‘Take this for the pain’
The evolution of pain management, and what to expect next
Before the dawn of modern medicine, pain was an acute issue — a short-term problem — as it was unlikely someone would survive a serious injury. By the 1990s, opioids were the go-to pain management solution in America for noncancer-related chronic pain for reasons that have contributed to today’s public health crisis: 19.7 million people battled a substance use disorder in 2017. As the health care system reins in opioid use, alternative pain management methods are proving to be effective long-term solutions to chronic pain.
Beginning of U.S. Opioid Crisis
The American opioid crisis has its roots in the way society understands and views pain. Increasingly, doctors perceived pain to be undertreated, and opioids were used for those with cancer-related and acute pain. In the 1990s, pain management experienced a shift:
• Doctors began using opioids to treat noncancer patients who have chronic pain, without considering the behavioral and psychological health of the patient.
• Pharmaceutical companies downplayed the risk of addiction to opioid drugs early on.
• State governments designated pain as the “fifth vital sign” and created a civil penalty for physicians to not address pain.
Confronting an Epidemic
While the rate of opioid prescriptions peaked by 2010 in the United States and has declined since 2012, the amount of opioids prescribed per person is still three times higher than the rate in 1999.
In order to combat the public health emergency, the health care system began changing its practices at every level — from doctors to researchers to pharmacies. There are a variety of treatments designed to help people recover from opioid abuse and to regain control of their lives:
• Inpatient treatment programs.
• Community support groups.
• Medication-assisted treatment (MAT)
• Psychotherapies.
Management Strategies for Chronic Pain
The main goal of any chronic pain management program is to increase function — not to eliminate pain entirely.
• Behavioral health evaluation: Individuals with sustained chronic pain have a higher likelihood of developing major depression. Psychotherapies and, if needed, medications can be helpful to eliminate this portion of chronic pain syndrome.
• Comprehensive evaluations and treatment planning: Primary care providers work in tandem with psychologists who have special training to provide comprehensive evaluations of patients’ pain. It is the best and most effective way to determine a safe and long-term treatment for chronic pain.
• Injections or local surgical interventions: A doctor may prescribe injections or permanent nerve disruption to address pain. Correction of underlying anatomy damage can decrease or eliminate the cause of the pain.
• Lifestyle modifications: Weight loss, exercise, proper sleeping habits, a healthy diet, yoga, meditation, relaxation techniques and several other factors can all play into chronic pain intervention.
• Other drug combinations: Antiinflammatory preparations such as topical anesthetics or topical steroids can provide substantial relief without systemic effects. Changing to oral medications such as ibuprofen and Tylenol can provide relief to patients with few side effects and essentially no risk of addiction.
• Physical therapy and functional rehabilitation: In certain cases, physical therapy can relieve pain over time through naturally strengthening the body. Functional rehabilitation also has a psychological care component that’s beneficial to all patients.
Each patient will experience and respond to pain differently. Patients with chronic pain should talk to their doctors about whether a prescription opioid is necessary, how to manage its effects and all other medications they are currently taking in order to avoid serious side effects.