March 01, 2017
Whether emotional or physical, pain is something most of us avoid as much as humanly possible. For some, however, pain is a constant and relentless companion.
Spinal injuries, severe arthritis, and certain surgeries can all cause several chronic pain in patients of nearly any age, due to healing or neural complications. Often this severe or persistent pain is treated through a combination of opioids and certain types of therapy, depending on the illness or injury.
Over time, opiate addiction becomes a real risk for many of these patients, sometimes leading to even greater suffering and more deadly consequences. According to a White House briefing from late 2016 that cited the National Center for Health Statistics, overdose deaths involving opioids rose from nearly 29,000 in 2014 to 33,000 in 2015.
With those kinds of numbers, there’s no doubt we have a problem, but what is the best solution in the long run for those who suffer from chronic pain?
The possible answers vary greatly.
According to a commentary published in the New England Journal of Medicine in 2015, better results in chronic pain management might be achieved through focusing on helping patients learn coping and acceptance strategies “to reduce the suffering associated with pain and only secondarily reduce pain intensity.”
In the commentary, the doctors put the current trends in opioid use into perspective:
Long-term opioid use does not stop the pain; it only lessens the intensity temporarily.
Chronic pain cases have increased due to the aging of the population, improved survival from disease and trauma, and other factors such as obesity that result in chronic ill health and long-term consequences for the body.
Since the late 1980s and early 1990s, opioid use has increased, with doses escalating in an attempt to drive down pain scores, while toxic drug effects have increased and vulnerable populations have fallen prey to dependency and a lower quality of life.
Greater access to opioids has also affected other populations, including adolescents and young adults, who have also succumbed in ever increasing numbers to opiate addiction and abuse, sometimes resulting in death.
Pain intensity, in general, may have as much to do with the bearer’s perception of the pain as the actual injury or malady itself--making social and psychosocial factors more influential over time.
Overall, the doctors make some valid points, but there are two sides to every argument. An article published in the Boston Globe in June 2016 explored the day-to-day challenges of managing severe chronic pain. According to many sufferers, they have experienced decreased access to their pain medications because, as the article states, “doctors are misinterpreting or overreacting to new federal and state guidelines intended to rein in opioid prescribing.”
The federal and state guidelines being referenced may relate to the recent Food and Drug Administration (FDA) Opioids Action Plan, which outlines a series of resolutions, steps, and anticipated outcomes that the FDA will be undertaking in an effort to curb opiate addiction and pharmaceutical abuse. None of the action items explicitly indicate a plan to eliminate or strictly reduce opioid access, but the general guidelines and outcomes do stress that assessments and evaluations will be taking place and that several different options are being considered.
As always, physicians must use their best judgment in how best to treat their patients. While no one will argue that lessening opioid addiction would be ideal, the methods by which some physicians are undertaking the task may be doing more harm than good for select populations.
The Boston Globe article goes on to cite a study (not yet published) on the long-term impact of decreasing access to opioid medications. The study found deaths caused by opioid overdose did indeed decline, but, during the same time frame, the chronic pain patients under review experienced higher medical costs and fewer productive work days as a result, suggesting an overall decline in health.
While opioid addiction is a potentially dangerous consequence of access to this type of pain relief medication, there is evidence to indicate that select patients may have a true need for at least some access to the opioid pharmaceuticals. Of course, without more solid and long-term evidence, it’s impossible to settle the dispute once and for all.
Ultimately, the battle for a high quality of life is a difficult enough journey, even without having to fight chronic pain every step of the way. The best approach for many doctors and practices at this time may be caution and observation. Doctors should always keep careful watch for the signs of opioid addiction, but a complete departure from pain treatment may not be in the best interests of every patient.
Taking each situation on a case-by-case basis seems to be the best philosophy until more definitive conclusions can be drawn about the threat of opioid addiction and the best methods to improve the quality of life for chronic pain sufferers across the U.S.
About the Author - Ashley Choate is a native of Jacksonville, FL where she lives with her son, dog, and three cats. She graduated Magna Cum Laude from Jacksonville University with a BA in English and holds an MAED in Adult Education and Training. She lives for reading and writing, learning and teaching, and figuring out the day-to-day traumas and joys of mommyhood.