There are plenty of new ways to treat chronic pain. It’s time to embrace them.
Officials nationwide finally appear to be tackling America’s opioid crisis. Last week, President Trump declared the epidemic a public health emergency, which will give states more flexibility in responding. A bill that would limit initial opioid prescriptions to one week is before the Florida state legislature. Maryland is making it more difficult to prescribe opioids, and Arizona is collecting data on the scope of the problem. These efforts are commendable. But they’re unlikely to bring an end to the crisis because they fail to address one of the opioid epidemic’s root causes — chronic pain.
Fortunately, there are plenty of new ways to treat patients suffering from chronic pain. It’s time to embrace them.
More than 100 million Americans suffer from chronic pain. The condition costs our country $635 billion every year in lost productivity and medical expenses. Over the last two decades, opioids have emerged as the default long-term treatment for chronic pain, largely because there has been little incentive to consider alternatives. Every Medicare plan, for instance, covers common opioids and does not require prior approval. Physicians can just write a prescription and provide their patients with immediate relief. But opioids are not indicated for all chronic pain problems. One comprehensive report from experts at six U.S. universities found that evidence of the long-term benefits of opioids is “scant” and that many opioid users “continue to have moderate to severe pain and diminished quality of life.” It’s no wonder that the Centers for Disease Control and Prevention recommends that opioids only be used for three days.
Yet prescription rates for opioids have skyrocketed, and the overall prevalence of chronic pain in the United States has stayed roughly the same.
Alternative means of treating chronic pain could break this stalemate. Take “interventional” pain therapies. These non-surgical procedures target the parts of the body that generate chronic pain — and thus could eliminate patients’ desire for opioids. Popular interventional therapies include the application of electric currents to nerve fibers; the injection of steroids or anesthetic into problematic joints, tissue, and nerves; or treatment with an electric spinal-cord stimulator.
Unlike opioids, these procedures are proven to provide long-term relief. In one study, three-quarters of patients who underwent a procedure that stimulated a specific part of the spinal column reported significant improvements in their level of leg pain over the course of a year.
Or consider another clinical study, of a device manufactured by Abbott* that stimulates the area of the brain that controls pain signals with electrical pulses delivered via the spinal cord. Chronic pain patients treated with the device saw their level of opioid usage stabilize or even decrease.
Doctors sometimes shy away from approaches like these because of pressure from insurers. Interventional therapies can be more expensive than pills initially, even if they’re more effective in the long run. So health plans often discourage their use, typically by classifying them as “experimental” and therefore providing little or no reimbursement. Some insurers even require doctors to first administer the popular opioid oxycodone before considering an interventional procedure.
That’s the wrong approach. The only way to solve the nation’s opioid crisis is to treat chronic pain effectively. By embracing interventional therapies, doctors can do just that.
-Peter Staats is chief medical officer of National Spine and Pain Centers, chief medical officer of Electricore, past president of the American Society of Interventional Pain Physicians, and past president of the North American Neuromodulation Society.