The time has come to rethink pain management

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Rarely a day goes by that we don’t hear a sad story about the impact of opioid abuse or, worse, see its impact on our communities first hand.

The addictive nature of opioids is resulting in a growing epidemic.

Every day, more than 115 people in the U.S. die after overdosing on opioids, according to the Centers for Disease Control (CDC) and their analysis of data through 2016. Often prescribed for chronic and acute pain relief, prescription opioids are misused by nearly one third of patients, the CDC noted, and up to 12 percent of patients who receive these prescriptions develop an opioid use disorder. An estimated 2 million Americans will suffer from addiction to prescription or illicit opioids in 2018 alone.

Prescription opioid misuse is exacting a significant economic toll, as well. The most recent research, based on 2013 data, suggests that prescription opioid misuse in the U.S. alone costs $78.5 billion a year in terms of healthcare costs, lost productivity, addiction treatment and criminal justice involvement. Costs are continuing to rise.

Our nation has gotten to this crisis point as a result of a perfect storm of factors: care providers over-prescribing opioids and under-prescribing alternative approaches to pain management; patients’ preference for opioids and reluctance to try other pain management options; and aggressive marketing by opioid manufacturers and distributors.

While it may sound simple, getting ahead of opioid abuse and stemming the current epidemic all starts with education – for both care providers and patients. The medical community is already addressing its role by developing guidelines for prescribing opioids. The public is rightly alarmed. It’s time for care providers and patients to talk openly before writing the prescription -- discuss the risks they face when taking prescription opioids, know how to identify signs of addiction and consider alternatives available for pain management.

Understanding Opioids
A proactive approach to patient education is necessary to ensure that individuals understand what opioids are, how they work and the inherent risks. Whether it’s dealing with an injury, managing chronic pain or planning for post-operative recovery, care providers should explain the pros and cons of different pain management protocols for patients’ individual needs, and empower them to choose the path that they believe is best.

Opioids can be effective and appropriate in pain management, when best practice guidelines are followed. Care providers should explain the types of opioids available (short-acting/immediate release vs. long-acting/extended release), and how they can best be used if a patient decides this is the course of action they wish to take. It’s important to stress how opioids work – since they attach to the body's receptor cells, they block or suppress how one feels pain, and make a person feel good or relaxed by affecting areas of the brain that produce feelings of pleasure, which is part of their addicting quality.

Care providers should explain to patients the opioid use risks, including:
Side Effects - There are a number of common side effects when taking opioids, including constipation, nausea, sleepiness, impaired motor skills and problem with memory, thinking and judgment.
Tolerance - Over time, a patient will need higher amounts to achieve the same pain relief effects. Taking opioids for more than a few weeks can cause patients to build up a tolerance.
Dependence - Withdrawal symptoms - sleeplessness, rapid heartbeat, rapid breathing and diarrhea - can occur when patients reduce or stop taking the medication.
Addiction – With more chronic use, patients can have the urge to seek out medication and cannot stop using it. Those who have a history of drug misuse are at higher risk for addiction.

Chronic pain patients, and their family and friends, should learn the warning signs of opioid-use disorder – opioid use may interfere with work, life and family relationships; may cause physical or psychological problems; and may make them crave more medication, use more than prescribed or take them in an unsafe manner.

Patients also need to avoid sharing pain medications with family or friends and know how to secure and properly dispose of pain medications to protect children and prevent misuse.

Exploring Alternatives
Given today’s opioid crisis situation, there is a stronger focus on alternative pain management strategies. The U.S. Department of Health and Human Services announced in May 2018 the creation of a new task force that will recommend updates to best practices for managing chronic and acute pain. Medical professionals, and patients alike, are also more aware that other means of pain management pain should be discussed and considered to prevent even more opioid addiction.

Patients, and their care providers, have options that have been shown equally as effective as opioids, without the significant risks. These alternatives include:
• Other pain relievers - acetaminophen or non steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen
• Other classes of medicines, including anticonvulsants, antidepressants and muscle relaxers
• Exercise and good sleep habits
• Physical or occupational therapy
• Cognitive behavior therapy, which can help teach different ways to respond to and cope with pain
• Mind/body therapies, such as deep breathing distraction, visualization, meditation and biofeedback
• Complementary therapies, such as massage, acupuncture, acupressure and chiropractic care
• Procedures, including transcutaneous electrical nerve stimulation (TENS), implantation of a spinal pump or nerve ablation

With more knowledge of the problems associated with opioid use - from addiction and personal harm to the costs to society – care providers and their patients can better share in the decisions about pain management. Responsible use of opioids, combined with alternative approaches, can effectively manage both acute and chronic pain. The key is education and open dialogue.

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