Over the past several years, stories on the opioid crisis in the US filled the media. The statistics regarding opioid-related overdose deaths remain dismal. In the past, great pressure was placed on physicians to treat pain. Currently, we face even greater demand to alleviate pain without the use of opioids.
Now that the issue of opioid abuse and related deaths stands in the spotlight, politicians, healthcare experts, and the American public weigh in with their views on how to solve this epidemic. The solution, however, does not seem that it is going to be an easy one. In fact, of over 1,000 doctors (verified US MD’s and DO’s) surveyed in a joint study conducted by SERMO and Physician’s Weekly, only 13 percent, believe that there will be an effective response either by the healthcare community or the government. This number seems staggering in the face of the news we see every day about this public health emergency.
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Obviously, the roots of the issue are much deeper than just an over-prescribing habit of these medications by physicians. The fact is, America has a problem with pain that is not going away any time soon and the longer we fail to face it, the more difficult it will be to uproot the problems that are anchoring this crisis in place. Despite the fact that all doctors understand the growing problem of opioid abuse and addiction, many of us need to do a better job treating pain.
What contributes to America’s problem with pain?
– Unrealistic expectations. Many patients want that magic pill to fix whatever ails them. The truth is that many conditions may never be rendered pain-free. Some degree of pain may actually be beneficial, such as during physical therapy when a patient needs to learn their limitations or when exercising and a patient needs to know he/she is doing something wrong.
– The nature of pain. We all learned the pain scale and how to use it to determine the degree of pain a patient may be experiencing. However, this scale is very subjective and can be quite misleading. One patient may be sitting comfortably with back pain rating it a ten out of ten while another patient may be rolling around weeping with a broken shoulder rating it an eight out of ten. Who is really having more severe pain? We need a better tool to rate pain.
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– Lack of physician training. Yes, we all know there are many “pain medications” available. Yet, there are many more treatment options available, such as corticosteroid injections, plasma rich platelet therapy/stem cell injections, percutaneous tenotomies, peripheral nerve stimulators, etc., that many of us don’t know how to use. In addition, there are newer abuse deterrent opioids on the market which many physicians have not even heard about.
– Unaffordability of treatments. Under our third-party payor system currently, it is simply much cheaper to take opioids than it is to try other therapies, such as physical therapy. If a patient gets pain relief with a cheaper alternative, what would motivate them to try something else? In addition, once a patient has been on an opioid for a long enough time, there is a certain degree of addiction that can occur in almost everyone. The fact is that pain medications only mask pain without addressing the underlying problem causing it. Until that dysfunction is corrected, pain will continue. Insurance companies need to step up and pay more for the options that fix the root of the problem.
– Stigmas around chronic pain. Patients with chronic pain often go untreated because of the stigma that they are automatically drug-seeking when they attempt to find pain relief. While this may be true for some, there are many patients that indeed suffer from chronic pain. In fact, In September 2018, the CDC released a report estimating the number of chronic pain sufferers in the US to be approximately 50 million people. As physicians, one of our responsibilities is to treat pain. The healthcare system must stop stigmatizing patients to prevent those who need help from receiving it.
– Clueless political rhetoric. Politicians have jumped into the game of solving the opioid crisis. New regulations are being devised and implemented in how physicians can prescribe opioids. Yes, we need to curb the number of opioid prescriptions out there. However, the politicians have offered nothing new in regard to what we do with the pain that is left. Patients are suffering. Regulating opioids is doing nothing to help these patients.
In the US, we have a very real problem with pain. We don’t possess enough tools to adequately treat it and those options that we do have are unaffordable for most. Politicians pass new laws without understanding the scope of the issue. The American culture itself contributes to the problem, making people believe there are easy fixes to complex problems and that no one should ever experience any pain. Legislation can help limit the number of pills prescribed, but it will never change the attitudes prevalent in our society that lead people to request opioids in the first-place. Our culture needs a strong dose of reality before we can make any headway in this crisis.
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