While there is considerable debate as to how much blame doctors should be assigned for the ongoing opioid crisis, there is little doubt they can do something to curtail it — that instead of prescribing drugs that have been found to be highly addictive they can resort to alternate forms of pain management.
Doctors’ prescription of powerful painkillers like OxyContin is frequently viewed as one of the major factors that triggered the opioid scourge — an epidemic that kills 115 Americans daily, took the lives of some 200,000 between 1999 and 2016 and incurs some $78.5 billion a year in costs, when such matters as healthcare and law enforcement are factored in.
In other words, the equation that has been put forth is that doctors prescribe painkillers, patients develop a dependency and then turn to such illicit drugs as heroin and fentanyl.
This is a vast oversimplification. In reality, most doctors are seeking to help their patients with pain management, and prescribe drugs accordingly. Unfortunately, there are ample examples of patients who abuse those prescriptions, and that abuse leads them down a darker path.
It is estimated that between 21 percent and 29 percent of those who are prescribed opioids for chronic pain abuse them, and that between eight and 12 percent of those develop an opioid use disorder. Moreover, 80 percent of those who use heroin started with prescription drugs.
While there are inarguably unscrupulous physicians out there, patient responsibility needs to be taken into account when the root causes of the opioid crisis are considered. So too does the role of the pharmaceutical companies who aggressively marketed painkillers in the mid-‘90s, while claiming that these drugs were not addictive.
The most notorious example is that of Purdue Pharma, maker of OxyContin. Released in 1995, that drug alone has enabled Purdue to realize some $35 million in profits through 2017, according to the Washington Post.
But in 2007 the company entered a guilty plea on a felony charge of “misbranding” OxyContin. Three top executives also pleaded guilty, and all told Purdue paid fines totalling over $634 million. Moreover, the New York Times reported that while the company claimed to be unaware that the drug was being abused until well after its release, Justice Department documents revealed otherwise.
The Post noted that Purdue reformulated OxyContin in 2010 so that it might be more difficult to inhale or inject. That did not prevent the company from being sued by the state of Kentucky — a place hard hit by the opioid crisis — in 2015. The parties settled out of court for $24 million, with the company making no admission of wrongdoing.
So the crisis continues. More Americans under the age of 50 die from overdosing on prescription drugs than any other cause, and among those in the 18-30 age range, it is the second-leading cause of death.
Physicians, especially those in the field of physiatry, can only hope to stem the tide by using alternate forms of pain management. That is especially true for those in the field of physiatry, who are experts in non-surgical pain management options.
There are many such options, not the least of which are non-opioid medications such as aspirin, ibuprofen and acetaminophen. There are several others, including the following:
Acupuncture, a Chinese healing art that dates back 2,000 years, primarily involves applying needles to certain parts of a patient’s body. And such needles, which gained FDA approval as medical devices in 1996, have indeed been found to be an effective pain deterrent.
There are those experts who explain that effectiveness is a result of nerves, muscles and connective tissue being stimulated, which in turn activates the body’s natural painkillers.
As the name implies, this treatment is physical therapy performed by a trained healthcare professional in a pool. Besides pain management, it also improves flexibility, balance, coordination, strength and endurance.
One report pointed out that the ancient Greeks and Romans bathed in hot springs, and that other cultures have seen the benefit of aqua therapy through the years. That same report listed the many benefits of water — how its warmth provides relief for aching joints, its resistance leads to strengthening and its buoyancy eliminates the dangers of falling.
CBD, the compound found in marijuana or hemp that is non-psychoactive (unlike THC, weed’s other ingredient), has been found to enhance the body’s own production of this compound. And that, in turn, is believed to reduce pain and inflammation; one study performed on laboratory animals suggested as much, and in 2018 the Food and Drug Administration approved a form of CBD known as Epidiolex for the treatment of two types of epilepsy.
Experts fear such side effects as liver issues, breathing problems and irritability, and there is concern that without FDA approval, CBD products will vary in quality and consistency. But there is reason for optimism on this front.
Cognitive Behavioral Therapy (CBT)
This is a branch of pain psychology, which operates under the premise that pain has a emotional component, in addition to a physical one.
While nobody struggling with chronic pain wants to hear that it’s “all in your head,” that is partially true. And CBT enables patients to change their mindset, to alter the helpless feeling that accompanies a chronic condition.
As noted on WebMD, that is done through regular consultations and might involve a patient keeping a journal to record the thoughts and feelings he or she associates with pain.
Trigger Point Injection (TPI)
Used to treat such maladies as fibromyalgia and tension headaches, TPI calls for the injection of a local anesthetic or saline into the knots of muscle that form under the skin when such muscles fail to relax. It is believed that this knots — i.e., trigger points — irritate nearby nerves and cause pain.
The injection renders the trigger point inactive, and diminishes the pain.
There are many other pain-management alternatives to drugs that are potentially addictive — mirror therapy and massage among them — but the inescapable conclusion is this: Physicians, while far from the sole cause of the opioid crisis, can do a great deal to curtail it.
Dr. Stanley Mathew is a psychiatrist and medical director working out of Cedar Rapids, Iowa focusing on pain management, spasticity management, and spine and musculoskeletal medicine, along with other areas.
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