Now that we know pharmaceutical companies are being punished for their roles in the opioid crisis, we can all relax and know that things are going to be okay, right? Not so fast. We know the pharmaceutical industry behaved like selfish monsters pushing pills on doctors, pharmacists and patients thus creating a deadly national health crisis. State legislatures responded with new laws restricting access to the drugs in the hopes of stemming the staggering number of deaths. The medical community is retraining doctors and staff regarding how and why they prescribe opiates. But these are only the first steps in addressing the opiate crisis. Just as trying to put out a forest fire with a simple bucket of water provides temporary relief at best, reducing the number of opiates prescribed only begins to address the crisis. There would not have been a market for the pills if there wasn’t a large contingent of patients with chronic pain. In 2016, a Centers for Disease Control study found “an estimated 20.4% of U.S. adults had chronic pain and 8.0% of U.S. adults had high-impact chronic pain.” That is over 50 million American experiencing chronic pain with four million in high-impact chronic pain. Why are we not looking more closely at other methods for managing chronic pain? As long as there are people in chronic pain, we will have people who are understandably looking for ways to escape it. Providing alternative methods and funding for more research into dealing with chronic pain would address one of the root causes of the opiate crisis.
Simply limiting the availability of opiates does not help those in pain. When patients seek medical treatment for pain, doctors prescribe all types of drugs and treatments beginning with the least potent, and then moving up the scale to opiates until pain is alleviated. However, for chronic pain patients, the pain does not subside. If they are taking opiates, they need a bigger and bigger dose to get the pain level to decrease, leading to addiction, and for many, abuse.
While we do not know exactly how pain signals work in the brain, theories of chronic pain indicate that the brain signal for pain is in a permanent “on” position. Chronic pain affects patients’ mental health leading to severe depression around the normal life they have lost, and anxiety about the return of the agony. Patients frequently have to stop working due to pain. This causes a major disruption to their lives both emotionally and financially. They lose their health insurance, and most have difficulty getting approved for disability. Their pain removes them from activities with friends, leading to isolation and depression. Anxiety builds as they wonder and worry about whether they will ever be able to live normal lives again. Anxiety around the duration and intensity of pain is a constant. If they do get to a place where pain is manageable, and they are ready to return to the workforce, they need support there as well. Explaining gaps in work history without revealing medical histories and falling behind on skills are just two common issues patients face.
What would a comprehensive pain treatment program look like? The Department of Health and Human Services commissioned an interagency task force to devise an all-encompassing plan for dealing with chronic pain. Recommendations emphasize using a biopsychosocial approach of interdisciplinary professionals for treatment. The multidisciplinary team included a primary care provider, an addiction specialist, a pain clinician, a nurse, a pharmacist, a psychiatrist, psychologist, physical or occupational therapists, and other possible behavioral health treatment specialists, e.g., social worker, marriage/family therapist, counselor. With all of these different specialties involved, we can see why having them all at one facility would make it easier and much more likely for patients to keep appointments and participate in their therapy.
We can look at a model example. The Mayo Clinic has a Comprehensive Pain Rehabilitation Center that serves patients on an outpatient basis. The program lasts for three weeks and patients attend daily from 8 am-4 pm. If the patient is addicted to opioids, the first order of business is to address this issue. They offer Cognitive Behavioral Therapy, physical and occupational therapy, biofeedback, and Mindfulness-Based Stress Reduction. While the program is not designed to eliminate pain, it is meant to help patients better manage pain. According to the Mayo website, “Of patients who complete the three-week program, 84 percent report better pain control despite discontinuing pain medications.”
Perhaps the biggest advantage to a comprehensive pain program is that the patient does not have to go to four or five various locations for care; psychiatric, medical, and pharmaceutical care are all in one place. The medical professionals working with the patient work as a team, communicating about progress on a regular basis. Compare this to a patient seeing individual providers in their individual offices working in silos. For those disabled by pain, having one place to go instead of getting rides to five different appointments is a gift.
In North Carolina, there are some promising programs like the Integrated Chronic Pain Treatment and Training Project in the western part of the state. Work began in 2016 with goals including: education about the potency of opioid medications and the potential for misuse, group medical visits that provide social connection and support, ways for patients to change their perception of pain (methods to endure pain and stay active), screenings to identify behavioral health issues such as prior substance abuse or trauma, and referrals for patients who would benefit from more intensive treatment. One of the barriers included challenges with staffing in the clinics in the most rural corners of the state.
While state and federal legislatures focus on laws regarding the disbursement of opiates, they must also provide funding for innovative research into chronic pain management, as well as for facilities offering a comprehensive approach to pain management. Until chronic pain patients have options other than opiates, the problem will persist. Getting to the source of the problems is of paramount importance if we truly want to see significant improvements.
Anna Lynch is a regular contributor to the Women AdvaNCe blog.
She is also the mother of an adult with chronic pain and knows first hand the difficulties faced by those with chronic pain.