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Natural Pain Relief

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Pain is our body’s warning signal that protects us from harm. But when pain becomes chronic, those pain signals can become a real problem. Whether it’s joint pain, knee pain, neck pain, back pain, or rheumatoid arthritis pain, medication isn’t your only option. So what gets rid of chronic pain naturally? We sat down with Wu-Hsun Tom Yang, ND, LAc, who practices at the University of Washington’s Sports Medicine Clinic at Ballard, the UW Primary Care Clinic at Northgate, and at Red Leaf Natural Medicine to learn more about how naturopathic doctors approach chronic pain.

What Causes Chronic Pain?

At the first visit with patients experiencing chronic pain, Dr. Yang takes a deep dive into their past and present. “Taking a detailed history is key, especially if something has become chronic,” he explains.

He often sees patients who have chronic muscle tension from sitting at a desk all day. They know that they’ve been tense for a long time, but it may only take one event to cause a pain flare. “[Chronic pain is] a compilation of all the things that have happened to them in the past, or a chronic pattern of tension that we were not aware of before,” Yang says.

With his patients, Yang explores other potential root causes of pain, such as past gut infections or food poisoning incidents or chronic, inflammatory gut diseases (such as celiac disease, Crohn’s disease, and ulcerative colitis) that may contribute to pain throughout the body and lead to nutrient deficiencies.

There’s also a psychological root cause of chronic pain: the impact of trauma and chronic stress. Yang’s patients include veterans, emergency room staff, and teachers. “Over time, these traumas pile up, which can manifest as chronic pain,” he explains. “They may not realize that they have taken on a lot of trauma and are still carrying it after work. And it’s not just musculoskeletal tension. They may have gut health or sleep issues, or increased anxiety and depression.”

Chronic pain is particularly prevalent among U.S. military veterans, affecting approximately one-third of veterans receiving healthcare through the Veterans Health Administration (VHA). A recent study of Spanish wildland firefighters found that approximately 60% reported suffering from chronic pain, with those over 35 years old being four times as likely to suffer from chronic pain.1García-Heras F, Gutiérrez-Arroyo J, León-Guereño P, Carballo-Leyenda B, Rodríguez-Marroyo JA. Chronic Pain in Spanish Wildland Firefighters. J Clin Med. 2022;11(4):989. https://doi.org/10.3390/jcm11040989

Many mental health conditions are also connected to chronic pain, particularly PTSD (post-traumatic stress disorder) and bipolar disorder.2Johnston KJA, Huckins LM. Chronic Pain and Psychiatric Conditions. Complex Psychiatry. 2023;9(1-4):24-43. https://doi.org/10.1159/000527041

Herbal Remedies for Chronic Pain Relief

How do you get rid of pain without painkillers? Herbs have been used for centuries across the globe to reduce chronic pain. Herbs can be taken as supplements or used as essential oils externally.

Herbs for Muscle Pain and Headaches

For musculoskeletal pain, Yang commonly recommends Frankincense, Centella (gotu kola), and Curcumin (turmeric) as natural pain relievers. For headaches, he suggests Butterbur or Feverfew.

Frankincense (Boswellia): This resin extract has been shown to significantly reduce pain in chronic prostatitis and chronic pelvic pain syndrome.3Presicce F, Barrese F, Cantiani A, et al. Boswellia resin extract and propolis derived polyphenols in patients with type III chronic prostatitis/chronic pelvic pain syndrome: An Italian prospective multicenter study. Asian J Urol. 2022;9(2):139-145. https://doi.org/10.1016/j.ajur.2021.09.002

Centella Asiatica: Reduces pain in chronic, inflammatory temporomandibular (jaw) disorders.4Rotpenpian N, Wanasuntronwong A, Tapechum S, et al. Standardized Centella asiatica (ECa 233) extract decreased pain hypersensitivity development in a male mouse model of chronic inflammatory temporomandibular disorder. Sci Rep. 2023;13(1):6642. https://doi.org/10.1038/s41598-023-33769-w

