If you take an opioid regularly for pain, you may well be wondering whether you have a better option. Don’t wait — talk to your doctor.
The nation is seeing a rash of opioid addictions as well as deaths. Every day, about 44 people die from overdoses of painkillers. The beloved rock star Prince died of an overdose of a painkiller, fentanyl, which is often prescribed after people have built up a tolerance to drugs like OxyContin. Prince, who suffered from debilitating hip and knee pain, was among the estimated 23.4 million adults, more than 10 percent of the population, who experienced a lot of pain over months.
Ask for a package of solutions both to reduce pain and cope. You may have dismissed OTC drugs that could help. Neuromodulation, which involves electric stimulation from a device like a pacemaker, can be effective. So can a variety of programs that address the brain’s role in perceiving pain.
Before the 1990s, American doctors had prescribed opioids to cancer patients and people in pain after an acute injury like a fracture. Few hospital patients who received opioids for an acute injury became addicted to it. Then OxyContin came along, and was marketed as an alternative to non-steroidal anti-inflammatory drugs, or NSAIDs, which include ibuprofen (Advil) and naproxen (Aleve). Too much of those remedies seemed to pose a risk of internal bleeding, especially dangerous forolder patients, a group that often suffers from chronic back and joint pain.
However, more recent evidence shows that the number of deaths from bleeding caused by NSAIDs is now much smaller than deaths from opioids.
It has also become clear that people who take opioids over long periods — not just for a broken bone, but for an arthritic hip — do become addicted. That said, your personal risk of abusing painkillers, taking them beyond what’s needed for the “high,” is tiny if you have no history of addiction.
But opioids may not even be necessary. Some doctors argue that they feel pressured to prescribe opioids by hospitals, since government payments are linked to positive reports from patients on pain management and the opioids may act faster. In a survey of 141 emergency department doctors, 40 percent said they or a colleague had been disciplined for failure to provide opioids.
Meanwhile, the NSAIDs are often overlooked, although they can be prescribed in higher doses than the OTC versions and be “remarkably effective,” notes Michael Leong, MD, former clinic chief of the Stanford Pain Management Center.
Leong sees pain management as a three-legged chair. The first leg is the non-addictive painkillers. The second leg, if needed, would be neuromodulation, in which an embedded device sends electrical pulses that interrupt or mask pain signals that travel to and from the brain.
The third leg requires coaching patients to respond to their pain differently, making it bearable. You might see a cognitive behavioral therapist, work with a biofeedback machine, or explore a kind of therapy called GMI, for graded motor imagery. Pain is an experience in the brain, and your brain can be retrained. For example, you might put a painful hip inside a mirror box — and move your other hip, without pain. In the mirror you’ll have the illusion that the painful hip is moving, but experience no pain. Over time, your brain may stop associating movements of the painful hip with pain.
“Only when these approaches have been exhausted should opioids be considered as a treatment option,” Leong argues.
The imagery treatments may work best combined with electric stimulation, according to some research. In a small study, 81 percent of participants in the experimental group with complex pain syndromes showed a clinically meaningful reduction in pain severity after six weeks, compared to 27 percent in the sham group. The experimental group received standard GMI for six weeks and a particular form of electric stimulation for five consecutive days, followed by once-a-week stimulation for four weeks.
When you talk to your doctor you’ll probably be asked to rate your pain on a scale of one to 10. Instead, consider using a quality-of-life scale, which you can print for reference. In this scale, zero corresponds to “stayed in bed all day,” 4 means “Do simple chores around the house. Minimal activities outside of home two days a week,” and so on, up the scale. Concrete information on how your pain is affecting your life may help your doctor see alternatives.
September 01, 2016
Janet O’Dell, RN