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9 Articles in Volume 17, Issue #9
Can Physiological Profiles Affect Pain Treatment?
Editorial: Moving Forward from Trump's Opioid Declaration
How Might Pain Practitioners Best Offer Patients Relief Without Pharmacology?
Letters to the Editor: An opportunity to learn what is on the minds of your colleagues and patients
Lumbar Lordosis and Back Pain
Oxytocin, an Opioid Alternative, Ready for Regular Clinical Use to Manage Chronic Pain
Pain, Sleep & Suicide: The Core Role of Interventional Care
Spiritual Factors Impacting a Patient’s Ability to Cope with Uncertainty (Part 3)
The Inter-Connection between Smoking and Opioid Misuse

Editorial: Moving Forward from Trump's Opioid Declaration

The recent declaration of opioid addiction as a national public health emergency addresses some key issues but misses the point on others. Practical Pain Management attempts to fill in the holes and help pain care providers meet their patients' needs.

While the nation is inundated with headlines about the opioid addiction crisis, Practical Pain Management (PPM) would like to examine some of the crucial factors missing from the discussion. When policy leaders focus on opioids as “dangerous and horrible” drugs,1 they are ignoring the millions of patients with chronic pain who rely on prescribed opioids, and who are not only compliant with their medication but are also high functioning and nearly pain-free in their day-to-day lives. These patients are able, against challenging odds, to regain a meaningful lifestyle thanks, in large part, to their pain medications and to thoughtful and effective care from their physicians. These individuals are patients seeking relief from long-term, severe, and intractable pain; they are not drug addicts.

Debate or Diatribe?

In many ways, the debate over opioids has become a politically driven effort rather than a purposeful conversation involving all relevant constituencies. While the issue plays out on Capitol Hill and in doctors' offices across the country, patients with valid chronic pain conditions are terrified about how they might be expected to manage their pain going forward,2 practitioners have become fearful of prescribing opioids even when they know it may be beneficial, and bio/pharmaceutical manufacturers are redirecting efforts toward alternatives that fit the unfounded and growing “avoid opioids at all costs” mentality.

Capitol HillPolicymakers should consider all sides of pain care management before moving forward on opioid prescribing limitations.

Take a look at some of the key points made by the President in his October 26 declaration of opioid addiction as a national public health emergency,1 and the tragic missed opportunities for moving forward:

In the last year, more than 11 million Americans “abused prescription opioids”1 
The missed opportunity: PPM acknowledges that this statistic is alarming, that sources of illegal or synthetic street opioids should be halted, and that many individuals do need addiction treatment. The country also needs to acknowledge, however, the 100 million individuals3 that are in chronic pain, caused by conditions ranging from diabetes and cancer to nerve damage and joint inflammation, the majority of whom are not misusing their opioid prescriptions. Policymakers are urged to pay attention to the underlying factors that may lead to abuse, including: a lack of information about opioid alternatives, unclear procedures for identifying patients who may have a tendency to misuse, providers who may overprescribe, and individuals who may seek out illicit opioids when their insurance will not cover the medication prescribed by their physician. There is also a lack of media coverage on the bio/pharmaceutical manufacturers who are working to responsibly promote safe and effective drugs—including opioids—that address significant areas of unmet medical need.

The opioid crisis includes the “families ripped apart and, for many communities, a generation of lost potential”1
The missed opportunity: Just as addiction can adversely impact an individual and family, proper medication use can also impact an individual’s home and work life—in a positive way. “Opioids have been demonstrated to help manage pain when other treatments have not offered sufficient pain relief,” explained Michael Barnes, JD, MIEP, managing partner at DCBA Law & Policy, LLP, and a former Bush staff member, at PAINWeek 2017.4

Forest Tennant, MD, PPM Editor-in-Chief, has further noted that “some chronic pain patients will always need a high opioid dose just like some people with diabetes may need a lot of insulin,” due to genetic and metabolic differences.5  The public must be made aware that prescription opioids may be managed safely and effectively by doctors and patients alike, ultimately providing functionality for individuals simply wishing to live normal pain-free lives. Their potential is just as significant as those who may abuse drugs.

Moreover, it is important to recognize that, when prescribed properly, opioids are only given to patients as a last resort. The 1982 World Health Organization’s Three-Step Analgesic Ladder calls for the use of non-pharmacologic measures and non-opioid pharmaceuticals as a first step.6  The WHO algorithm directs practitioners to begin with a weak opioid, leaving the more potent opioids to manage severe pain only when prior measures have proven ineffective.6It is erroneous to act as if every healthcare provider turns to the strongest opioids as a first-line treatment.