Curcumin: Derived from turmeric, Curcumin has powerful anti-inflammatory properties. A recent trial where healthy adults with chronic knee pain were given a curcumin product daily for 3 months found that it alleviated knee pain and improved joint function.5Thanawala S, Shah R, Somepalli V, Alluri KV, Desomayanandam P, Bhuvanendran A. A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial Assessing Efficacy and Safety of a Novel Low-Dose Turmeric Extract Formulation in Healthy Adults with Chronic Knee Pain. Clin Pharmacol. 2021;13:91-100. https://doi.org/10.2147/CPAA.S307464

Butterbur and Feverfew: Well-known globally, these two herbs are excellent natural options to naturally treat headaches as well as prevent migraine headaches.6Grazzi L, Toppo C, D’Amico D, et al. Non-Pharmacological Approaches to Headaches: Non-Invasive Neuromodulation, Nutraceuticals, and Behavioral Approaches. Int J Environ Res Public Health. 2021;18(4):1503. https://doi.org/10.3390/ijerph18041503

Herbs for Stress Relief and Sleep

“When it comes to stress relief and sleep, I think of a category of herbs called nervines,” says Yang. “They’re gentle but really help us relax. I commonly recommend lemon balm, lavender, rosemary, milky oats, passionflower, skullcap, and chamomile.

Lemon Balm: Improves sleep quality and insomnia, as well as related depression and anxiety. research has shown that lemon balm can increase calmness and help with stressful situations.7Shirazi M, Jalalian MN, Abed M, Ghaemi M. The Effectiveness of Melissa Officinalis L. versus Citalopram on Quality of Life of Menopausal Women with Sleep Disorder: A Randomized Double-Blind Clinical Trial. Rev Bras Ginecol Obstet. 2021;43(2):126-130. https://doi.org/10.1055/s-0040-17218578Kenda M, Kočevar Glavač N, Nagy M, Sollner Dolenc M. Medicinal Plants Used for Anxiety, Depression, or Stress Treatment: An Update. Molecules. 2022;27(18):6021. https://doi.org/10.3390/molecules27186021

Lavender, Peppermint, and Rosemary: When used in aromatherapy as essential oils, lavender and peppermint oil has been shown to improve the sleep quality of cancer patients, while lavender and rosemary oil can significantly improve disturbed sleep and insomnia.9Cheong MJ, Kim S, Kim JS, et al. A systematic literature review and meta-analysis of the clinical effects of aroma inhalation therapy on sleep problems. Medicine (Baltimore). 2021;100(9):e24652. https://doi.org/10.1097/MD.0000000000024652

Passionflower and Skullcap: Taken in capsule, tincture, or tea form, the sedative action of passionflower can effectively treat chronic insomnia and lower blood pressure, while skullcap can improve sleep quality.10Janda K, Wojtkowska K, Jakubczyk K, Antoniewicz J, Skonieczna-Żydecka K. Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review. Nutrients. 2020;12(12):3894. https://doi.org/10.3390/nu1212389411Hong KB, Han SH, Park Y, Suh HJ, Choi HS. Romaine Lettuce/Skullcap Mixture Improves Sleep Behavior in Vertebrate Models. Biol Pharm Bull. 2018;41(8):1269-1276. https://doi.org/10.1248/bpb.b18-00267

Milky Oats and Chamomile: Milky oats have been shown to help with stress and improve cognitive function, while studies show chamomile as an effective natural remedy for stress, insomnia, and anxiety12Kennedy DO, Bonnländer B, Lang SC, et al. Acute and Chronic Effects of Green Oat (Avena sativa) Extract on Cognitive Function and Mood during a Laboratory Stressor in Healthy Adults: A Randomised, Double-Blind, Placebo-Controlled Study in Healthy Humans. Nutrients. 2020;12(6):1598. https://doi.org/10.3390/nu1206159813Amsterdam JD, Li Y, Soeller I, Rockwell K, Mao JJ, Shults J. A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol. 2009;29(4):378-382. https://doi.org/10.1097/JCP.0b013e3181ac935c

Adaptogen Herbs to Increase Stress Resilience

“When chronic pain progresses, there’s usually a stress component,” notes Yang. “That’s when we reach for adaptogens that help people cope with chronic and acute physical or emotional stress: Rhodiola, Schizandra, Ashwagandha, Astragalus, Centella, and Siberian ginseng help us build our resilience to stressors.”

