Lessons From the Olympics: Managing Pain Without Opioids

With the Olympics fading in our rearview mirrors, this is a good time to talk about ways to manage pain without relying on opioids. Olympic athletes provide a model for this because this high-performance population shares concerns very similar to those of nonathletes. They want to maintain reaction time and coordination, avoid sedation and cognitive slowing, ensure they do not become dependent, and maintain readiness to compete (or, in the case of nonprofessional athletes, continue with the activities of daily living).^1-4 Policies from the World Anti-Doping Agency and monitoring by the International Olympic Committee also encourage safer analgesic strategies.⁴

Opioids primarily reduce pain perception, but they do not necessarily improve physical function.^5,6 Experts recommend avoiding opioids as first-line therapy for dental pain, headaches (including episodic migraine), kidney stones, low back pain, minor surgeries associated with minimal tissue injury, mild postoperative pain, musculoskeletal injuries, and neck pain.⁵ Nonopioid strategies such as anti-inflammatory drugs, physical therapy, and rehabilitation often target the underlying biomechanical or inflammatory causes of pain, supporting functional improvement.⁷

Focus on Function

In pain management, the goal is not always complete pain relief.⁷ Instead, athletes focus on function when they incur injuries. Functional recovery means restoring a person’s ability to perform normal activities and functions (Table 1), rather than simply eliminating pain. Focusing on helping patients move, work, exercise, and perform daily tasks despite some residual discomfort is more realistic than complete pain relief.⁷ Pharmacists can help the multidisciplinary team manage patients’ expectations by focusing on function.

Helping patients with functional recovery must start with setting specific, measurable, achievable, realistic, and time-tagged goals. For example, a discussion with a patient with knee osteoarthritis may lead to an agreement that the patient can tolerate moderate pain but wants to walk a quarter mile, garden, and climb stairs twice a day. The plan should start with nonpharmacologic interventions, such as applying heat or ice to the affected areas for 10 minutes every hour and continuing to move as much as possible.⁸ As the patient’s pain improves or worsens, clinicians need to be prepared to adjust these goals.³

Think Local

Athletes often favor local treatment to avoid systemic adverse effects.^2,5 For many patients experiencing mild to moderate pain, a topical treatment may provide enough relief to restore function. Topical diclofenac is available OTC and can often take the edge off mild to moderate pain, whether acute or chronic.⁵ Capsaicin may provide relief, especially for joint pain or diabetic neuropathy, but patients may need to use it for a few weeks before noticing relief.⁵

In certain types of pain, topical (ie, lidocaine patches) or injected anesthetics target painful areas without systemic effects.² Lidocaine patches are available OTC, but a stronger composition (Lidoderm; Endo Pharmaceuticals, Inc) contains 700 mg of lidocaine (50 mg/g) in an aqueous base and requires a prescription.⁹ The FDA-approved indication is postherpetic neuralgia, and it should be applied only to intact skin. Patients with hepatic disease should not use these patches, and patients receiving Class I antiarrhythmic drugs (eg, tocainide and mexiletine) should also avoid this product.⁹

It’s a Marathon, Not a Sprint

Olympic athletes rarely rely on a single therapy.⁴ Instead, sports medicine prescribers combine anti-inflammatory drugs, topical therapies, neuropathic pain medications, and rehabilitation strategies to control pain while maintaining function. This approach works for other populations, too, but sometimes, the patient’s insurance may not cover some helpful therapies.⁵ Table 2^5,10,11 lists prescription medications that may alleviate pain.

Effective pain management does not always require opioids. Pharmacists can inform patients about multimodal pain management strategies and collaborate with the clinical team to help restore the patient’s functional abilities.

About the Author

Jeannette Y. Wick, RPh, MBA, is the director of the Office of Pharmacy Professional Development at the University of Connecticut School of Pharmacy.

REFERENCES

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5. CDC Clinical Practice Guideline for Prescribing Opioids for Pain. Centers for Disease Control and Prevention. November 4, 2022. Accessed March 17, 2026. https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm

6. Krebs EE, Gravely A, Nugent S, et al. Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial. JAMA. 2018;319(9):872-882. doi:10.1001/jama.2018.0899

7. Deshpande KS, Roehmer C, Raum G, Slavin-Spenny O. Functional recovery program: An interdisciplinary approach to treating chronic pain. J Pain Manage. 2020;13(4):383-391.

8. Thornton JS, Caneiro JP, Hartvigsen J, et al. Treating low back pain in athletes: a systematic review with meta-analysis. Br J Sports Med. 2021;55(12):656-662. doi:10.1136/bjsports-2020-102723

9. Lidoderm. Prescribing information. Endo Pharmaceuticals Inc; January 2015. Accessed March 15, 2026. https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/020612s012lbl.pdf

10. Chou R, Wagner J, Ahmed A, et al. Treatments for acute pain: a systematic review. Comparative effectiveness review no. 240. Rockville, MD: Agency for Healthcare Research and Quality; 2020. https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/cer-240-acute-pain-review.pdf

11. Journavyx. Prescribing information.Vertex Pharmaceuticals Incorporated; 2026. Accessed April 8, 2026. https://pi.vrtx.com/files/uspi_suzetrigine.pdf