Old Drug, New Use: Alternatives To Opioids In Pain Management

Posted on: 21 December 2016


With increasing concern over the use of opioids for acute and chronic pain management, doctors and patients are seeking alternatives to keep pain under control with fewer risks of addiction. In some cases, old drugs used in new ways are providing a suitable alternative to opioid use or can be used in conjunction with current treatments.

Low-Dose Ketamine

Ketamine may be familiar to most people as the street drug "Special K." When used in a therapeutic manner, ketamine can be an effective pain reliever and is sometimes used in emergency department settings to manage severe migraines or cervical spine pain. It can also be used in pediatric populations. Traditionally, ketamine is used for its anesthetic and sedative properties at higher doses. At low doses, ketamine can help control pain for several days after administration. Another option is to use ketamine in conjunction with opioids to control pain. For people who are currently taking opioids for pain management, integrating ketamine into their current therapy can reduce the amount of opioids they need to achieve the same benefits.


Diphenhydramine is the active ingredient found in over-the-counter antihistamines and motion-sickness medications. It seems unlikely this medication can have pain relieving benefits, but it can be useful to manage headaches, especially when combined with other retail pain relievers. Some medical practitioners have found it is beneficial when used in conjunction with standard pain control methods in the management of pain related to cancer. Diphenhydramine can be administered orally or through IV. Subcutaneous injections of diphenhydramine have been used in lieu of lidocaine to control topical pain during suturing. Since this medication is readily available, it may be worth adding on to a current pain management regimen.

Lidocaine Patch

Lidocaine is typically used to anesthetize the skin and soft tissues during simple surgeries, such as cyst removals, or to make arterial blood gas sampling less painful. It is less often seen in an overall pain management treatment plan. Lidocaine can be administered in the form of a patch to help with musculoskeletal pain. It is also useful for residual nerve pain after the shingles virus. Fortunately, some variants of lidocaine patches are available over-the-counter. These retail products typically contain 5% lidocaine per patch. The transdermal route for lidocaine can be useful for the spot treatment of pain and used in lieu of opioid pain relievers. It is also ideal for people who currently take opioids, but need additional treatment for breakthrough pain.

Several medications that have been on the market for decades are receiving more attention due to their ability to help with pain management. With the increase in options for pain management, doctors and patients can find alternatives to opioids or lessen the current dose.