Rhodiola: Research shows that rhodiola’s dual actions of cognitive stimulation and emotional calming can benefit brain function. One study of adults with life-stress symptoms who were given Rhodiola revealed a significant, consistent, and steady improvement in stress symptoms, fatigue, quality of life, and mood.Edwards D, Heufelder A, Zimmermann A. Therapeutic effects and safety of Rhodiola rosea extract WS® 1375 in subjects with life-stress symptoms–results of an open-label study. Phytother Res. 2012;26(8):1220-1225. https://doi.org/10.1002/ptr.3712[/mfn]

Schisandra and Ashwagandha: Both of these herbs reduce the impacts of stress, while a double-blind study showed that Ashwagandha (when taken over a period of 4 months) can improve psychological well-being and sleep quality.14Gopukumar K, Thanawala S, Somepalli V, Rao TSS, Thamatam VB, Chauhan S. Efficacy and Safety of Ashwagandha Root Extract on Cognitive Functions in Healthy, Stressed Adults: A Randomized, Double-Blind, Placebo-Controlled Study. Evid Based Complement Alternat Med. 2021;2021:8254344. https://doi.org/10.1155/2021/8254344

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Supplements and Nutrition

“When it comes to nutrients, I often think about magnesium, melatonin, and the B vitamins,” says Yang. “Riboflavin (vitamin B2) can be helpful for migraines, while magnesium helps with stress-induced constipation.”15Haghdoost F, Togha M. Migraine management: Non-pharmacological points for patients and health care professionals. Open Med (Wars). 2022;17(1):1869-1882. https://doi.org/10.1515/med-2022-059816Zhang L, Du Z, Li Z, Yu F, Li L. Association of dietary magnesium intake with chronic constipation among US adults: Evidence from the National Health and Nutrition Examination Survey. Food Sci Nutr. 2021;9(12):6634-6641. https://doi.org/10.1002/fsn3.2611

Diet

Yang recommends that people suffering from pain avoid foods that they know upset their stomach or that they are sensitive to. But he also avoids suggesting diets that are too restrictive as people with chronic pain may be afraid to eat certain foods that could cause pain and/or inflammation flare. He recommends whole foods that are cooked, as they are easier to digest and absorb nutrients from.

Inflammation and oxidative stress have been identified as major pathways of chronic pain. Research shows that choosing foods with anti-inflammatory and antioxidant properties (such as the anti-inflammatory diet) can effectively reduce chronic pain, though the precise foods used depend on the nature and location of where the pain is.17Seaman DR. The diet-induced proinflammatory state: a cause of chronic pain and other degenerative diseases? J Manipulative Physiol Ther. 2002;25(3):168-179. https://pubmed.ncbi.nlm.nih.gov/11986578/

Holistic Activities to Reduce Muscle Pain

While herbs and supplements are vital natural remedies for preventing and treating chronic pain, there are many lifestyle changes that can also act as natural pain relievers. “Whether the pain is musculoskeletal, in the gut, or psychological, I always come back to the foundations,” says Yang. “It’s about good sleep, good digestion, and ways to lessen their pain.”

Exercise and Yoga

For Yang, setting realistic exercise goals with informed patient consent is key. “Many people had enjoyable exercise regimens that they had to stop when their chronic pain began. By tapping into those, we invoke curiosity,” Yang explains. “They see that they are getting stronger, which incentivizes them to continue.”

Walking has been shown to significantly reduce chronic lower back pain and prevent future pain by improving muscle endurance, and there is extensive evidence that yoga reduces chronic pain in the long term.18Suh JH, Kim H, Jung GP, Ko JY, Ryu JS. The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial. Medicine (Baltimore). 2019;98(26):e16173. https://doi.org/10.1097/MD.000000000001617319Chopra D, Stern E, Bushell WC, Castle RD. Yoga and pain: A mind-body complex system. Front Pain Res (Lausanne). 2023;4:1075866. https://doi.org/10.3389/fpain.2023.1075866

For many of Yang’s chronic pain patients, their only outdoor exposure is going from doctor’s office to doctor’s office. “Sometimes their schedule is packed with medical appointments. They’re tired and in so much pain that they have no energy to do other things. Going gently, then trying to figure out what they’re able to do is key.”

