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Chronic Pain, the Opioid Crisis, and Alternatives

September 1, 2017 • 3 min read
Summary

Opioids are frequently prescribed to manage pain, a condition that is becoming more and more common among Americans.

It is no exaggeration to call the increase in opioid overdoses and overdose deaths a crisis, as many policymakers and public officials have done recently in the United States. The number of deaths caused by opioid overdose has increased dramatically in recent years. In 2014, 28,647 individuals died from a drug overdose involving an opioid.

Pain Prevalence and Severity are on the Rise

Opioids are frequently prescribed to manage pain, a condition that is becoming more and more common among Americans. A 2015 analysis from the National Institutes of Health (NIH) found that most American adults have experienced some pain: chronic or acute, minor or severe: over 55% of American adults reported having had experienced at least some pain in the preceding three months. Based on 2012 data, the report indicated that 11.2% of American adults experience chronic pain, defined as pain everyday for three months, and 17.6% of American adults experience severe pain.

Recent data show that the number of individuals experiencing pain and that the severity of pain reported are increasing each year. This increase in prevalence and severity is most pronounced among individuals with lower levels of wealth and education. Indeed, a 2017 publication in the journal Pain found that “people with the least education are 80% more likely to experience chronic pain than people with the most.” The prevalence of pain is more common than cardiovascular disease, cancer, and diabetes combined, but remains an under-studied and poorly understood condition, affecting women, elderly adults, and low-income individuals at disproportionate rates.

Causes and Effects of Pain

The growing prevalence and severity of pain are surprising, given data from the Centers for Disease Control and Prevention (CDC) showing that, between 1999 and 2015, the amount of opioids sold in the United States nearly quadrupled. The increase in use of opioids might lead one to believe that the number of Americans experiencing pain would decrease, but that is not the case. Research including a 2011 study has suggested that the increase in reported pain might be due to the opioids themselves: that long-term use of opioids may increase pain sensitivity, rendering pain more severe. It has also been suggested that the increasing prevalence of overweight and obesity in the United States may contribute to pain particularly of the joints. While increased “wear and tear” on the joints due to weight gain may contribute to pain, a study published in August 2017 found that the prevalence of osteoarthritis, a leading source of chronic pain, has doubled since the 1950’s. The authors of that study suggest, rather, that the dramatic decrease in physical activity in the past century plays a major role in joint deterioration and, perhaps, resultant pain.

It should come as no surprise to healthcare practitioners and those of us who work in public health that individuals who experience pain, particularly severe pain, have overall worse health status. The 2017 study on demographics of individuals who experience pain and related interviews with the author indicated that, while previous studies showed that pain plateaus around age 60, new data shows that pain increases with age. Indeed, the researcher found that “pain predicts death,” so individuals who experience the most severe pain die sooner and are not included in future analyses of pain data. This phenomenon is known in epidemiology as a “harvesting effect” and makes longitudinal analyses of complex conditions like pain very challenging. The mechanism connecting pain and death remains to be determined, but may include the association of pain with other severe chronic diseases or with mental and psychological health outcomes and exposures.

Alternatives to Opioids for Pain Management

Adopting alternative pain management and alleviation strategies is crucial as policymakers, public health officials, healthcare providers, and patients seek therapies other than opioid painkillers. Understanding barriers to access to complementary approaches to pain management are crucial for healthcare providers, especially given the disparities in pain by socioeconomic status. A 2016 qualitative study of patients with chronic musculoskeletal and their healthcare providers investigated challenges associated with seeking pain therapies other than opioids. Issues such as cost, insurance coverage, availability of alternative therapies, and perceptions of how quickly pain relief should “kick in” are major barriers for the patients who may need pain relief and management strategies the most urgently.

The NIH’s 2015 report on the prevalence of pain found that complementary health approaches are common among patients who suffer pain. The most commonly used complementary health approach was natural products, defined as dietary supplements other than vitamins and minerals, which were used by 17.7% of patients. Deep breathing exercises, yoga, chiropractic care, and meditation were also in the top five most commonly used complementary therapies for pain.

It is clear that there is demand for alternative therapies for pain management among patients, policymakers, and healthcare providers. The concurrent health problems of chronic pain and opioid misuse can make uptake of alternative therapies like chiropractic care or acupuncture challenging, but makes them all the more relevant and important to improving the lives of individual patients and public health. Integrative medicine and cross-sector collaboration are crucial to managing this complex and multi-factorial condition.

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Grol-Prokopczyk H. Sociodemographic disparities in chronic pain, based on 12-year longitudinal data. Pain. 2017 Feb;158(2):313-322.

Lee M, Silverman SM, Hansen H, et al. A Comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011 Mar-Apr;14(2):145-61.

Penney LS, Ritenbaugh C, DeBar LL, Elder C, Deyo RA. Provider and patient perspective on opioids and alternative treatments for managing chronic pain: a qualitative study. BMC Fam Pract. 2016; 17:164.

Wallace IJ, Worthington S, Felson DT, et al. Knee Osteoarthritis has doubles in prevalence since the mid-20th century. Proceedings of the National Academy of Sciences of the United States of America. 2017 Aug.

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