Chronic pain is real for millions of Americans, and those patients need help. But with a raging opioid epidemic in the United States, physicians and patients must be mindful and extremely cautious when prescribing opioids to treat pain. As primary care providers, our job is to assess the risks and benefits of opioid use on a case by case basis for every patient. We should recognize when opioids are needed while actively seeking alternatives when possible. Reducing our reliance on opioids requires awareness and education for providers and patients and a willingness to try new treatments instead of falling back on the same old solutions.
What Is Chronic Pain?
According to the Centers for Disease Control, chronic pain is pain lasting more than three months, beyond the period usually required for healing. Some of the causes include underlying diseases or conditions, injury, medical treatment, and inflammation, while other reasons are unknown. The CDC estimates that around 20 percent of U.S. adults experience chronic pain, with eight percent living with disabling “high-impact” chronic pain.
Why Are Opioid Medications So Problematic?
The risks of opioid abuse have become startlingly clear in the last decade. According to the CDC, opioid overdoses caused more than 70,000 deaths in 2017, and adults between the ages of 25 and 54 years old have the highest rates of opioid overdose deaths. In addition to the risk of overdose, opioid use disorder (also known as opioid addiction) is a problem of its own, preventing patients from leading full lives and diminishing their roles as parents and community members. Since prescriptions by primary care providers account for nearly half of the opioid prescriptions in America, primary care providers must have a clear understanding of the benefits and risks of opioid medications.
How Can Opioids Be Prescribed More Safely?
In addition to understanding and weighing the risks of opioid medications, primary care doctors should work to build relationships with patients. Getting to know patients helps doctors understand health history (including mental health), lifestyle and other factors that contribute to successful treatment. Taking the time to get to connect with a patient helps primary care providers develop treatments for chronic pain that will be safe and effective. Some of the factors to consider before prescribing opioids include:
- History of substance abuse
- Mental health profile including depression and anxiety
- Sleep apnea or other sleep disorders
Providers should take a close look at which medication will work best and review the dosage and length of use to avoid addiction or overdose. Primary care physicians should also work with patients to actively pursue alternatives to opioid medications when possible.
What Are the Best Alternatives to Opioids for Pain Management?
Getting to the root causes of chronic pain can help providers avoid opioid medications and find alternative treatments. For example, the CDC has linked chronic pain to mobility limitations and anxiety/depression. In many cases, tackling those issues head-on can bring relief without opioids. However, this sometimes means a more significant commitment from both patients and providers beyond merely swallowing a pill.
- Physical therapy is one of the best tools for combating or preventing chronic pain. A high-quality physical therapy program can help patients regain strength and relieve pain after surgery or injury or when dealing with a chronic illness. Your primary care provider can help you find a PT program that’s right for you.
- Behavioral medicine and counseling can help address the mental health aspects behind chronic pain. CDC research has established the effectiveness of Cognitive Behavior Therapy in managing pain and disability.
- Many patients benefit from alternative medicine practices, including therapeutic massage, acupuncture and other treatments. Be sure to talk with your primary care provider before trying an alternative therapy program.
- Something as simple as starting with a non-opioid medication following surgery or injury can prevent a vicious cycle of dependence. NSAIDs like ibuprofen can be highly effective in treating pain. Antidepressants can be useful in addressing chronic pain related to depression and anxiety.
- Taking steps to stay healthy is another critical way to avoid chronic pain and opioid dependence.
How Can Preventive Medicine Fight Chronic Pain?
Working to stay healthy and following up with routine primary care is one of the best ways to avoid chronic pain and the need for opioid medications. Exercise and good nutrition can help you feel better and boost your mood. Weight loss can ease painful pressure on joints and help patients feel better overall. If you need help with diet and exercise, your primary care physician is a great place to start. And be sure to schedule regular check-ups to catch any potential problems early and keep yourself on track for good health.
Can CPC’s Chronic Care Management Program Help with Chronic Pain?
Comprehensive Primary Care’s Chronic Care Management Services are available through Medicare to seniors with two or more chronic conditions. This program can improve pain management by working with patients in key areas like medication management and risk assessment, including fall prevention, behavioral health, home safety and nutrition.
Treating Pain at Comprehensive Primary Care
At CPC, our goal is to treat chronic illness and chronic pain with compassion and mindfulness while working for real results. Sometimes opioid medications are essential. So we work hard to find the correct medication, dosage and length of use while carefully tracking the patient’s progress. We also know the value of finding alternatives to opioids whenever possible. We encourage patients to leave their comfort zones and try new strategies as we work together toward an effective long-term solution.