PAIN MANAGEMENT WITHOUT OPIOIDS

As our country’s opioid epidemic continues to impact every state, community, and town in the United States, the shocking toll of this epidemic has caught the attention of the press, the government, and the healthcare system. The overdose statistics and national financial burden of the epidemic continue to rise as the United States healthcare system and government seek intervention against this chemical plague. To put it in perspective, the United States represents only 4-5% of the global population but consumes around 80-90% of the world’s pain medications. Over three years ago, the US Surgeon General (at the time) stated that we “are in the middle of the worst public healthcare crisis our country has ever seen” – and it’s only gotten worse since then. With the destruction that opioid misuse has caused, one has to wonder: “is there a better way to treat chronic and acute pain?”

Pain management without opioids is possible, and, according to recent studies, opioids may not offer much more relief than a placebo. But first, how did we get to this point?

HOW DID THE OPIOID EPIDEMIC HAPPEN?

Prescription opioid use and overdose rates began to rise in 1991, as major manufacturers of popular opioid medications (such as Purdue Pharma, the makers of OxyContin) began marketing aggressively to prescribing doctors, which resulted in profits that exceeded the tens of billions. By 1999, only 14% of the patients using opioids were using them for their intended purpose: chronic, cancer-related pain. The other 86% of patients were using these powerful medications for conditions that did not necessarily require this strength of medication.

Since then, Purdue Pharma has been hit with over 2,000 lawsuits from local and state governments… but it’s a little too late for the families who have lost loved ones. Drugs like OxyContin (a prescription drug similar in strength to heroin) helped ignite the opioid epidemic in the 1990s, and it has had lasting effects that have been felt from every corner of the United States. Around 2010, the second wave of the epidemic hit the United States, as laws that decreased the amount of opioid prescriptions began to take effect. Since prescription opioids became harder to find, many users hooked on prescription pills turned to widely-available heroin (a wildly cheap, dangerous, and illegal opioid). According to the CDC, heroin overdoses rose a whopping 286% from 2002 to 2013. Here’s the kicker: 80% of those addicted to heroin admitted that they turned to the drug after they had become addicted to prescription pills.

In 2013, overdoses from illicitly-manufactured, synthetic opioids such as fentanyl (an opioid 50 times stronger than heroin) skyrocketed as the market became flooded with these drugs to fill the demand that prescription pills and heroin once filled. In 2016, there were almost 20,000 deaths related to fentanyl and other drugs of the same class. Just like the brain disease of addiction, the opioid crisis has proven to be a progressive, chronic, and fatal epidemic.

WHAT’S HAPPENING NOW?

Currently, the United States and the CDC are ramping up their efforts to help educate the public, support healthcare systems, and partner with public safety programs to reduce the deadly outcome of the epidemic. The Rx Awareness program is a step in the right direction, which helps to educate the public on the dangers of opioid medication misuse and addiction. With more than 702,000 overdose deaths from 1999 to 2017 (68% involving opioids), we believe more action needs to be taken to ensure public safety.

Opioid prescriptions and public use are now facing heavy government scrutiny amidst the destruction caused by the opioid epidemic. However, there is still quite a bit of erroneous information, inaccurate assumptions, and myths around the proper and safe use of opioids and treatment of pain. Used appropriately, opioids can be a valuable resource for treating acute pain and post-surgery pain. That being said, there are a tremendous number of options that a patient can utilize to offset or even eliminate their level of opioid consumption and chronic pain.

These powerful drugs were never meant for long-term, chronic pain. In fact, there is overwhelming evidence and research that demonstrates just how ineffective opioids are at treating chronic pain.

DIFFERENT OPTIONS FOR PAIN

For instance, use of non-narcotic anti-inflammatories have been shown—through numerous trials—to be more effective at treating chronic pain than opioid medication.

These non-narcotic medications, along with a holistic and integrative approach that includes nutrition, physical therapy, preventive measures, meditation, and psychotherapy, have been shown to provide far more pain management relief (along with supporting overall wellness and improved quality of life) without the dangers associated with opioid addiction. Even pain after surgery can be effectively managed with minimal-to-no opioid consumption, according to research published in the Journal of the American Medical Association. The investigation, which was an exhaustive, systemic review, scrutinized 96 clinical trials that included an excess of 26,000 participants. The study found that opioids only provided a small improvement in pain management, sleep quality, and physical functioning compared to a placebo. Remember… opioid medications come with a risk of dry mouth, nausea, drowsiness, constipation, dizziness, vomiting, addiction, and overdose.

The researchers found that non-opioid alternatives such as antidepressants, anti-seizure drugs, and nonsteroidal anti-inflammatories can be just as effective in the treatment of pain when compared to an opiod. Jason Busse, the lead author of the study, had this to say:

“We found that, compared to a placebo, 12% more patients treated with opioids will experience pain relief, 8% more will notice an improvement in their physical functioning, and about 6% more will find improvement in their sleep quality. These are very modest effects, and opioids were not associated with any important improvement in social, role, or emotional functioning.”

These numbers – all around the 10% mark – do not indicate a statistically significant advantage that would justify the use of opioid medication in the treatment of chronic pain. In fact, these numbers show that the amount of opioid prescriptions that flooded the United States on a national scale were wholly unnecessary and counterproductive.

Alternative medications and therapies can be utilized without negatively affecting pain scores, postoperative complications, or patient’s requests for additional opioids – demonstrating that alternative approaches to pain management can be both safe and highly effective. Due to so many viable alternatives, it is always best to talk to your doctor, ask questions and advocate for yourself. No one should fall needlessly into the depths of addiction.

IF YOU HAVE TO USE OPIOIDS…

There may be some instances where opioid use may be acceptable. However, these instances are few and far between, and include serious diagnoses such as near-fatal accidents, cancer treatment, and other situations that instigate a high degree of acute pain.

If you absolutely have to use opioid medications:

  • Talk to your doctor before using opioids and ask about alternatives or other resources that could be added (other meds can treat neuropathic pain for several days without the danger of dependence or addiction. There are many ways to minimize the consumption of unnecessary opioids. This is especially important if one has a history of substance use disorder or misuse in their own history or family history.
  • Stick to the minimum effective dose. Understand that healthcare crisis, injury, and surgery are uncomfortable scenarios; however, medicine is not supposed to eliminate all pain and discomfort to the point where a person should expect to not feel anything. This would be an unrealistic expectation of modern medicine.
  • Establish a short-term time table that details when you will stop taking opioids and transition to other pain management resources.
  • Know the risks and side effects—they are plentiful. Always discuss your options and situation with family members and long-term friends who have your best interest in mind.
  • Do NOT take opioids for long-term pain management. You’d be surprised just how effective regular exercise, proper nutrition, and adequate amounts of sleep can be.