The goal of chronic pain treatment is to maximize function while providing pain relief. There is a global epidemic surrounding chronic pain with its related disability, opioid use, and resulting fatalities. A report from the United Nations Office on Drugs and Crime states that 90% of global consumption of opioids registered in 2009 occurred in Australia, Canada, New Zealand, and the U.S. Also, the U.N. report illustrates that the U.S. population constituting 4.6% of world's population consumed 83% of world's oxycodone and 99% of the world's hydrocodone in 2007. Sales of opioid analgesics quadrupled between 1999 and 2010. The data also shows an increase from 96 mg of morphine equivalent per person in 1997 to 710 mg per person in 2010.
At Advantia Health, we recommend multimodal and multidisciplinary treatment. What does this mean?
When a physician uses a multimodal approach, they prescribe a combination of non-narcotic pain relievers, physical therapy, spinal injections, yoga, acupuncture, meditation, guided imagery, etc.
Multidisciplinary treatment means getting the appropriate specialist recommendation such as an orthopedic surgeon, spine surgeon, podiatrist, psychiatrist, neurologist, chiropractor, physical therapist, or other health professional for treating a patient’s painful condition.
Does a multimodal, multidisciplinary approach actually work?
Can we truly achieve better pain control and improve functionality through a multimodal, multidisciplinary approach? Yes, and here are some fun facts that support this approach:
- In a study from Denmark, where opioids were prescribed liberally for chronic pain, it was demonstrated that in patients receiving opioids, pain was worse, healthcare utilization was higher, and activity levels were lower compared to matched chronic pain patients who were not using opioids.
- In a study published in 2010 evaluating the role of opioids, it showed that the odds of recovery from chronic pain were almost 4 times higher among individuals not using opioids compared with individuals using opioids. Moreover, strong opioids were associated with poor quality of life and higher risk of death.
- Pain medications that are used strictly on an as-needed basis allow pain to escalate and require more medication for future pain control.
Here are some conclusions that we can draw from these facts:
- Opioids prescribed for chronic back pain may be effective for short-term pain relief. To date, however, there are no high quality studies that demonstrate any long-term efficacy of opioids after 16 weeks.
- There is no significant difference in effectiveness or adverse effects between long and short acting opioids.
- There is limited evidence for opioid rotation.
- Improvement in quality of life is fair with short-term opioids but limited for long term opioids.
Bottom Line: No Opioids Needed
Non-narcotic pain treatment can and should be a first-line approach. Multimodal, multidisciplinary treatment should be tailored to suit a patient's needs, and it may include interventional treatment with injections for pain relief, physical therapy, acupuncture, aquatic therapy, and even a regular exercise regimen, which can stimulate the body's natural pain relief system to release endogenous (produced naturally in the body) opioids, such as endorphins.
The path to true long-term relief from chronic pain is not through the use of narcotics.