Acupuncture

As a licensed acupuncturist, Yang often recommends acupuncture for chronic pain.20Huang L, Xu G, Sun M, et al. Recent trends in acupuncture for chronic pain: A bibliometric analysis and review of the literature. Complement Ther Med. 2023;72:102915. https://pubmed.ncbi.nlm.nih.gov/36610367/ He notes that some acupuncture points generate neurotransmitters that can induce a sense of happiness.21Chen Y, Hao C, Chen W, et al. Anti-depressant effects of acupuncture: The insights from NLRP3 mediated pyroptosis and inflammation. Neurosci Lett. 2022;785:136787. https://doi.org/10.1016/j.neulet.2022.136787 “Anytime a needle goes through the skin, your body has an immune response. That can mean getting more immune cells to the area to generate more potential for healing and remodeling, and more blood flow to the area for circulation or nerve regeneration.”22Kubo K, Iizuka Y, Yajima H, Takayama M, Takakura N. Changes in Blood Circulation of the Tendons and Heart Rate Variability During and After Acupuncture. Med Acupunct. 2020;32(2):99-107. https://doi.org/10.1089/acu.2019.1397

Mindset

Yang doesn’t think that there is one correct mindset to reduce chronic pain. Instead, he tries to set realistic expectations. “I tell patients that chronic pain is a journey, just like grief,” says Yang. “There will be ups and downs. There will be weeks that they feel better and weeks that they feel worse. It’s not necessarily about hitting milestones and never regressing.”23Bruce M, Lopatina E, Hodge J, et al. Understanding the chronic pain journey and coping strategies that patients use to manage their chronic pain: a qualitative, patient-led, Canadian study. BMJ Open. 2023;13(7):e072048. https://doi.org/10.1136/bmjopen-2023-072048

He also recommends his patients engage in positive self-talk and take an active role in their treatment. “We are there to facilitate their health, not dictate their health. I don’t want the patient to feel like everything hinges on the practitioner,” Yang says.

When Should I Use Conventional Treatments?

Conventional treatments for chronic pain usually involve over-the-counter or prescription medications such as NSAIDs (non-steroidal anti-inflammatory drugs) or opioids, as well as cognitive behavioral therapy (CBT).24Heath L, Philip A. Chronic pain care: time for excellence. Fam Med Community Health. 2020;8(2):e000285. https://doi.org/10.1136/fmch-2019-000285

Yang recommends acute pain flares as a good time to consider pharmaceuticals. Reducing pain temporarily can help patients implement more long-term lifestyle recommendations. Yang also advises his patients that they don’t have to take pain medications indefinitely. “With chronic pain, patients often get a lot of medication. Half of the time, they don’t remember what those medications are for. Over-the-counter pain medications may help at first, but over time people find them less effective, even when they are at the maximum dose.” Yang makes sure to ask his patients what has worked (and what hasn’t) to reduce their pain in the past, so he can find the best strategy for each patient.

What Are the Possible Side Effects of Pain Medication?

Potential adverse effects of NSAIDs can impact many body systems, including the gut, kidneys, heart, and liver.25Ghlichloo I, Gerriets V. Nonsteroidal Anti-inflammatory Drugs (NSAIDs). In: StatPearls. StatPearls Publishing; 2023. Accessed August 1, 2023. https://www.ncbi.nlm.nih.gov/books/NBK547742/ Addiction to opioid medication is now at epidemic levels; approximately 3 million Americans have had or currently suffer from opioid use disorder (OUD).26Azadfard M, Huecker MR, Leaming JM. Opioid Addiction. In: StatPearls. StatPearls Publishing; 2023. Accessed August 1, 2023. https://www.ncbi.nlm.nih.gov/books/NBK448203/

Before considering something stronger, it’s important to look at the exact nature of their pain and see if referrals are indicated,” says Yang. “Whether it’s acupuncture, physical therapy, therapeutic massage, or counseling – could those be more appropriate before they consider opioids?”

