Much of the discussion about overuse of opioids recently has been about the dangers of long term use. Few have questioned the “need” for opioids for acute pain, such as post-surgically or immediately after a serious injury. The 2016 CDC opioid prescribing guidelines recommend that doctors prescribe opioids for acute pain for three days or less. The guidelines also state that rarely will they be needed for more than seven days. The CDC recognized, in making this recommendation, that opioid addiction and overdose often starts with a prescription for acute pain.
Critics of the CDC guidelines complain that often acute pain lasts more than seven days and more leeway is needed so that patients are not made to suffer. Both the CDC and its critics are making the assumption that the only treatment for severe, acute pain is opioids. This is not the case.
Consider these examples:
Many Americans first heard about acupuncture in 1971 when Henry Kissinger, President Nixon’s secretary of state, visited China after the resumption of diplomatic relations between the two countries. James Reston, a journalist working for the New York Times who accompanied Kissinger, experienced acute appendicitis while in China, necessitating emergency surgery. During his recovery, he was successfully treated with acupuncture rather than drugs for pain and wrote about his experience for the newspaper. Although the use of acupuncture for pain and other ailments is becoming more popular in the U.S., it has not been incorporated into hospital settings for post-surgical and other acute injury care.
Low level laser therapy (LLLT), which uses near-infra red light to speed tissue regeneration and reduce inflammation and pain, has been in use in Europe for more than 40 years. It has begun to attract interest in the U.S. but is not generally available in hospital settings and few people know about it. Dr. Steve Pershing, who practices internal medicine in Tennessee, had been using LLLT in his practice for a wide variety of conditions, including diabetic ulcers, musculoskeletal injuries, postsurgical healing, plantar fasciitis, gout, and lupus. Pershing treated himself with LLLT when he had to have abdominal surgery. He used it pre- and post-surgery and had minimal pain and no inflammation. His doctor offered him pain medication, but he said no thanks, he didn’t need it.
Medical marijuana is now widely recognized to have powerful pain relieving properties. It has fewer side effects than opioids and is better tolerated by most patients. Marijuana is not physically addictive and there is no lethal dose level. It’s another treatment that is unavailable in the hospital setting. One mom, Carol, told me a story about her teenage daughter. Her daughter Julia is a dancer who suffered a serious injury that required extensive surgery. Julia was sent home after surgery with opioids for pain. Despite the opioids, Julia was screaming in pain. Carol repeatedly called her doctor’s office and each time was told to increase the dosage of the opioids. At first Carol followed the doctor’s advice but became increasingly concerned because the medication wasn’t working, Julia continued to scream, and Carol was worried about overdose. Finally Julia said, “I know what I need. Please drive me over to my friend’s house”. When they arrived, Julia got marijuana from her friend and after one puff of marijuana was pain free. This occurred in Texas, where possession of even small amounts of marijuana (less than two ounces) is a misdemeanor punishable by up to six months in prison and a $2000 fine.
Incorporating these three treatments into hospital and aftercare treatment could probably eliminate the use of opioids for acute pain and save many lives.