The opioid crisis is, unquestionably, one of the most urgent and pervasive public health issues facing the United States at present. The indiscriminate nature in which powerful prescription painkillers like oxycodone and hydrocodone; synthetic opioids like fentanyl, and illicit opioids such as heroin have cut a path of mortality through the nation makes opioid addiction a threat to every segment of the American population. The Centers for Disease Control and Prevention (CDC) reports that there were 70,237 deaths due to opioid overdose fatality, the latest in a series of record-setting years. These deaths account for an overwhelming majority of overall deaths that occurred that year.
At the same time opioid addiction is causing more and more deaths, it’s also derailing the long-term health and quality of life for millions Americans. The CDC also reports that opioid overdoses increased 30 percent from July 2016 through September 2017 in fifty-two areas in forty-five states. One of the primary drivers of the urgent and escalating American opioid addiction crisis is the high collective rate of chronic pain conditions faced by Americans. Identifying, embracing, and implementing alternative effective measures of treating chronic pain is a critical part in reversing the course of this public health issue and has been a going concern for the scientific community.
Data from the CDC indicates that more than 20 percent (fifty million) of American adults suffer from chronic pain, 8 percent (more than nineteen million) of whom experience what is characterized as a “high-impact” form of the condition. Research from Johns Hopkins University indicates that over ten million Americans take opioids to regularly manage these pain-related conditions, and the National Institute on Drug Abuse (NIDA) reports that 21 to 29 percent of patients prescribed opioids for chronic pain misuse them. At the same time, a report from the Department of Health and Human Services (DHS) illustrates a glaring lack of consistent medical guidance in the treatment of mild to moderate pain conditions, claiming that there is one physician for roughly 28,500 Americans living with chronic pain.
The reality is that, while obviously effective in a limited and supervised clinical context for severe conditions such as post-surgical, cancer-related, and end-of-life pain, prescription opioids aren’t meant to treat long-term chronic pain conditions, nor are they demonstrably successful in doing so. One recent study published in JAMA last March found that people who took opioids for chronic back, knee, or hip pain did no better—and in some cases had worse pain—than those who took non-opioid medication
At the same time, recent changes in legislation have even curtailed their use in acute pain treatment as well. Doctors and treatment professionals must look beyond the sole reliance of medications to alleviate pain and explore credible modalities to help patients achieve long-term relief to regain their health and quality of life. To that end, many promising non-opioid interventions have emerged to treat chronic pain. Below are some examples of these findings and techniques.
Mind-body-spirit techniques such as yoga, tai chi, chiropractic care, and others have proven to be a reliable, safe, and consistent alternative to opioid-related pain management. For the treatment of lower-back pain specifically, a condition that will impact roughly 80 percent of American adults over the course of their lifetimes, according to data from the National Institutes of Health (NIH) , the American College of Physicians has officially recommended the use of non-opioid interventions as superficial heat, massage, acupuncture, or spinal manipulation. If drug therapy is desired, physicians and patients should select nonsteroidal anti-inflammatory drugs (NSAIDs) or skeletal muscle relaxants.
These guidelines, published in the Annals of Internal Medicine in 2017, also recommend the co-occurring implantation of exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise (MCE), progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy (CBT), or spinal manipulation.
Physical therapy is a commonly used practice in the treatment and rehabilitation of acute injury; however, it is often an underutilized resource in the treatment of mild to moderate chronic pain. One 2015 study from BMC Health Services Research found that while those with new incidents of lower-back pain who received physical therapy within two weeks of symptoms were less likely to pursue opioid-based treatment, less than a quarter availed themselves of the option.
In a joint study by the University of Michigan and the University of Nevada published in JAMA in 2017, researchers called not just for “responsibly” utilizing opioid therapy to treat chronic pain, but rather for a comprehensive approach based on an understanding of chronic pain pathophysiology that emphasizes the patient-physician relationship, shared decision making, nonpharmacological treatments, and selective use of non-opioid pharmacotherapy. Physical therapy can be a fundamental component of these plans.
Data from the CDC indicates that use of acupuncture to treat mild to moderate pain and discomfort has increased by a third over the past twenty years. The technique is believed by practitioners and proponents to be effective in the treatment of multiple pain-related conditions. Consumer Reports cites a widespread analysis of twenty-nine studies with a total of 17,922 participants with back and neck pain, osteoarthritis, chronic headache, and shoulder pain that found respondents experienced significantly more relief with acupuncture than those who had no treatment. It’s important that interested acupuncture candidates find a quality and reputable practitioner to ensure safe and effective delivery of treatment.
In addition to promoting improvements in everyday comfort and quality of life, massage therapy is gaining more and more traction as a means of effectively managing chronic pain. Data from Harvard Health Publishing indicates that hour-long massages can be effective in treating some pain-related conditions and suggests that it may be helpful in stimulating competing nerve fibers and impeding pain messages to and from the brain. Findings cited by the university also suggest that massage can be helpful in alleviating depression or anxiety. Massage can be applied through various types of pressure to accommodate differing levels of pain and discomfort in patients.
Medication-based treatment for chronic pain doesn’t have to mean the strict reliance on powerful opioid painkillers. Safer nonprescription drugs have proven to be effective in the relief of mild to moderate pain. NSAIDs reduce the inflammation that leads to pain. A 2017 joint study by Albany Medical College, Albert Einstein College of Medicine, and Montefiore Medical Center revealed that participants who received ibuprofen plus acetaminophen for severe pain reported the same amount of pain reduction as those who received an opioid plus acetaminophen. Other types of non-opioid medications, such as antidepressants, muscle relaxers, and even prescription fish oil can also help reduce inflammation associated with recurring chronic pain.
There is a growing body of research to suggest that CBD oils extracted from hemp can help reduce inflammation and alleviate various pain-related conditions. Though regulatory roadblocks and social stigma continue to get in the way of further clinical exploration, proponents say CBD products can help relieve joint and muscle pain, arthritis, and other pain-centric ailments. Very recently, a breakthrough study from the Addiction Institute at Mount Sinai published in the American Journal of Psychiatry indicated that the use of CBD oil could help reduce opioid cravings and related stress and anxiety. Study authors assert that this is a promising development for the many who find themselves unable to access medication-assisted treatment (MAT). Data from NIDA indicates that only one third of patients in private treatment centers receive medications for opioid addiction.
Proper sleep, nutrition, and fitness are also useful in reducing inflammation and pain-related conditions. Data reported by Harvard Medical School indicates that diet can play a key role in reducing inflammation, increasing energy,, and helping heal chronic pain. In some extreme acute cases, patients may be eligible for surgery to reverse the course of their pain for good. It’s critical that patients carefully consider the ramifications and benefits of surgery prior to making this important decision. It’s also important to realize that no surgical procedure is guaranteed and they may not lead to better outcomes than safer non-pharmacological clinical treatments. Patients should integrate the aforementioned therapies, wherever appropriate, into a customized and comprehensive care plan that they develop under the guidance of their physicians.
As the risks of opioids become increasingly difficult to ignore, more and more medical professionals and clinicians are offering non-pharmacological alternatives for everyday and moderate pain treatment. Insurance companies are covering these therapies with increased regularity as well as working to make these interventions more accessible and affordable. One last thing to consider: NIDA reports that around 80 percent of people who use heroin first misused prescription opioids. With tens of thousands of Americans succumbing to opioid use disorder (OUD) and millions more becoming ensnared in addiction every day, it’s time to ponder whether or not there’s a better way to treat pain.