Opioid Overprescription: Safer Alternatives for Chronic Pain

Opioid overprescription for chronic musculoskeletal pain is a serious public health problem — and safer alternatives to opioids for pain exist. A 2019 study in The Journal of Pain found that doctors prescribed opioids at 21.5% of first visits for chronic musculoskeletal pain, even though non-opioid medications, physical therapy, and behavioral treatments are often just as effective and far less risky.

The Study's Findings

Researchers analyzed data from a survey conducted between 2007 and 2015 and found that doctors more frequently prescribed pills, either non-opioid or opioid, rather than recommending other treatment options, such as:

• Physical therapy

• Counseling

• Other nondrug interventions

At patients' first visits, doctors most often prescribed:

1. Non-opioid painkillers (40.2%)

2. Opioids (21.5%)

3. Counseling, nonpharmacological treatments, and physical therapy

Consequences of Opioid Overprescription

The overprescription of opioids can lead to several serious consequences, including:

• Increased risk of addiction

• Overdose

• Other health complications

The study's findings are particularly concerning because they directly contradict the recommendations of experts, including those outlined in the CDC Guideline for Prescribing Opioids for Chronic Pain.

Recommended Alternatives to Opioid Treatment

Instead of relying on opioids, experts recommend several alternative treatments for managing chronic musculoskeletal pain, such as:

• Physical therapy

• Counseling and behavioral therapy

• Nondrug interventions (e.g., massage, acupuncture)

• Non-opioid pain medications (e.g., acetaminophen, NSAIDs)

• Creams/gels with pain meds and cannabis formulations can help with pain

Non-Opioid Prescription Options for Chronic Pain

Many people don't realize how many prescription options exist that aren't opioids. For chronic musculoskeletal pain, a provider may recommend one or more of the following medication classes depending on the cause and severity of your pain.

NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)

Prescription-strength NSAIDs like naproxen, celecoxib, and diclofenac reduce both pain and inflammation. They are often a first-line choice for conditions like osteoarthritis, rheumatoid arthritis, and back pain. Long-term use requires monitoring for stomach and kidney side effects, but for many patients they provide meaningful relief without the addiction risk of opioids.

Muscle Relaxers

For pain tied to muscle spasms or tension — common in back and neck conditions — muscle relaxers like cyclobenzaprine or tizanidine can be effective short-term options. They work best as part of a broader plan that includes physical therapy and movement.

Nerve Pain Medications

Conditions like fibromyalgia, sciatica, or neuropathic pain often respond better to medications that target nerve signaling than to opioids. Gabapentin, pregabalin, duloxetine, and certain tricyclic antidepressants are all used for this purpose and carry a much lower risk of dependence.

Topical Treatments

Topical NSAIDs (like diclofenac gel) and lidocaine patches deliver pain relief directly to the affected area with minimal systemic side effects. These are particularly useful for localized joint or muscle pain in older adults or anyone trying to limit oral medication.

Getting the Right Prescription Without an In-Person Visit

One barrier many patients face is simply accessing a provider who will take the time to explore non-opioid options. Telehealth makes this easier. Through Doctronic, our AI doctor can review your symptoms, walk you through evidence-based alternatives, and connect you with a licensed provider who can prescribe the right medication for your situation — all from home. You don't have to accept opioids as the default answer for chronic pain.

The Need for Education and Awareness

The study authors emphasize the need for improved education among healthcare providers to ensure that patients receive the most appropriate and effective treatments for chronic musculoskeletal pain. It is important to note that the study period (2007-2015) preceded much of the recent work and advocacy aimed at reducing opioid prescriptions, so the situation may have improved since then.

By raising awareness about the risks of opioid overprescription and promoting safer alternatives, we can work toward better pain management and improved outcomes. If you are experiencing chronic musculoskeletal pain, our AI doctor can help you understand your options and connect you with a provider for a non-opioid treatment plan — no in-person visit required.

The Bottom Line

Most chronic muscle and joint pain responds better to non-opioid treatments that don't carry addiction risks, yet many providers still prescribe opioids inappropriately at first visits. If you're concerned about your pain management approach or want to explore safer alternatives, Doctronic can help you understand your options quickly.