down.
posted by annathea at 11:22 AM on October 13, 2022 [1 favorite]

Anecdotally, when my husband and I were on the Whole30 diet, he found a lot of relief from constant low level pain that was plaguing him—arthritis, foot pain, etc. That or another anti-inflammatory diet might be worth a try. Whole30 has you eliminate a bunch of food groups for 30 days straight, no cheating: no grains, legumes, dairy, alcohol, added sugar or other sweeteners, carrageenan, or sulfites. You’re supposed to be strict with it for 30 days to give your body time to settle and the anti-inflammatory stuff to work. I’m sure it won’t be as powerful as an actual drug, but it could help reduce general pain level to a point where the other drugs can make it bearable.
posted by music for skeletons at 11:23 AM on October 13, 2022 [1 favorite]

If you're interested in trying some physical approaches you might look into Gyrotonics. It's a movement practice that is specifically focused on joint mobility. You work on a specific piece of equipment and there are pulleys and light weights. There are licensed physical therapists who can develop and guide you through a program. Most insurance will cover some number of physical therapy visits, so I would look into this.
posted by brookeb at 11:27 AM on October 13, 2022

Seconding referral to a medical pain clinic or a pain specialist. Mr. Blah has issues similar to your partner, and being referred to a pain specialist has helped him immensely. Basically, the pain specialist's #1 job is to help with the pain, and they have an array of solutions at hand.
posted by BlahLaLa at 11:43 AM on October 13, 2022 [1 favorite]

I would take a look at Pain Science, from journalist Paul Ingraham.

It's an amazing site, full of knowledge and science and good advice. I had pretty significant back and neck pain for YEARS, and finally got it resolved based entirely on what I'd learned at Pain Science. He really helped me cut through all the woo and nonsense that is everywhere when it comes to pain.

Most of the site is free, although I think some is newly behind a paywall. And he sells a few e-books, which I have happily paid for and benefited from.
posted by Susan PG at 11:53 AM on October 13, 2022 [1 favorite]

Just a supplement to what’s being said above, and news that I’m sure won’t affect your decision, but I figure might be good to share in this thread anyways: a friend of a friend just published the first long-term study comparing opioids to other pain meds, and it finds that they are no better over the long term at managing chronic pain.

Even apart from the issues with dependency, I was pretty shocked by this - I didn’t realize that the Sacklers et al. had been pushing opioids for management of chronic pain to prescribing clinicians with literally *zero studies of chronic pain lasting more than a few months*.
posted by rrrrrrrrrt at 12:02 PM on October 13, 2022

Temperature. If my legs are cold, they hurt. If they're warm, they don't hurt.
posted by Stuka at 12:03 PM on October 13, 2022

I would recommend looking into medical tourism honestly. Just because there are no good doctors nearby doesn't mean no good doctors exist. No one deserves to live like this.
posted by bleep at 12:13 PM on October 13, 2022 [2 favorites]

In addition to steroid injections, I have gotten tremendous relief for back pain via nerve ablation, in my case by a doctor who specializes in the spine.

Reading this thread with great interest and grateful for all the suggestions for my own pain management needs.
posted by Well I never at 12:35 PM on October 13, 2022

I can't swim, but hanging out in cold water and moving my body around helps both through the anti-inflammatory coolness and by letting me stretch and exercise the joints a little bit without exacerbating the pain.

Gabapentin? Hydroxychloroquine?
posted by metasarah at 12:43 PM on October 13, 2022

My partner saw a pain coach online for treatment-resistant nerve pain and says it's the best money they've ever spent in their life. They met once a week, one on one, for a few months.

The coach taught them a lot of research-supported recommendations for what to do in their daily life, and helped them figure out how to put those recommendations into action. Some of the recommendations were pretty intuitive. Some were surprising but worked. None of it was generic wellness bullshit like "rest" or "practice mindfulness." It was concrete and specific to their condition.

Another thing that came out of this was that my partner finally got a wheelchair to use when necessary. They'd thought about it before, but they weren't sure if it would make things better or worse in the long run. The coach showed them evidence that it would make things better, and gave specific advice on when to use it vs when to avoid it.

They're still on pain meds too, and probably always will be (and they're still not at zero pain). But the coaching and the chair took their pain from "utterly unmanageable" to "manageable with a combination of non-opioid medications," which was a massive improvement.

(Also, re doctors: Your partner may be able to convince a pain specialist to take their pain seriously even if other doctors don't listen. That was my partner's experience: their pain doc is the first doctor who really even believed that they were in pain at all.)
posted by nebulawindphone at 3:58 PM on October 13, 2022 [7 favorites]

If your spouse wants to try diclofenac for free, PM me. I bought a generic tube for $7.50 in July and never opened it. I'm happy to mail in the US (I'm in California). Was gonna give it away on NextDoor, what's the difference.

