The decision to use opioids for chronic pain is a serious one. Harm is common. Official estimates of the percentage of chronic, non-cancer pain patients who become addicted to opioids is 25 percent. Some studies have put that percentage even higher, at 37 percent or more. 190,000 Americans have died of prescription opioid overdoses. According to CDC Director Thomas Frieden, “We know of no other medication that’s routinely used for a nonfatal condition that kills patients so frequently.“
Besides overdose, there are lesser known risks too. Opioids contributed to more than 21 percent of automobile fatalities in 2010. Over 14 percent of pregnant American women used prescription opioids at some point during their pregnancy, which put their babies at increased risk of miscarriage, birth defects and neonatal abstinence syndrome (drug withdrawal at birth). Elderly people who take opioids are at increased risk of falling, which can sometimes result in serious harm or death. Opioids also negatively impact immune system function, exposing the user to increased risks of infections and cancer.
The potential for harm is not just limited to the opioid user, but to family members who must live through the hell of addiction and loss, communities that experience higher crime rates, other travelers on the road with the opioid user and offspring. No other treatment for pain poses this degree of risk to self and others.
Therefore, it’s reasonable to consider every other avenue for treating pain first. Most chronic pain patients who depend on opioids for pain relief insist that they have tried everything else and it didn’t work.
There are widespread knowledge gaps on the part of physicians, who on average receive less than two hours of education on pain in medical school, and difficulties in access to many pain treatments due to lack of insurance coverage or availability. Also, patients rarely have the ability to sift through all the conflicting claims to determine which treatments might be worth trying. Therefore, I think it’s unlikely that most opioid users have tried everything else first.
Here’s a list of what many of these patients have probably tried:
• Other prescription and over-the-counter drugs including Celebrex (celecoxib), ibuprofen, acetaminophen, Lyrica, gabapentin and other anticonvulsants, muscle relaxants, anti-anxiety drugs including Xanax and antidepressants including SSRIs like Cymbalta and tricyclics like Amitriptyline. These drugs rarely work well and have significant side effects.
• Injections, which usually work only for short periods of time and can be risky
• Surgical interventions which often create more problems than they solve
• Physical therapy for a small number of sessions, limited by insurance coverage cutoffs
• Chiropractic for a small number of sessions, limited by insurance coverage cutoffs
Here’s a list of therapies that most patients probably haven’t tried, all of which have significant scientific evidence of effectiveness and safety but are rarely covered by insurance:
• An optimal course of physical therapy treatment with sufficient time for hands on treatment and patient education
• An optimal course of chiropractic treatment with sufficient time for hands on treatment and patient education
• Optimizing nutrition, especially increasing intake of anti-inflammatory fruits and vegetables
• Nutritional and herbal supplements (vitamin D, magnesium, omega 3s, turmeric, ginger, boswellia, butterbur, feverfew, chondroitin, glucosamine and many others)
• Avoiding toxins including aspartame, MSG, gluten and processed foods
• A comprehensive exercise program that includes stretching, strengthening and aerobics
• Massage, especially deep tissue and myofascial release—ten or more weekly sessions
• Mind/body approaches including Cognitive Behavioral Therapy, biofeedback, neurofeedback, meditation, visualization and trauma release techniques
• Low level laser therapy
• Medical Marijuana
• Energy healing, such as Reiki and Therapeutic Touch
According to research studies, the most effective treatment for chronic pain is an interdisciplinary one, where health care providers from different disciplines all evaluate a patient and collectively come up with a comprehensive treatment plan that includes body-based and mind-based treatments and emphasizes self-management skills. Insurance companies in the U.S. used to provide coverage for interdisciplinary pain treatment programs, but with the advent of opioids, which they saw as a cheaper alternative, stopped paying for them. The vast majority have closed as a result.
Pain patients and their advocates need to demand access to and coverage for safer and more effective therapies. You can start by signing my petition on change.org for a Pain Treatment Parity Act.
To learn more about the safety and effectiveness of available pain treatments read my book: