In the 1990s, prescription opioids were touted by the drug industry and began to be widely prescribed for the management of chronic pain. Despite pharma’s claim that these drugs were helping people, opioids have had a particularly insidious and detrimental impact, leading to the deaths of hundreds of thousands of people.
How did we get here?
It all started in the nineties (though the seed actually started with a letter to the New England Journal of Medicine in 1980) when pharmaceutical companies convinced physicians that opioids were a safe and effective treatment for long term management of chronic pain. In 2000, hospitals required medical staff to assess and manage pain itself as the “fifth vital sign” (along with body temperature, breathing rate, heart rate, and blood pressure). This regulatory measure convinced the medical community that it was necessary to eliminate pain quickly and keep it away. While opioids were clearly effective in getting rid of the pain fast, the lack of oversight of opioid prescribing allowed some patients to misuse their prescriptions or divert them to others who misused them.
Signs of an epidemic
The over-prescribing of opioids that started in the 1990s is now understood to be the first wave of the opioid epidemic. In 2011, the CDC declared an “epidemic” of overdoses of prescription opioids. Most of the overdoses between in the 1990s and early 2000s involved prescribed opioid analgesics.
Next, came the “second wave” of opioid overdose deaths, which started in 2010 and were more likely to involve the illicit opioid heroin. In 2013, the third wave began, and it continues to this day, with overdose deaths occurring because of illicitly manufactured fentanyl (which is 50 to 100 times more potent than morphine).
Between 1999 and 2019, almost half a million people in the U.S. died from an opioid overdose, and deaths from opioids continue to increase rapidly today. In 2020 alone, more Americans died from drug overdoses than died in car accidents and gun fatalities combined.
Why are opioids prescribed?
Opioids are sometimes indicated for the alleviation of severe acute pain, such as after a broken bone or a major surgery. However, they are often prescribed for chronic musculoskeletal pain. In fact, 63% of chronic opioid users report that they struggle with arthritis and 59% with back pain. Contrary to the thinking of the 1990s, we actually know now that opioids are not more effective for the relief of chronic musculoskeletal pain than non-opioid therapy, including acetaminophen, ibuprofen, and/or physical therapy.
It is the prescription of opioids for longer periods of time that can be problematic. In addition to not being especially effective for chronic pain, opioids dramatically increase individuals’ risks for falls, misuse (using opioids for non-medical purposes), or unintentional overdose (particularly when prescribed in high doses and/or in combination with other sedating medications). And, of course, unintentional overdose can lead to death. Furthermore, the presence of opioids in individuals’ homes exposes others to these same risks. “But what about addiction?” you might ask. Only about 8-12% of persons who are prescribed opioids will develop an addiction (called “opioid use disorder”). This number may seem small, but, given how many people are prescribed opioids for chronic pain, that is still thousands of people. Many patients who do develop an opioid use disorder will eventually transition from prescribed opioid analgesics to illicit pills to heroin/fentanyl, which puts them at much higher risk of unintentional overdose and death.
Tackling the opioid crisis and chronic pain
With approximately 50 million Americans suffering from chronic pain (around 20% of the adult population), not only do we have an opioid epidemic on our hands but also a chronic pain crisis. So, what do we do when the drugs don’t work and/or they are unsafe to use?
Holistic pain management offers a safe, sustainable, effective alternative to opioid analgesics for chronic pain. “Holistic” is an approach to pain that takes into account not only structural (i.e., bodily or physical) issues but also mental, spiritual, and emotional needs. Research shows that holistic, integrative treatment is the most effective approach for chronic pain. Despite the known efficacy and safety of holistic pain management, most health systems do not offer this multifaceted approach.
When it comes to musculoskeletal pain like arthritis of the knees or back, the CDC recommends using multiple behavioral, educational, and therapeutic interventions and exercises to manage the chronic pain instead of diving right into a treatment of prescription drugs. If a pharmacologic treatment is necessary, it strongly suggests using muscle relaxants or nonsteroidal anti-inflammatory drugs (NSAIDs) instead of opioids.
A holistic pain management plan might include therapies like yoga, massage, acupuncture, chiropractic treatment, guided imagery, hypnosis, cognitive behavioral therapy (CBT), weight and nutrition management, stress management, meditation, and biofeedback. A combination of these treatments (and others) can help to alleviate musculoskeletal chronic pain without the use of any pharmaceuticals.
How You Can Manage Chronic Pain Without Opioids
The evidence is clear that there are much safer, more effective ways for managing chronic pain than opioids. Although the idea of blocking pain receptors in the brain sounds appealing, opioids have substantial risks (including falls, misuse, addiction, overdose, and even death). So how do we cope with what can be debilitating pain in our daily lives? The answer lies in a holistic pain management care program that approaches your chronic pain from multiple angles. At Lin, we’ll pair you with a compassionate and knowledgeable health coach who will work with you to design and implement a customized care plan to tone down your pain. Lin delivers best-in-class care from the convenience of your home. Learn more today!