Treating Chronic Pain without Opioids
July 7, 2017
By Best Doctors
Chronic pain is one of the most common conditions in America, and the most common cause of long-term disability, affecting 1 in 4 Americans—more than diabetes, heart disease and cancer combined. It’s also one of the most expensive conditions, costing the American economy $635 billion each year.
Since their 19 th century discovery, opiates have been used to relieve pain symptoms, a practice that continues today. While they are often effective for short-term use, such as when treating acute pain, the side effects and dependence issues that arise in long-term use often do more harm than good. When opioids travel through the bloodstream, the chemicals attach to specialized brain receptors that create the feeling of pleasure. As the brain becomes used to opioids, higher doses are necessary to achieve the same levels of pain relief. In fact, many patients experience increased pain on opioids. Over time, this can cause dependence on the drugs, and sometimes even further drug use by patients.
A different way to treat a different painExperts say a better approach to chronic pain management is a multidisciplinary and largely non-medical approach. Michael Lacroix, MD, associate medical director at Aetna, explains that chronic pain symptoms are often both physical and mental. Those suffering are victims of the chronic pain cycle. They are forced to cut back on physical activity, which lowers stamina and can lead to depression, which, in turn, causes problems with sleep, appetite, libido, fatigue, and most importantly, an enhanced focus that shapes the patient’s perception of pain.
Treatment must take into consideration all of those pieces, rather than just pain relief. One solution is enlisting the help of a pain specialist. Trained in evaluating, diagnosing and treating pain of different kinds, pain management doctors should have completed a fellowship in pain medicine, be certified by the American Board of Pain Medicine, as well as be certified in their primary specialty, says Reza Ghorbgani, MD, president and medical director of the Advanced Pain Medicine Institute in Chevy Chase, MD.
Common specialties of pain management include:
- Anesthesiologists – They can provide nerve blocks, trigger point injections, prescribed medications and implantable devices.
- Surgeons – In addition to services provided by anesthesiologists, surgeons can also perform neck, back, knee or hip surgeries. Though, it’s typically a good idea to get a second opinion when considering an orthopedic surgery.
- Physiatrists/physical therapists – These clinicians specialize in rehabilitation, physical therapy and occupation therapy, which are often effective alternatives to surgery.
- Psychiatrists/psychologists – Because chronic pain often has psychiatric side effects, psychiatrists can provide counseling or medication for depression and depression-induced problems.
Integrating treatment found the correct diagnosis and treatment for one Best Doctors memberThe same treatment won’t work for every patient, so it’s important for patients to partner with their health care professionals. In many cases, an effective treatment plan involves collaboration between more than one type of specialist. For example, one Best Doctors member suffered from chronic pain for years after an injury, despite surgical and other interventions.
Best Doctors utilized experts specializing in orthopedic surgery, pain management and psychiatry to review the member’s diagnosis and treatment plan. The experts changed the initial diagnosis to myalgia, neuritis and somatoform disorder, which informed more effective treatment options. Additionally, they recommended a psychiatric evaluation to look for an underlying mood disorder, somatic symptom disorder or personality issues that could potentially impact his perception of pain and his response to pain management treatment efforts.
Through the collaboration of the multiple experts, the new treatment plan accelerated the functional recovery of the member, giving the member pain relief and saving hundreds of thousands of dollars in unnecessary treatment.
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