Everywhere you turn today, you’ll see reporting on the opioid epidemic, raising the alarm about overprescribing, community overdose rates, and attempts to control both legal and illegal use of opioids. Less frequently discussed, though, is the impact of new restrictions on chronic pain patients, many of whom rely on opioids to get through the day.
Is there a way to balance the needs of chronic pain patients who are not abusing medications, but simply trying to manage excruciating pain with the demand to cut back on opioid prescribing? A true solution is one that recognizes how patients have been harmed by aggressive marketing while also acknowledging that there is a real need for long-term opioid use among a small subset of pain patients.
Medicine Or Marketing?
One core reason that individuals with chronic pain are overlooked in expert attempts to address the opioid epidemic is that many public health advocates view all pain patients as dupes of the system. As the story goes, pain patients are a creation of the pharmeutical industry, not people served by it.
As Lawrence Golbom, author of Not Safe as Prescribed notes, prescription drug manufacturers, specifically the makers of OxyContin, a highly addictive pain medication, successfully lobbied to have pain named the “fifth vital sign” as part of a marketing ploy to sell more drugs. And while this may have diminished short-term pain among patients with acute conditions, it also created a vast oversupply of medication that fed addictions and that was funneled into the drug trade.
What Golbom and others miss here, though, is that there have always been patients suffering from severe pain who would benefit from stronger treatment. So while OxyContin and its kin were developed to treat late stage cancer pain, others with chronic conditions regained a significant measure of function by taking these drugs.
A Question Of Alternatives
What do doctors and advocates want chronic pain patients to do or take in place of taking opioids? Some recommend a decrease in the medication while others believe that mindfulness, physical therapy, and similar treatments are the answer. If you ask patients like Rob Hale who was diagnosed with ankylosing spondylitis 24 years ago, though, he’ll tell you what opponents really want – to kill him and others like him off so that they don’t weigh on the system.
Hale had his opioid prescription drastically cut in the wake of new CDC guidelines, which meant he could no longer do chores around the house, help his father, or go to work – all things that his prior prescription allowed him to do. Instead, he took over the counter medications and ultimately fell unconscious for days do to drug toxicity in his liver. It was a complete reversal of fortune.
Other chronic pain patients tell similar stories, but they also have a long list of alternative approaches doctors, family, and friends have recommended for treating their pain. The most common suggestion is yoga.
The Limits Of Non-Prescription Treatment
Why does everyone think yoga is the solution to opioid dependency in chronic pain? The answer has to do with the fact that, for those with mild to moderate pain, yoga can work. Many yoga poses relieve back pain, improve flexibility, and build core strength, which helps you maintain proper posture and further reduces pain in daily life.
Of course for the most seriously affected patients, yoga may not always be an option. Someone like Rob Hale, whose condition causes parts of the spine to fuse, or those who have pain and joint instability from Ehlers-Danlos Syndrome either cannot or should not do yoga. Acupuncture and chiropractic treatment may also help but many insurance plans don’t cover these treatments.
Potentially the most effective way to treat chronic pain without opioids is through intensive treatment like that offered at the Mayo Clinic’s Pain Rehabilitation Center. The program, which requires patients to taper off their opioid treatment, uses meditation, cognitive therapy, and physical and occupational therapy to help people learn to both physically ease and mentally manage their pain on a daily basis and most do very well.
Successful mindfulness-based treatment can improve attention and sleep, as well as improving the patient’s ability to both cope with and reduce physical pain, all valuable skills that can help people reduce their use of opioid treatments. But until insurance companies begin covering these programs, they will remain out of reach.
The Center’s director, Wesley Gilliam, notes that combating the opioid epidemic while caring for those who suffer from real, severe pain will require many more programs like theirs, but for now, as a society, we’re relying on stopgap measures. Chronic pain patients are falling through the gaps as we fight addiction. The medical community has a responsibility to reach out a hand in aid.