The problems with pain medications are not new ones. The epidemic that many talk of in terms of opioidaddiction is real. Many states in response to this problem have created new guidelines and requirements for the prescription of these medications. Some physicians have simply stopped prescribing them because they may not agree with or want to work with the new guidelines. This has left some patients without a prescriber.
A few months ago I posted a blog about non-pharmaceutical interventions for the treatment of chronic pain. The response to that blog was in general positive, but I got a number of angry responses from people who felt I was saying that pain medication should be replaced with these non-pharmaceutical interventions. That is not what I was saying. Unfortunately, people can become so dependent upon these medications they firmly believe there is no way they could manage without them. And for some that may be true. Continue reading “Addiction to Pain Medications”
In the past few posts, I discussed a number of pharmaceuticals that can be used in treating pain. Most recently, CBD has received a great deal of attention and press, but there is still a lack of consistent research findings to support many of the claims being made. I also discussed the use of non-pharmaceutical interventions to treat pain. But before we talk more about these, we will talk about what pain is.
The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage.” Acute pain is usually transitory and resolves quickly. Pain that lasts a long time, usually 3 to 6 months, is called chronic or persistent. Continue reading “Living in Pain”
Part One of Two: A look at the many causes of this epidemic
As you are undoubtedly aware our communities continue to struggle with an epidemic of opioid misuse and abuse. In 2016 42,000 people died of an opioid overdose. Apparently, 11.5 million people misuse prescription opioid painkillers. Almost 950,000 people used heroin and 2.1 million people suffered from opioid use disorder in the United States.
This epidemic has many causes. One contributing factor is our healthcare system’s over-reliance on narcotic pain medications to treat a large number of patients with chronic pain. Most physicians receive little training in the treatment of chronic pain. Opioids are most effective in the treatment of acute pain but in the treatment of chronic pain, pain that goes on for 3 to 6 months, opioids, in the end, may actually make the pain worse. Most individuals who develop an opioid addiction received opioids initially through a prescription from their physician.
In many communities, primary care physicians provide most of the care for chronic pain patients. They are often unaware of nonpharmaceutical interventions for chronic pain. To be fair those who provide these interventions such as psychologists, physical therapists and acupuncturists have not done enough to educate other providers or the public about the effectiveness of these interventions.
There is little evidence to support the use of long-term opioid therapy in the treatment of chronic noncancer pain. Considering the risk of harm posed by the misuse of opioid prescriptions and the lack of evidence to support opioids for chronic noncancer pain the Centers for Disease Control and Prevention recommend nonpharmaceutical treatments or non-opioid pharmaceutical treatments to be considered as the initial treatment approach for chronic pain. Non-opioid alternatives include, but are not limited to, acetaminophen, anti-inflammatory drugs, membrane stabilizers such as gabapentin, and muscle relaxants. And there are others. Recent research has indicated that these non-opioid alternatives are at least as effective as opioids for low back pain and are less associated with adverse events.
The most widely studied and effective interventions for chronic pain that are nonpharmaceutical include cognitive behavioral therapy and other interventions such as acceptance and commitment therapy, exercise, physical therapy, and interdisciplinary rehabilitation. Depending on the pain condition other therapies with evidence of efficacy include yoga, biofeedback, acupuncture, spinal manipulation, and massage.
The American Psychological Association is encouraging its members to become better educated and trained in these nonpharmaceutical interventions and to educate other providers in the community and the public about these interventions. We will be talking more about these interventions in future posts.
This article was originally posted to Psychology Today, “In the Face of Adversity”, by Dr. Ron Breazeale, Ph.D. With his permission, we will share a series of posts on the Chronic Pain and related issues as a prologue to introducing what Maine has to offer for treatment options.
So why is there is so little care in healthcare? Many would say follow the money. Healthcare has become the focus of corporations and insurance carriers bent on making a profit. Health insurance for most of the 20th century was a lost leader. Continue reading “Our Healthcare System: Follow the Money”