It’s still on the news regularly, and though the drug was initially supposed to be a solution for pain treatment, the opioid problem is showing little sign of slowing down. Opioid addiction and opioid overdose deaths are much more than statistics, but the numbers help underline just how serious the problem is. According to the Centers for Disease Control and Prevention, close to 42,000 deaths in 2016 were opioid related, and that number is five times higher than it was in 1999. Put another way, that’s about 115 Americans dying of an opioid overdose every day. Every day.
The problem began in the 1990s with an increase in the prescription of opioid drugs for pain treatment. Then, in 2013, fentanyl and its analogues, sold illegally, brought another wave of an increase in overdose deaths. The problem arises with just how powerful opiates are and how much they affect our brains. Think you’re immune? The fact is that anyone who takes prescription opioids can become addicted to them. The stats show that approximately one in four patients who are taking long-term prescribed opioid treatment are struggling with addiction. Furthermore, of those who manage to quit, many will experience relapses because changes in the brain can lead to cravings long after stopping use.
With close to two million Americans (26 to 36 million people worldwide) noted in 2014 to be either abusing or dependent on prescription opioid pain treatment medication, clearly there’s a huge problem at hand. It’s not only a U.S. problem either, with GPs in England having prescribed 23.8 million opioid painkillers in 2017—approximately 2700 prescriptions per hour—and being accused of creating drug addicts.
Healthcare providers recognize this problem and the challenge that comes with finding other pain treatment options. I’ve been to pain conferences where lecturers have emphasized the benefits and underplayed the risks associated with opioid prescribing. But many of us have friends or family members who have struggled with opioid withdrawal symptoms even months after quitting. Physicians will sometimes prescribe these powerful drugs to manage difficult pain, knowing they’ll need to deal with the addiction later.
What information should health practitioners gather when dealing with pain?
In a recent article in from the Academy of Integrative Pain Management, Dr. Jennifer Schneider, MD, and Dr. Stephen Schenthal, MD discussed their survey of 395 physicians who had taken a 21-CME remedial and proactive prescribing course, “Opioids, Pain, and Addiction,” between 2013 and 2016. They found several common errors in opioid prescribing, and from this we can learn how to improve opioid prescribing practice, as well as how to do better intake and assessment for all practitioners managing pain patients.
However, a shocking 31% of those physicians surveyed never or rarely ask chronic pain patients about their current level of pain, while 25% only sometimes asked. Make sure your practitioners ask about your current pain levels, and if I ever forget to ask, remind me!
The researchers also state, “There is a great need for not only familiarity with appropriate opioid therapy but also about the need for behavioral health and physical therapy integration into a holistic treatment plan which recognizes the complexity of pain.”
Dealing with the pain
While opioids are one powerful tool in pain treatment and management, they clearly come with serious risks, so the question then arises, how else can we treat pain effectively?
In 2017 the American College of Physicians put out new clinical guidelines for low back pain management. Since low back pain is one of the most common reasons for visits to the doctor in the U.S., it’s significant that medical doctors were advised, when possible, to treat low back pain with non-drug therapies, including acupuncture, massage, spinal manipulation, mindfulness-based stress reduction, exercise, superficial heat, and more.
Unfortunately, not everyone is on board with this. The British Medical Journal (BMJ) posed the question, “Should doctors recommend acupuncture for pain?” Answering that debate were Mike Cummings, medical director of the British Medical Acupuncture Society, for the “Yes” side, and Asbjørn Hróbjartsson and Edzard Ernst, from the Center for Evidence-Based Medicine, for the “No” side.
Hróbjartsson and Ernst state that “real” acupuncture is no better than “sham” acupuncture. Yet both are often better (with fewer risks and side effects) than a variety of other, more conventional, pain management therapies, including acetaminophen, NSAIDs, and even surgery. What’s even more surprising is that a systematic review of orthopedic surgeries found sham surgery just as effective as real. Yet, few question the “realness” of surgical interventions. Part of the challenge lays in the difficulty of creating a “fake” treatment for both acupuncture and surgery. Regardless, acupuncture has been shown to be effective and statistically better than sham acupuncture (or analgesic injections) for immediate relief of disease-related pain, chronic pain, and lasting pain relief.
It’s sometimes stated that there is no evidence to support acupuncture treatment, yet acupuncture continues to grow as a safe, efficacious, and cost-effective way to treat pain. Many in the integrative medicine community recognize this, and have specific patient stories to support it, but equally important is the growing body of evidence to back that.
Dealing with opiate addiction
What about those who have used opiates to help with pain treatment and management, but are now suffering from an opiate addiction? Because the fatal overdose rate is nearly double the national average for veterans, Veteran’s Affairs has been using acupuncture increasingly to treat both pain and opiate addiction. A recent update of their employee handbook shows that they’ve increased their opportunities for acupuncturists to work for them, that those acupuncturists must be board certified as acupuncturists (not weekend-course-taking needlers), and that they call acupuncture a “profession” instead of just a “modality.” For TCM professionals and acupuncturists, that’s a significant step in the right direction.
While it is not a complete treatment, the NADA (National Acupuncture Detoxification Association) protocol is a simple, but powerful, treatment that involves needling up to five acupoints on each ear and leaving those needles in place for 30-45 minutes. The treatment has been shown to help decrease cravings, body aches, headaches, and emotions of anger, anxiety, and depression, while increasing energy and concentration.
Pain Treatment is Complicated
While acupuncture is the most researched and talked-about component of Traditional Chinese Medicine, it’s certainly not the only component. TCM considers the whole person, not just the symptom, be it pain, addiction, or other. No person experiences pain or addiction without some emotional impact. Excepting the NADA protocol, there are no recipes of treatment protocols for treating a particular kind of pain or condition, and even the NADA protocol is only one part of a complete treatment plan.
Each person suffering from pain or addiction has a different personal and medical history, a different lifestyle, and different biology. Acupuncture alone may not be enough to turn a person around. A TCM practitioner may also employ herbs, supplements, dietary changes, tui na massage, lifestyle recommendations, or other treatment modalities.
Even better, when the case is complicated by severe pain and its many byproducts of addiction, depression, anxiety, insomnia, grief, digestive disorders, and more, is to work with an integrative team of medical doctors, massage therapists, nutritionists, physiotherapists, kinesiologists, counsellors, and so forth. It’s been recognized increasingly by major healthcare centers, the benefit of an integrative medical approach, as clinicians from a variety of approaches can better improve pain, function, and quality of life.
I’m really happy to see that some of the thought leaders in American healthcare are making greater use of complementary and integrative treatments, especially in the context of pain management,” said Bob Twillman, Ph.D., FAPM. “It’s always been true that, the more eyes you have on a patient, the greater the likelihood that you will be able to accurately identify existing issues, and these anecdotes reinforce that notion.
In some cases, it’s the hands-on therapists who identify previously undetected pathologies, as noted in a Mayo Clinic article involving licensed acupuncturists and massage therapists in clinic and hospital settings.
There’s no question that it’s time for integrative medicine teams to step forward to help manage pain and addiction and stop the tide of opioid overdoses.