Yang sees a paradigm shift happening, where patients are seeking holistic options to opioid dependency. And the conventional medical profession is following suit. “In the past six or seven years, there has been a shift,” Yang notes. “Most clinicians and medical offices now have very stringent monitoring protocols to make sure that people are using them as indicated and not overusing them.”27Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain – United States, 2022. MMWR Recomm Rep. 2022;71(3):1-95. https://doi.org/10.15585/mmwr.rr7103a1

Yang also sees conventional doctors gaining a better appreciation for how the naturopathic approach can support patients experiencing chronic pain. “We’re seeing more and more large medical centers take chronic pain management in a more integrative direction. We see more exercise, counseling, group sessions, nutrients, and herbs being recommended as part of their integrative approach to chronic pain. I feel that as naturopathic doctors, we are ahead of that game!” Yang exclaims.

“We are already trained in these treatments. The wait can be quite long to get into chronic pain centers. That’s another reason why people should give naturopathic doctors a chance—to see what all their options are for managing their pain. It doesn’t have to be mutually exclusive to conventional care; it can be complimentary.”

Footnotes

  • 1
    García-Heras F, Gutiérrez-Arroyo J, León-Guereño P, Carballo-Leyenda B, Rodríguez-Marroyo JA. Chronic Pain in Spanish Wildland Firefighters. J Clin Med. 2022;11(4):989. https://doi.org/10.3390/jcm11040989
  • 2
    Johnston KJA, Huckins LM. Chronic Pain and Psychiatric Conditions. Complex Psychiatry. 2023;9(1-4):24-43. https://doi.org/10.1159/000527041
  • 3
    Presicce F, Barrese F, Cantiani A, et al. Boswellia resin extract and propolis derived polyphenols in patients with type III chronic prostatitis/chronic pelvic pain syndrome: An Italian prospective multicenter study. Asian J Urol. 2022;9(2):139-145. https://doi.org/10.1016/j.ajur.2021.09.002
  • 4
    Rotpenpian N, Wanasuntronwong A, Tapechum S, et al. Standardized Centella asiatica (ECa 233) extract decreased pain hypersensitivity development in a male mouse model of chronic inflammatory temporomandibular disorder. Sci Rep. 2023;13(1):6642. https://doi.org/10.1038/s41598-023-33769-w
  • 5
    Thanawala S, Shah R, Somepalli V, Alluri KV, Desomayanandam P, Bhuvanendran A. A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial Assessing Efficacy and Safety of a Novel Low-Dose Turmeric Extract Formulation in Healthy Adults with Chronic Knee Pain. Clin Pharmacol. 2021;13:91-100. https://doi.org/10.2147/CPAA.S307464
  • 6
    Grazzi L, Toppo C, D’Amico D, et al. Non-Pharmacological Approaches to Headaches: Non-Invasive Neuromodulation, Nutraceuticals, and Behavioral Approaches. Int J Environ Res Public Health. 2021;18(4):1503. https://doi.org/10.3390/ijerph18041503
  • 7
    Shirazi M, Jalalian MN, Abed M, Ghaemi M. The Effectiveness of Melissa Officinalis L. versus Citalopram on Quality of Life of Menopausal Women with Sleep Disorder: A Randomized Double-Blind Clinical Trial. Rev Bras Ginecol Obstet. 2021;43(2):126-130. https://doi.org/10.1055/s-0040-1721857
  • 8
    Kenda M, Kočevar Glavač N, Nagy M, Sollner Dolenc M. Medicinal Plants Used for Anxiety, Depression, or Stress Treatment: An Update. Molecules. 2022;27(18):6021. https://doi.org/10.3390/molecules27186021
  • 9
    Cheong MJ, Kim S, Kim JS, et al. A systematic literature review and meta-analysis of the clinical effects of aroma inhalation therapy on sleep problems. Medicine (Baltimore). 2021;100(9):e24652. https://doi.org/10.1097/MD.0000000000024652
  • 10
    Janda K, Wojtkowska K, Jakubczyk K, Antoniewicz J, Skonieczna-Żydecka K. Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review. Nutrients. 2020;12(12):3894. https://doi.org/10.3390/nu12123894