It might be worthwhile to speak with a pharmacist. If you are a part of a health care management organization, they have departments for this, so call the nurse line and ask how to consult the pharmacist. If not, ask for a consultation with the pharmacist next time you are picking up whatever meds you are on at whatever pharmacy you are at. They can have ideas about stacking/rotating various OTC meds to best manage pain that non-pain-specialist physicians are sometimes unaware of.
posted by holyrood at 7:17 PM on October 13, 2022

Seconding low dose naltrexone. I went on it because I was desperate, but I had zero expectations that it would do anything. And it really noticeably helps! Occasionally I'll forget a dose, and I always realize it when the pain flares up again. It doesn't make it go away completely, but it makes it more manageable.

Just a heads up, I'm on 4.5 mg, but I found the effects wore off when I took it all in one dose, so I split it and take half am and half pm.

But yes, it can counteract effects of opioids, so not the best choice while on opiate pain killers

Also, I'm generally skeptical of supplements, but if you want to go down that route, you may want to look into palmitoylethanolamide (abbreviated PEA, but be aware, there's another supplement also that uses PEA as an abbreviation). There's some evidence that it may help with pain. It seems to interact with the endocannabinoid system. It's a fatty acid your body makes naturally. The main thing it has going for it is that it seems to carry no significant risks/side effects, unlike a lot of other supplements. I didn't stick with it b/c I ended up with some GI side effects, but I've got food intolerance lists a mile long.
posted by litera scripta manet at 7:19 PM on October 13, 2022 [1 favorite]

Have you considered gabapentin? It's not a miracle drug but some people find it to be very helpful. It's generally prescribed for nerve pain, but it's non-narcotic and cheap and might be worth a try.
posted by citygirl at 8:18 PM on October 13, 2022 [1 favorite]

This is a long-term thing, but strength training (with a knowledgeable trainer who can account for pain and knows how to start GENTLY and ramp up slowly!). Essentially, strengthening the muscles and tendons around the joints takes pressure off the joints. Probably won't be a miracle cure, but I'd expect it to relieve at least some of the pain.

And I mean long-term: I started training a year ago, and I can finally notice a difference in the pain from the arthritis in the ball joints of my feet. Previously, if I went up a flight of stairs or walked more than a few minutes, my feet would hurt for 24 hours or so, enough that when I was in bed the pressure of the sheet on my feet would hurt. I wasn't disabled from it--I could still go on vacation and walk all day, but I'd be popping OTC painkillers and resigned to have feet that hurt--sometimes enough to make me cry--until we got home and I could stop walking.

We went to Chicago a week ago. I walked around all day, including a 15,000-step day according to my phone, stood around at museums, went up and down stairs. And the arthritis in my feet...it wasn't gone, but all I had to do was sit down and it stopped hurting. I didn't take any painkillers for it. The pain was completely gone by the next morning, and wouldn't start up again until later in the day. (And I have not lost any weight over the course of this year--this isn't the result of getting weight off the joints.)

For me, my trainer is key: she emphasizes paying attention to how my body is feeling and learning the difference between "this muscle/tendon is hurting in a way that indicates it's overloaded and I need to stop," "this is that muscle/tendon being tired and I need to be careful," and "this is a sensation that shows this muscle/tendon is unused to this movement, but I'm okay to keep going." She keeps me using good form, and on days when something is hurting too much we just work on other parts of my body and let the hurting part rest, and she keeps me from jumping ahead and tackling too much (as I have a tendency to do, resulting in me injuring myself).
posted by telophase at 9:37 AM on October 14, 2022

Curable app has helped me.
posted by fozzie_bear at 8:37 PM on October 14, 2022

Mod note: From the OP:
To address the questions in the post: (One update and then I'll step out, but I knew I forgot some details)
- we have a variety of braces which help some depending on the joint and the day
- they have a cane and elbow crutches that get used periodically. They would rather hurt and walk than use a mobility aid, they were on a walker after the hip replacement for awhile (I know, I know).
- cortisone shots fail in anywhere between 3 days (no, that's not a typo) and 3 months, not the 6 months they're supposed to last
- tramadol and gaba cause allergic reactions
- they are currently in PT. Please trust me when I say that the medical establishment has not been helpful re: pain.

thank you all so much for the ideas! This is really help.
posted by taz (staff) at 10:48 PM on October 14, 2022 [1 favorite]

I have psoriatic arthritis, and being sandwiched between a heated mattress pad and an electric blanket helps a lot in warming up my joints in the morning so they hurt less throughout the day
posted by Jacqueline at 3:13 PM on October 15, 2022

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