Breaking free of opioids

A neurologist shares alternative treatments for chronic pain and the importance of steering clear of opioids. 

12:15 PM

Author | Jane Racey Gleeson

figure of person drawn seeing lines inside from brain and yoga poses on shoulders, pills going into mouth and cream on shoulders orange blue white
Justine Ross, Michigan Medicine

With established evidence supporting the relationship between opioid usage and addiction, it's no surprise that physicians like University of Michigan Health neurologist Brian Callaghan, M.D., M.S., are committed to researching alternative therapies for the estimated 20 million Americans suffering from chronic pain, also known as neuropathic pain.

Callaghan is lead facilitator in an American Academy of Neurology clinical guideline on oral and topical treatments for painful diabetic neuropathy, published in January 2022.

The guideline recommends physicians prescribe these treatments instead of highly addictive opioids, which block receptors in the brain responsible for pain but also increase feelings of euphoria, resulting in abuse for some patients.

Like nicotine, opioids work on certain receptors in the brain, says Callaghan.

SEE ALSO: New guideline urges ditching opioids for painful diabetic neuropathy

"Addiction depends on the brain chemistry. Everyone reacts to these medications differently, so there's no way to know who will become addicted."

What causes neuropathic pain?

Patients with neuropathic describe what they experience as burning, electric and/or stabbing pain typically in the hands, legs and feet, says Callaghan.

Although diabetes is the number one cause of neuropathic pain, followed by idiopathic (unknown) reasons, other causes include:

  • Alcoholism


  • Nutritional deficiencies

  • Chemotherapy

  • Genetics

Treating neuropathy

The goals of treatment for neuropathy are to provide relief from pain, help maintain functionality and improve quality of life. To achieve these goals, the guideline recommends patients be treated with one of three alternatives to opioids:

1. Oral medications:

  • Gabapentinoids

  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)

  • Tricyclic antidepressants (TCAs)

  • Sodium channel blockers

2. Topical treatments such as capsaicin

3. Non-pharmacologic therapies such as exercise, mindfulness and cognitive behavioral therapy

"These three treatment categories are not addictive," said Callaghan, who noted another aspect of the new guideline is to help patients avoid the addictive nature of opioids altogether.

"While we have evidence that opioids work in the short term for acute surgical pain, we are learning we should avoid them if we can, and reduce the amount given to a patient if possible. If we give patients less, they are less likely to become addicted.

We've made a lot of inroads in reducing opioid usage – but it's still a big issue.
Brian Callaghan, M.D., M.S.

"But we don't have evidence opioids work in the long term for neuropathic pain. In contrast, we do know about the harm they cause, particularly when used for chronic pain conditions, so we really urge people not to use opioids."

This also includes tramadol, which works in the brain to change how your body feels and responds to pain, says Callaghan.

"Tramadol is a type of opioid and SNRI that some clinicians think is a safe alternative to opioids, but it has the same addictive issues."

The future of medication

Callaghan admits there is still a long way to go in phasing out opioids.

"We've made a lot of inroads in reducing opioid usage – but it's still a big issue. Our current pain medications are good, but we really don't have any great options," said Callaghan, who noted that many of the recommended therapies have been shown to reduce pain while not completely eliminating it.

"Much of our research energy is focused on finding the next treatment that can help reduce pain, has fewer side effects and is not as addictive."

But while medication is helpful for most individuals suffering from neuropathic pain, Callaghan says there are other ways to minimize symptoms.

"Pain is a very complicated thing, not just due to the underlying injury but also related to other factors, such as sleep quality and mood issues."

For this reason, he's told his patients: "Make sure all the other aspects of your life are doing as well as possible in dealing with pain, including depression, anxiety and sleep. Pain causes problems in those areas and vice versa."

More Articles About: Brain Health Neuropathy & Peripheral Nerve Disorders chronic pain Neurological (Brain) Conditions
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories family smiling togehter
Health Lab
Ketogenic diet helps 4-year-old live seizure free
Last year, a young girl experienced up to 40 seizures a week. Today, after nearly a year of working with the ketogenic diet team at University of Michigan Health C.S. Mott Children’s Hospital – overseen by a pediatric neurologist and dietitian – she’s celebrating six months of seizure freedom.
Health Lab
Managing scleroderma symptoms through a team approach
Research published in the Arthritis Care and Research Journal from Michigan Medicine found that scleroderma patients made significant strides when working with trained peer health coaches in adhering to wellness routines, leading to resilience and improvements in fatigue, pain and depressive symptoms.
Person tying shoes on floor
Health Lab
Different pain types in multiple sclerosis can cause difficulty staying active
Chronic pain can present in multiple forms for multiple sclerosis patients. Some forms make it harder to stay active than others.
vial of blood in container lab blue yellow grainy graphic
Health Lab
Drawing a tube of blood could assess ALS risk from environmental toxin exposure
Investigators have developed an environmental risk score that assesses a person’s risk for developing ALS, as well as for survival after diagnosis, using a blood sample.
cells floating pink purple green
Health Lab
Scientists develop new model for understanding sudden death in epilepsy
Researchers at the University of Michigan have developed a model for studying one type of familial epilepsy, opening the door to understanding—and eventually targeting—the mechanisms that lead to the disorder and its associated fatalities.
cars jammed on highway
Health Lab
Nearly one-fifth of older adults travel 50-plus miles to see a neurologist
A Michigan Medicine study finds older Americans with complex neurologic conditions travel may travel great distances for care, many of whom live in rural areas or regions with a limited number of specialists.