Non-Opioid Options
Not all pain management requires the use of opioid medication. First, consider non-medication options that may work for your patient. Sometimes, these conversations can be difficult. Review the Non-medication Options and Effective Conversations sections of the toolkit.
The pain management plan developed by you and your patient will likely involve a mix of non-medication and non-opioid options. Each patient requires a holistic approach, and the management plan will be tailored to their circumstances and needs.
There are evidence-based ways to manage pain without opioids. Below are considerations when recommending non-opioid options.
Summary of Non-Opioid Treatments for Pain Management
This provider-geared table contains information on various evidence-based, non-opioid treatment options for pain.
These are general recommendations and should be reviewed by the provider for appropriateness for the individual patient.
Not all pain management requires the use of opioid medication:
- Opioids are not recommended as the first-line or routine therapy for chronic pain.
- Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred for chronic pain.
- If opioids are used, they should be combined with non-pharmacologic therapy and non-opioid pharmacologic therapy, as appropriate.
Effective approaches to chronic pain should:
- Identify and address co-existing mental health conditions (e.g., depression, anxiety, PTSD).
- Focus on functional goals and improvement, engaging patients actively in their pain management.
- Use disease-specific treatments when available (e.g., triptans for migraines, gabapentin/pregabalin/duloxetine for neuropathic pain).
- Use first-line medication options preferentially.
- Use multimodal approaches, including interdisciplinary rehabilitation for patients who have failed standard treatments, have severe functional deficits, or psychosocial risk factors.
Definitions:
Non-pharmacological therapies (non-medication treatments):
Referring to therapies that do not involve drugs.
Non-opioid pharmacological treatments (medication treatments):
Referring to non-opioid pain medications.
Non-Opioid Treatment Options for Pain
For more information on non-pharmacological treatment options for pain, visit the Non-Pharmacological Treatment Options section of this toolkit.
For additional specific non-opioid pain medication recommendations organized by type of pain, please visit the Understanding Types of Pain section of the toolkit.
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Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews
A systematic review of antidepressants for pain management – open access Ferreira GE, Abdel-Shaheed C, Underwood M, Finnerup NB, Day RO, McLachlan A, Eldabe S, Zadro JR, Maher CG. Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews. bmj. 2023 Feb 1;380.
Non-Opioid Therapies for Pain: A Clinical Reference
Non-Opioid Therapies for Pain: A Clinical Reference
A synopsis of the recommendations in the nonpharmacologic and nonopioid pharmacologic therapies described in the 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain (2022 Clinical Practice Guideline).
Alternatives to Opioids for Managing Pain
An article that summarizes the best evidence related to non-opioid pain management. Dey S, Sanders AE, Martinez S, et al. Alternatives to Opioids for Managing Pain. [Updated 2024 Nov 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK574543/
Non-Opioid Treatments for Pain: Patient Table
This table contains information for patients on different non-opioid pain management options.
Handouts
Michigan OPEN: Patient Counseling
As providers prescribe fewer opioids, this resource offers information on setting expectations and norms for pain management.
Non-Opioid Treatments for Pain: Provider Table
This provider-geared table contains information on various evidence-based, non-opioid treatment options for pain.
Handouts
Nonnarcotic Methods of Pain Management
This article discusses factors influencing choice of treatment options for acute and chronic pain.
Chronic pain: Medication decisions
Learn about the risks and benefits of common pain medications to better inform your patients of their options.
Non-pharmacologic and non-opioid solutions for pain management
This two-page handout provides a list of evidence-based, non-opioid treatment options to consider for treating pain.