Healing after an injury without opioids starts with what the body already does

Healing after an injury without opioids is possible for some people because the body runs its own pain control and its own repair. Stress chemistry turns pain down in the first hours, and inflammation starts the rebuild. After a hit and run on October 11, I chose non-opioid tools that let me keep moving. That was my call for my body, not a rule for yours.

Patients have watched me move carefully around the clinic for two weeks, so here is the short version. On Sunday, October 11, at around 5:50 a.m., on the way to the gym, I stopped my car on the highway for a woman whose car was burning. A driver hit me as I walked her to the shoulder and never stopped. She came out of it well.

My left leg took two fractures: the fibula, and the medial malleolus on the inner side of the ankle. A cut of about 15 centimeters opened the ankle and tore the tibial artery. I bled out close to 40% of my blood volume, enough to activate the trauma team. Two ribs broke. Nothing needed surgery, and the team closed the wound.

I have worked every scheduled day since. I still can’t stand for long stretches, so my procedure schedule has run below full capacity. Update, October 26: I am fully functional again and back to a full procedure schedule.

What does the body do for pain right after an injury?

It suppresses it. A threat activates a brake that starts in the brainstem, reaches down the spinal cord and damps the pain traffic climbing up from the injury. That brake draws on endorphins, monoamine messengers, cannabinoids, GABA and glutamate. The name for it is stress-induced analgesia, and its strength differs enormously from one person to another.

Henry Beecher saw it in soldiers in 1946: men with severe wounds who seemed oddly untroubled by pain, many of whom never requested relief. My endorphins and epinephrine were high that morning, and I was not feeling much pain. Call it the body’s own pharmacy, open before any prescription is written.

Why did I decline opioids in the ER?

They were offered repeatedly, and I declined every time, for two reasons. The first exposure is the pathway into chronic use, and keeping that initial dose as small as possible is worth it. Priming my body for a drug it might not need later was not a trade I wanted. And with that much of my own analgesia already on board, I was not hurting enough to need one.

The first-exposure worry has data behind it. A CDC analysis followed commercially insured, cancer-free adults starting opioids for the first time. Each extra day supplied in that first episode raised the chance of long-term use, and the steepest jumps came after the fifth and the thirty-first day. We lay out the whole approach on our opioid stewardship page.

Does inflammation help healing after an injury?

Yes. Inflammation is the opening stage of repair. The swelling, heat and soreness around a fresh injury are the signal that cleanup and rebuilding have started. The aim is not to erase that stage. It is to let it do its job. How tissue moves through each phase is laid out on our page about the healing timeline after an injury.

This is where infrared light came in for me. Inside each mitochondrion sits cytochrome c oxidase, which takes up red and near-infrared wavelengths and raises ATP, the fuel cells spend on work. Where cells are already locked in an inflammatory state, the same light brings inflammatory markers down. Be clear about the evidence: most of it comes from cells and animals, including models of traumatic injury, not from large human trials. In our clinic the tool is laser therapy.

How can you control injury pain and keep moving?

I wanted tools that would let me keep working and walking, so for the first couple of days I paired ibuprofen and acetaminophen with infrared light, a small vibration plate set against the sore area, TENS for the nerves and EMS (electrical muscle stimulation) for the muscles. Distractive tools is my name for the physical ones, and that label is not me trying to be woo-woo. Each has a plain physiological reason to work.

• Ibuprofen and acetaminophen together. In an emergency department trial, 411 adults arrived with a sore arm or leg rated moderate to severe. They were randomized to the ibuprofen and acetaminophen pair or to one of three opioid combinations, and relief at two hours was not meaningfully different. The trial used a single dose and did not track side effects.
• TENS. Think of the spinal cord as a narrow doorway. Large nerve fibers carrying touch and pressure compete there with small fibers carrying pain, which is the gate control theory from 1965. If the touch signals crowd the doorway, fewer pain signals squeeze through. In a 2022 meta-analysis spanning 381 trials, people hurt less with TENS running, or just after, than with a dummy unit. The evidence was graded moderate, and serious adverse events did not show up. See TENS therapy and the home TENS unit.
• EMS. Electrical muscle stimulation contracts the muscle directly, a second stream of input for the nerves to process.
• Localized vibration. Vibration travels on the same large fibers, so it adds traffic at the same doorway. Here is how we use vibration therapy.

The trauma bay came first. These tools bridged the first days so an opioid was never needed, and it kept me upright and at work. The rest of our hands-on program is on the physiotherapy page.

Is skipping opioids right for everyone after an injury?

No. This was my personal journey, and the approach I took is not automatically the one you should take. Some patients need opioids, full stop. Pain that is left untreated carries costs of its own, and nobody earns a medal for enduring it. What I am arguing is that declining is an option that sometimes works, and it is ignored far too often.

Each person arrives with a different body and history, so we treat the patient who is actually in the room, not the one we pictured before they walked in. Stewardship, as we practice it, is harm reduction for individuals rather than a blanket rule in either direction. For people already taking opioids, we use interventional procedures to help them taper, and we keep withdrawal from setting in while the dose comes down.

Frequently asked questions

Can a fracture heal without surgery?

Many can, when the pieces stay lined up and stable. Mine did not need an operation. Whether yours does is a decision for the surgeon reading your images, not something to settle from a blog post.

Is infrared light therapy proven for injuries?

Not in the way a large human trial proves something. The mechanism is well described, and the strongest evidence comes from cell and animal studies. I used it as one distractive tool among several, not as the main treatment.

Does TENS help with fresh injury pain?

In the largest review to date, the benefit did not differ between acute and chronic pain. Pain was lower while the unit was on or right after it was switched off. It works best as one part of a plan, between visits as well as in the clinic.