When patients walk into a pain clinic today, the conversation with the physician often starts like this: “I’m worried about taking pain pills — what are my options besides opioids?”
Many patients are more informed than ever and increasingly cautious about the risks of opioid use. At The University of Texas Medical Branch (UTMB Health), that question is helping shape a more personalized approach to pain management.
For Adam Romman, MD, a pain medicine specialist at UTMB Health, these conversations often begin at the first appointment.
“When I see a patient, many already have some awareness of prescription or street opioids, and for some it’s almost the first question they ask,” Romman said. “It’s good that there’s awareness of the dangers, but education must continue. We need to talk about what nonopioid options can offer, how they’re different, and the difference between side effects and risks.”
A shift away from routine opioid use
In the past, opioids were commonly prescribed for pain management. Today, Romman said, care is shifting toward treatments that target the source of pain more precisely, rather than relying on medications that can be effective but carry broader risks.
“We now limit the use of certain higher-risk medications because they’re not always necessary,” he said. “They have a role in surgery, but typically only for the short term — in the hospital, with appropriate monitoring, around a surgery or severe injury — usually for just a few days to a week.”
For patients with cancer or those receiving palliative care, opioids may still play a longer-term role. But for many others, including those recovering from surgery or fractures, newer approaches offer safer ways to manage pain with fewer risks.
Targeting the source of pain
“In the pain clinic, we frequently treat chronic conditions, including back pain, pain from old injuries, and joint pain,” Romman said. “Today, we focus on the type of pain a patient is experiencing and address it with a more comprehensive approach.”
That approach can include steroid injections, x-ray-guided procedures, ablations, and other techniques designed to target the source of discomfort.
“Procedures such as peripheral nerve stimulation, where a small wire is implanted near a nerve or painful joint, can provide consistent, localized relief,” he said. “This approach is more targeted than taking pills and, in some cases, may offer long-lasting relief without the risks associated with certain medications. It reflects a different way of thinking about how we treat pain.”
Expanding care beyond medical procedures
Care plans now often extend beyond procedures to include physical therapy, rehabilitation, and lifestyle changes.
“We encourage a healthy diet because it can help reduce inflammation,” Romman said. “We look at a patient’s weight, encourage smoking cessation, and work to optimize sleep. Addressing these factors can lower pain levels and is an important part of a comprehensive approach to care.”
Understanding the limits of opioids
While opioids can provide effective short-term relief, Romman said they come with significant limitations.
“They can work well initially, but over time the dose often needs to be increased to achieve the same effect,” he said. “They can also change the body’s chemistry. When patients stop taking them, the pain may feel worse, and the medications can affect multiple systems, including the immune and endocrine systems.”
Nonopioid approaches do not always eliminate pain entirely, but they can help patients better manage it and maintain their quality of life.
“We have procedures that work for some patients, but there is no single solution for every type of pain,” he said. “Physical therapy and other treatments help people manage their pain so they can continue living their lives and minimize its impact.”
Addressing the psychological impact of pain
Treating chronic pain also means addressing its psychological impact, which medication and physical therapy alone cannot resolve.
“The psychological component is an important part of the equation,” Romman said. “Pain psychologists can help patients understand triggers such as stress or poor sleep. These factors can act like a volume dial for pain in the brain — mood and stress can turn it up or down, and patients can learn strategies to help manage that.”
Encouraging patients to take an active role
For those living with chronic pain, Romman encourages patients to take an active role in their care.
“Chronic pain is not like the acute pain of a fracture that can be treated with surgery and short-term medications,” he said. “A quick fix is not always possible. But participating in physical therapy, understanding how emotions affect pain, and maintaining healthy habits, including diet and sleep, are all essential parts of a comprehensive plan.”