“Teach Young People Not to Take Drugs”1
The missed opportunity: Antidrug education, from a young age, has been a directive across the country for decades (eg, the “Just Say No” campaign of the 1980s, and the DARE campaign of the 1990s). President Trump’s suggestion that individuals simply be instructed not to drink or not to smoke in connection with opioids through “really big, really great advertising” is probably not the best use of federal funds to turn around the opioid epidemic. A more effective method, which has already been gaining support, is individualized patient education combined with integrative care teams. These approaches take into account a patient’s full behavioral and biopsychosocial history in order to implement the best treatment plan—including adequate, collaborative follow-up—for each patient.

In addition, new and continuing education programs, such as the University of Massachusetts’ Opioid Safe-Prescribing Training Immersion Medical School Program,7 for emerging and current pain practitioners, are paving the way for safe pain-relief and pain management approaches while deterring “rogue prescribers.”4 These programs, however, need financial and policy support to be accessible, if not required, for all healthcare providers.

The President’s call for an $81 million partnership to research better pain management techniques for veterans and a task force to develop and update best practices for pain management across the government1 is needed. In fact, PPM has relied on the Veterans Health Administration and medical specialists treating the armed forces, as one of the most reliable sources for sharing effective advances in pain care for many years.8

“A presidential commission” … “has consulted with experts across America to listen, to learn, and report back on potential solutions”1
The missed opportunity: We may all agree that collaboration is crucial indeed, but only when policymakers work “with the addiction community, and they with us, rather than being at odds in order to seek ways to permit responsible and reasonable access to opioids while preventing abuse,” stated Stephen J. Zeigler, PhD, JD, associate professor emeritus of public policy at Purdue University.4 Insisting that all players have a seat at the table will assure that best practices rather than politically expedient mandates are part of any future recommendations, he added.4 The Integrative Pain Care Policy Congress  has already set out in this direction.9

 

Understanding the Whole Patient & Sharing Best Practices Are the Way Forward

Practical Pain Management has served as the premier teaching journal for professional pain care providers across the United States for nearly 20 years. Our mission has been, and remains, to provide practitioners across the board – from primary care and osteopathic physicians to anesthesiologists and surgeons to physical, integrative and alternative therapists, to psychologists and pharmacologists – with the latest advances and best-in-practice strategies for helping to relieve their patients’ pain. We understand that our readers and contributors are on the front lines of pain management every single day. 

Pain practitioners are our boots on the ground when a person experiences long-lasting nerve damage, diabetic neuropathy, a traumatic accident that leads to amputation, cancer-related pain, age- or gene-related inflammation, musculoskeletal damage, chronic migraines, and so much more. They understand that their patients’ pain is real, because they are seeing the individuals who struggle to do things that people who are not in pain take for granted: sleep through the night, drive to work, pick up their toddler, or simply get out of bed. In today’s changing pain care landscape, these patients—100 million of them—are the ones caught in the middle of insurance coverage, regulations, and politics. 

“This is not the first war on opioids. Presidents from Nixon to Bush have been declaring a war on drugs, and yet, they have failed to distinguish between drug abusers seeking illicit street drugs and legitimate patients with unyielding pain who need treatment,” said Dr. Tennant. “It is time to focus on drug abusers, but not at the cost of the 80-year-old woman with diabetic neuropathy, or the many patients struggling with cancer pain, and their physicians who should not be hindered from delivering proper pain medication…. Any effort that precludes patient access to a full array of medical options, tailored specifically to the individual, including opioids, is irresponsible.”

PPM respects the passion that drives so many pain practitioners to care for their patients, and we are committed to helping them keep their primary goal in mind: lessening their patients’ pain and improving their quality of life. Undaunted by the dynamics at play nor the challenges ahead, we will continue to focus on what matters: helping pain practitioners deliver the best care to patients suffering from chronic pain. Acknowledging that every case is unique, the “best care” may range from opioid alternatives and integrative approaches to opioid treatment, and our journal will cover all effective options to arm our readers with the knowledge and tools they need to deliver the most effective care to their patients today and tomorrow.

By valuing patients as people and practitioners as professionals, our journal will not let misinformation or missed opportunities for moving forward get in the way of expedient coverage.

 

PPM welcomes your feedback on this topic. Please send your thoughts to the editor at ppmeditorial@verticalhealth.com or join the conversation online by accessing this article through your PPM user login. 

Last updated on: November 17, 2017
Continue Reading:
Letters to the Editor: Ehlers-Danlos Syndrome, Arachnoiditis

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