  • 11
    Hong KB, Han SH, Park Y, Suh HJ, Choi HS. Romaine Lettuce/Skullcap Mixture Improves Sleep Behavior in Vertebrate Models. Biol Pharm Bull. 2018;41(8):1269-1276. https://doi.org/10.1248/bpb.b18-00267
  • 12
    Kennedy DO, Bonnländer B, Lang SC, et al. Acute and Chronic Effects of Green Oat (Avena sativa) Extract on Cognitive Function and Mood during a Laboratory Stressor in Healthy Adults: A Randomised, Double-Blind, Placebo-Controlled Study in Healthy Humans. Nutrients. 2020;12(6):1598. https://doi.org/10.3390/nu12061598
  • 13
    Amsterdam JD, Li Y, Soeller I, Rockwell K, Mao JJ, Shults J. A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol. 2009;29(4):378-382. https://doi.org/10.1097/JCP.0b013e3181ac935c
  • 14
    Gopukumar K, Thanawala S, Somepalli V, Rao TSS, Thamatam VB, Chauhan S. Efficacy and Safety of Ashwagandha Root Extract on Cognitive Functions in Healthy, Stressed Adults: A Randomized, Double-Blind, Placebo-Controlled Study. Evid Based Complement Alternat Med. 2021;2021:8254344. https://doi.org/10.1155/2021/8254344
  • 15
    Haghdoost F, Togha M. Migraine management: Non-pharmacological points for patients and health care professionals. Open Med (Wars). 2022;17(1):1869-1882. https://doi.org/10.1515/med-2022-0598
  • 16
    Zhang L, Du Z, Li Z, Yu F, Li L. Association of dietary magnesium intake with chronic constipation among US adults: Evidence from the National Health and Nutrition Examination Survey. Food Sci Nutr. 2021;9(12):6634-6641. https://doi.org/10.1002/fsn3.2611
  • 17
    Seaman DR. The diet-induced proinflammatory state: a cause of chronic pain and other degenerative diseases? J Manipulative Physiol Ther. 2002;25(3):168-179. https://pubmed.ncbi.nlm.nih.gov/11986578/
  • 18
    Suh JH, Kim H, Jung GP, Ko JY, Ryu JS. The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial. Medicine (Baltimore). 2019;98(26):e16173. https://doi.org/10.1097/MD.0000000000016173
  • 19
    Chopra D, Stern E, Bushell WC, Castle RD. Yoga and pain: A mind-body complex system. Front Pain Res (Lausanne). 2023;4:1075866. https://doi.org/10.3389/fpain.2023.1075866
  • 20
    Huang L, Xu G, Sun M, et al. Recent trends in acupuncture for chronic pain: A bibliometric analysis and review of the literature. Complement Ther Med. 2023;72:102915. https://pubmed.ncbi.nlm.nih.gov/36610367/
  • 21
    Chen Y, Hao C, Chen W, et al. Anti-depressant effects of acupuncture: The insights from NLRP3 mediated pyroptosis and inflammation. Neurosci Lett. 2022;785:136787. https://doi.org/10.1016/j.neulet.2022.136787
  • 22
    Kubo K, Iizuka Y, Yajima H, Takayama M, Takakura N. Changes in Blood Circulation of the Tendons and Heart Rate Variability During and After Acupuncture. Med Acupunct. 2020;32(2):99-107. https://doi.org/10.1089/acu.2019.1397
  • 23
    Bruce M, Lopatina E, Hodge J, et al. Understanding the chronic pain journey and coping strategies that patients use to manage their chronic pain: a qualitative, patient-led, Canadian study. BMJ Open. 2023;13(7):e072048. https://doi.org/10.1136/bmjopen-2023-072048
  • 24
    Heath L, Philip A. Chronic pain care: time for excellence. Fam Med Community Health. 2020;8(2):e000285. https://doi.org/10.1136/fmch-2019-000285
  • 25
    Ghlichloo I, Gerriets V. Nonsteroidal Anti-inflammatory Drugs (NSAIDs). In: StatPearls. StatPearls Publishing; 2023. Accessed August 1, 2023. https://www.ncbi.nlm.nih.gov/books/NBK547742/
  • 26
    Azadfard M, Huecker MR, Leaming JM. Opioid Addiction. In: StatPearls. StatPearls Publishing; 2023. Accessed August 1, 2023. https://www.ncbi.nlm.nih.gov/books/NBK448203/
  • 27
    Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain – United States, 2022. MMWR Recomm Rep. 2022;71(3):1-95. https://doi.org/10.15585/mmwr.rr7103a1

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