On January 18, 2016

Finding effective treatment for America’s pain crisis

By Bob Twillman

More than 100 million Americans suffer from chronic pain, at an annual cost of $635 billion. That’s more than we spend treating cancer, diabetes, and heart disease combined. Worse, our efforts to treat this pain have led to a significant increase in the use of prescription pain relievers, with tragic and often ineffective outcomes.

Taken together, these trends constitute a pain crisis—one that demands a new treatment model that better balances safety and effectiveness through the responsible use of prescription drugs and alternative therapies.

How did the pain crisis come about? Advocacy for pain sufferers grew in the 1990s, as many medical professionals began to recognize that pain was being undertreated. To help their patients, they turned to powerful opioids like oxycodone and hydrocodone. Prescriptions soared. In 2013 alone, 207 million prescriptions were written for opioids. Today, hydrocodone still tops the list of most prescribed drugs.

But opioids turned out to be more addictive and dangerous than previously thought. With long-term use, some patients develop tolerance, meaning they require higher doses to get the same amount of pain relief.

The unintended, yet devastating, consequence of our current pain management practices is a prescription drug abuse epidemic—one punctuated by a fourfold increase in opioid-addiction-related hospitalizations, triple the number of fatal overdoses involving prescription drugs, and a resurgence of heroin use.

To reverse this crisis, healthcare providers need to treat both acute and chronic pain in ways that don’t exacerbate prescription drug abuse.

Decades of research have shown the effectiveness of “multimodal” approaches to treating pain. A multimodal model maintains that treatment for pain requires much more than just using opioids. This approach focuses on treating the whole person through traditional methods along with self-care, pain education, and complementary or alternative treatments.

Effective pain care regimens might include medications other than opioids, like acetaminophen—the same compound sold as Tylenol—or nonsteroidal anti-inflammatory drugs (NSAID) like aspirin and ibuprofen. When combined with other therapies, this approach is known as “multimodal analgesia.” It can expedite recovery and reduce morbidity, while carrying fewer adverse effects than opioids do.

Multimodal care also recognizes that pain is a multifactorial problem. It arises from a number of sources: surgeries, broken bones, diseases, or elusive causes–an inexplicable headache or back pain–that can be difficult to pin down, but no less real.

Because pain is so unique and complex, every patient needs an individualized approach for treatment. Opioid pain medications are just one, oftentimes over-used, tool to treat pain. A multimodal approach might involve stress management and relaxation, physical therapy, improved sleep and nutrition habits, and exercise. In some cases, a multimodal approach will mean getting patients on the right dose of an appropriate medicine.

Moving toward a more integrated model of pain management will require a real investment in educating doctors and patients. Few physicians have adequate training in pain relief, and there’s a lack of standard practice to guide them. Non-drug alternatives have traditionally not been covered by insurance. They also require the patient to engage in the healing process and not expect a magic bullet. Safe and effective pain management is a balancing act. Careful and judicious use of prescription drugs will remain an important tool for physicians in treating pain. But they and their patients should not overlook other tools to relieve pain and improve quality of life.

Bob Twillman, Ph.D., FAPM is the executive director of the American Academy of Pain Management and member of the Alliance for Balanced Pain Management.

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