Addiction and overdose related to opioid/narcotic medications — like Vicodin, Percocet and Oxycontin — are epidemic in the United States. As a result, doctors are feeling pressure to prescribe fewer painkillers, and patients are feeling pressure to reduce their usage.
Does that mean patients with chronic pain will no longer get the medication they need? Not necessarily. But it might mean you should be considering safer pain treatments and adopt a new workout routine. Multiple studies show that low-impact exercise, such as yoga and walking, is more effective at reducing chronic pain than other therapies.
Approximately 40% of older adults live with chronic pain caused by complications like arthritis, cancer, surgery and injury. It’s a leading cause of disability. For most people, standard over-the-counter medications are just fine for relieving their pain. But when Tylenol and ibuprofen aren’t enough, opioid pain medications are often a doctor’s drug of choice to help their patients feel, move and heal better.
The Decade of Pain Management
Opioids used to be reserved for severely painful conditions such as cancer, broken bones or surgery. But in 2001, pain management modalities shifted gears in a big way when the US Congress declared the next ten years to be The Decade of Pain Control and Research. Hospitals and physicians were motivated to adopt “no pain” initiatives and keep patients as pain-free as possible. Opioids were prescribed more frequently and at higher doses than ever. Today, they’re the most commonly prescribed class of medications in the US.
With record numbers of pain prescriptions came record numbers of opioid-related deaths. The Centers for Disease Control (CDC) says that 28,000 people died from overdoses in 2014, more than any other year on record, and quadruple what it was in 1999. Three out of five overdoses involved opioid pain medication.
Safer Guidelines for Pain Management
In March 2016, in response to this crisis, the CDC issued new guidelines to educate physicians and patients about risks for opioid abuse, misuse and overdose, and to ensure patients get the safest, most appropriate and effective pain management treatment possible. The guidelines are intended to help primary care physicians evaluate how they prescribe opioids and give serious consideration to getting long-term patients to reduce their doses or quit altogether.
“Opioids are fantastic short term for a few hours or days, but certainly no more than a week,” explained Anna Lembke, MD, Chief of Addiction Medicine at the Stanford University School of Medicine. “The fundamental problem is that the body’s neurologic system adapts to their presence and the drugs essentially stop working. That happens to almost everybody, some people faster than others. That’s why long-term opioid users need more medication to get the same relief.”
Lembke goes on to explain that if patients reduce or quit their dose, the body rebels with opioid withdrawal symptoms, which can be extremely uncomfortable. “One of those symptoms is full body pain, which we call opioid withdrawal mediated pain,” said Lembke.
“In the long term, these opioids aren’t really treating the underlying pain. They’re treating withdrawal symptoms from the last dose. When patients can go off their opioids, they initially feel increased pain, but once they recover from withdrawal symptoms and the hyper-sensitivity to pain that opioids cause, their pain levels go way down.”
Opioid Dangers for Older Adults
Older patients need to be particularly careful with opioids because they can contribute to significant cognitive dysfunction, depression, hormonal imbalances and mobility problems, even at low doses.
They can also cause death if they slow down a person’s breathing and heart rate too much. Lembke hopes the new CDC guidelines will get patients to access non-narcotic pain management modalities that include safer medications, physical therapy, massage, acupuncture and treatments that address the underlying disease or injury that’s causing pain.
Are the New CDC Guidelines Going to Help?
Edward Michna, MD, an anesthesiologist and pain management specialist at Brigham and Women’s Hospital in Massachusetts, thinks the new guidelines place undue stress on too many patients and physicians.
“The guidelines are a reactionary response to the opioid healthcare crisis, but they’re not evidence based,” explained Dr. Michna. “They’re being utilized inconsistently all over the country and they’re missing a lot information. We don’t know how many patients abuse their medications. Some do, certainly, and addiction exists in about 10% of the population. But we don’t know which patients will transition from appropriate use to abuse. Most patients probably won’t.”
Dr. Michna says that regulating the drug and enacting laws can cause secondary, unintended consequences that may do more harm than good. “What happens when patients need those medications in order to function?” Michna asked. “What happens when their primary care physician feels pressured to stop prescribing and they can’t find another doctor?”
While Lembke and Michna have differing opinions, both agree that the best advice for opioid users is to use the lowest dose possible for the shortest period of time, and consult with an expert when your condition requires a long-term prescription.
How to Get Help for Pain Management
A pain management specialist is essential, but so are doctors who specialize in treating whatever condition is causing your pain.
- Talk with your primary care physician about how opioids affect your pain and health and how new guidelines will affect your prescription.
- Consult a hospice or palliative care specialist for extreme pain or end-of-life circumstances. The new CDC guidelines do not apply in these conditions.
- Ask a rheumatologist, oncologist, neurologist, physical therapist or other specialist about safer, pain-relieving medications and therapies.
- Consult a nutritionist and improve your diet.
- Consider alternative therapies like meditation, naturopathy massage and acupuncture.
- Exercise daily. See your doctor and fitness professional for safety guidelines.
Most importantly, if you know you’re taking more pain medicine than you should, take the step that could save your life — ask for help.
Talk to a family member or your doctor, or call the Substance Abuse Mental Health Services Administration National Hotline at 1-800-662-HELP (4357).
