Opioid abuse and chronic pain: Twin epidemics

We are all aware of the serious opioid misuse, abuse, diversion and overdose issue in our country and the devastating effect it is having on communities across the United States.   Consider this alarming statistic – overdoses (>50,000) have now surpassed car accidents as the number one cause of injury-related deaths nationwide.
 
Less familiar to the public and to policymakers are the millions of Americans suffering from debilitating chronic pain; however, the statistics are just as alarming.  The Institute of Medicine (IOM) has called chronic pain a public health problem of epidemic proportions.  According to the IOM’s Relieving Pain in America report, 1 in 3 Americans suffer from chronic pain; 100 million American suffer from back pain, headaches and arthritis; chronic pain is the number one cause of adult disability and it costs the United States economy more than $600 billion in direct healthcare costs and lost productivity every year.
 
{mosads}The opioid epidemic has appropriately caught the attention of the media, policymakers and the public; but unfortunately, we still have a lot of work to do to raise awareness about the chronic pain crisis in America.  As policymakers and healthcare professionals in Washington, DC and across the country grapple with how to address pain management and alternatives to opioid therapies, it is critical to address chronic pain as well.
 
Reducing overreliance on opioids for both acute and chronic pain will help reduce the negative consequences of abuse and diversion overall.  I believe a balanced approach to manage pain – providing structured well-thought out policies that focus on interdisciplinary management that preserves access to the full range of medical options with appropriate screening and educational tools in place – is the ideal means by which to reform and revitalize the treatment of chronic pain and reduce opioid prescriptions overall.
 
As a board-certified, practicing pain physician here in Washington, D.C., I recently testified before the U.S. House of Representatives’ Bipartisan Task Force to Combat the Heroin Epidemic. I spoke about caring for patients every day who suffer from severe and debilitating chronic pain, and how every treatment solution should be different and individualized to the needs of that patient.
 
While opioids can and should be used as one form of pain management, there are many alternative solutions that should be promoted and explored further, including medical devices.  It is important to note that there are numerous FDA-approved, non‐pharmacological, evidence‐based, cost-effective products currently on the market that are often overlooked. Examples of technology that help patients manage chronic pain include spinal cord stimulation, radiofrequency ablation, and implantable drug pumps.
 
The health care system needs to better understand which treatments are currently available to treat pain, whether or not they have strong evidence for efficacy, and the positive, long‐term impact they have on cost of care and outcomes. Opioids may continue to play a role in helping certain patients manage both acute and chronic pain, but learning about and employing additional treatment options including  medical devices, physical therapy, acupuncture and other alternatives can provide patients with the comprehensive care they need – and possibly reduce the risk of opioid misuse, abuse and overdose overall.
 
The House Energy & Commerce Committee will mark up several pieces of opioid legislation this week, including HR 4641 sponsored by Representatives Susan Brooks and Joseph Kennedy.  This legislation takes steps to address the challenges associated with chronic pain care, promote best practices and encourage adoption of alternative therapies – including medical technologies – to replace or to augment opioids.  Substance abuse disorders and chronic pain are interrelated public health crises that must be addressed simultaneously and with equality, one without the other is tantamount to worsening each individual crisis.  Passage of the Brooks Kennedy Pain Best Practices bill is an important advancement in addressing these two public health crises. 

Desai, is board certified in Pain Medicine and Physical Medicine & Rehabilitation and President of the International Spine, Pain & Performance Center in Washington, D.C. He is an Instructor at The George Washington University School of Medicine and Health Sciences. Dr. Desai is also the former Director, Pain Medicine & Non-Operative Spine Services at The George Washington University/Medical Faculty Associates.