Non-opioid pain management: a guide for Veterans

Before your appointment

If you are a Veteran whose pain still interrupts sleep, work, or time with family, it is reasonable to ask for a fuller plan. You should be able to explain what has helped, what has failed, and what you need to do more comfortably.

This guide draws on Harvard Medical School's 2018 seminar, The Science of Pain Management, with updated clinical guidance. The seminar covers pain biology, opioid risks, and drug discovery. Its experimental treatments and historical statistics should not be read as current treatment recommendations.

Start with the kind of pain you have

Pain lasting more than three months is generally considered chronic. Duration is only one part of the assessment. Your clinician also needs to understand what may be causing it and how it affects you. CDC clinical guideline.

Three terms can help you follow that conversation:

• Nociceptive pain arises when actual or threatened damage to tissues outside the nervous system activates protective nerve signals. An inflamed joint can involve this mechanism.
• Neuropathic pain comes from a disease or injury affecting the sensory nervous system. Burning or electric sensations may prompt evaluation, but those descriptions alone do not establish the diagnosis.
• Nociplastic pain involves altered pain processing without clear evidence that tissue damage or a sensory nerve lesion explains the pain. More than one mechanism can contribute at once.

These are ways to understand pain, not a ranking of whose pain is real. A person's report deserves respect, including when the explanation is incomplete. IASP pain terminology.

At an appointment, ask: “What do you think is driving my pain, and how does that change the treatment plan?”

What can a non-opioid plan include?

You do not have to try every treatment on a list. Ask your team to choose a manageable starting plan, explain its purpose, and set a date to review it. Options depend on the condition, other health problems, previous treatment, and your preferences.

CDC describes these broad treatment categories, while VA offers CBT-CP to help reduce the impact of chronic pain on Veterans' lives. Ask your VA team about the full program or its brief primary care version. CDC options, VA CBT-CP.

A referral for pain coping skills does not cancel the need for physical assessment. You can ask how the two parts of care will work together.

Which medicines are non-opioid?

Depending on the diagnosis, clinicians may consider anti-inflammatory medicines, certain antidepressants such as duloxetine, or selected medicines used for nerve pain. Acetaminophen is another option for some situations. “Non-opioid” describes a drug category; it does not mean risk-free or appropriate for every person.

For example, kidney disease, cardiovascular problems, or a history of gastrointestinal bleeding can affect whether an anti-inflammatory medicine is suitable. Ask your pharmacist to review prescription medicines, over-the-counter products, and supplements together before adding something new. CDC medicine guidance.

One detail matters when watching the seminar: its slide lists tramadol separately as an atypical analgesic. Tramadol is still an opioid, with opioid risks. FDA opioid safety information.

What does research in Veterans show?

The SPACE trial compared two medication strategies in 240 patients recruited from VA primary care clinics who had chronic back pain or hip or knee osteoarthritis pain. Over 12 months, the opioid strategy did not improve pain-related function more than the non-opioid strategy, and medication-related symptoms were more common in the opioid group. SPACE trial.

This was a study of particular conditions and treatment strategies. People already receiving regular opioid therapy were excluded. It therefore does not show what will happen if an individual Veteran stops an established opioid regimen. Trial design and eligibility.

If you already take an opioid, plan changes with your prescriber

An appointment about additional options should include what your current medicine does for you, its side effects, and what happens when a dose is missed. Ask whether another treatment could help alongside it.

CDC recommends shared decisions about continuing treatment. When benefits outweigh risks, clinicians can continue opioids while improving other parts of care. When a reduction is appropriate, it should be planned with the patient. Except for a life-threatening situation, abrupt discontinuation is not recommended. Do not make a dose change based on this article. CDC guidance on continuing opioid therapy.

What about new pain medicines and laboratory discoveries?

In the seminar, Clifford Woolf describes work on pain-selective nerve targeting and laboratory-grown sensory neurons. Those neurons were research tools for studying pain and testing compounds, not a recommendation to receive stem cell injections. The later company presentation also describes an early drug-development program. Promising laboratory findings cannot establish that a treatment is safe and effective for patients. Research portion of the seminar.

There has been progress since 2018. FDA approved suzetrigine, sold as Journavx, in January 2025 for moderate to severe acute pain in adults. The prescribing information revised in January 2026 specifies acute pain, including postoperative pain; use beyond 14 days has not been studied for that indication. This is not a general approval for chronic pain. It also has side effects and drug interactions. FDA approval, current prescribing information.

How to ask VA for a more complete pain plan

VA's stepped care model supports matching the level of care to a Veteran's needs, including coordinated care from different disciplines. Your primary care team is a place to start that conversation. VA team-based pain care.

Bring a short note with your current medicines, treatments already tried, and one or two specific goals. For example, you might want to stand long enough to prepare dinner or get through a work shift with fewer interruptions. Include practical barriers such as travel, appointment timing, or difficulty using video visits.

Questions to bring:

• What is the next treatment we will try, and what is it meant to improve?
• Would physical therapy, CBT-CP, or a pain specialist be useful in my case?
• How long should we try the plan before reviewing it?
• Who should I contact if side effects or worsening symptoms make it hard to continue?
• Can the relevant appointments be coordinated with my other VA care?

If routine care outside VA is being considered, ask your team about eligibility and a referral before scheduling. Confirm the authorized provider, services, and dates before receiving care. A clinic's willingness to see you is not itself VA approval. VA referral instructions. Valor's Community Care guide explains the process in more detail.

Common questions

What is the strongest non-opioid pain medicine?

There is no single choice that is best for every pain condition. The useful comparison is how much a treatment helps your pain and function, balanced against its risks. Ask for a recommendation based on your diagnosis and medication history.

Can I request non-opioid options without agreeing to stop my current medicine?

Yes. You can ask for an assessment and a discussion of additional options. Decisions about changing an existing prescription should be made with your prescriber, with a plan for follow-up.

Does non-opioid treatment mean I should manage alone?

No. Ask who will coordinate your care and when you will meet again to review progress. A treatment plan needs follow-up, especially when the first approach has not helped enough.

Educational information only. No clinician review of this guide has been recorded. New or markedly changed symptoms need clinical assessment rather than an assumption that they are part of your usual chronic pain.