Congress Must Consider Inextricable Association Between Pain, Opioid Addiction

Last week concluded Pain Awareness Month, a time when various medical societies, medical professionals and patient advocacy groups across the country worked together to raise public awareness about pain and pain management.

This year, I called on my colleagues, patients and legislators to consider the inextricable association between chronic pain and the chronic opioid epidemic that continues to plague communities throughout America.

While there is no shortage of publications attempting to prescribe solutions to limit opioid addiction and opioid-induced overdoses, most reports fail to analyze the very reason patients are seeking powerful prescription medication in the first place: pain. Chronic pain is a very real and legitimate condition, even a disease of its own right. While opioid addiction and chronic pain should be viewed as two separate problems, it is important to recognize that there are overlapping solutions and that many acute and chronic pain patients are on opioids because they do not have access to more-effective treatments and procedures.

According to the National Institutes of Health and the Institute of Medicine, 25 million American adults experience pain every day, with over 100 million suffering from chronic pain every year. Severe pain creates immense emotional and physical distress for individuals in our most vulnerable communities, including veterans and those with disabilities. In fact, a recent report in the Annals of Internal Medicine shows that the percentage of suicides related to pain have increased considerably in the last decade: from 7.4 percent in 2003 to 10.2 percent in 2014.

Thus, it is evident that we don’t just have an opioid problem in America — we also have a pain problem. While Congress has taken important steps to limit opioid over-prescription and increase funding toward opioid treatment and prevention, including passage of the Comprehensive Addiction and Recovery Act in 2016, we need to do more to alleviate pain before doctors and patients resort to opioids. In other words, we should expand safe and effective non-opioid treatment options for patients in pain and should incentivize physicians to make non-opioid procedures efficient and affordable.

For this reason, I am encouraged that the U.S. House of Representatives recently passed a bipartisan bill to encourage non-opioid alternatives for Americans facing severe levels of acute and chronic pain. Led by Congressmen John Shimkus (R-Ill.) and Raja Krishnamoorthi (D-Ill.), the Post-Surgical Injections as an Opioid Alternative Act restores Medicare reimbursements for safe non-opioid interventional pain procedures that help Americans suffering from pain, typically in the neck and back.

These procedures, which include epidural steroid injections and facet joint injections, require physicians to locate the source of an individual’s pain rather than masking the problem by solely prescribing opioids. Numerous studies have proven that these interventional procedures help over 70 percent of patients relieve 50 percent or more of their pain. The research also suggests that patients who receive injections are much less likely to undergo costly surgeries. It should come as no surprise that this legislation is supported by both medical societies and patient advocacy organizations, such as Hope United and Friends of Recovery — New York.  

There has never been a more important time to debate this issue. At the end of September, Congress passed H.R. 6, the SUPPORT for Patients and Communities Act, a comprehensive legislative package that offers several solutions to decrease the number of overdose deaths caused by opioids.

While this was a monumental step in the right direction, it was not enough. To improve conditions for the millions of Americans suffering from severe pain, and to decrease America’s growing dependence on prescription opioids, it is imperative that Congress implement bipartisan reforms to incentivize non-opioid medical alternatives. Congress must enact H.R. 5804 and similar provisions into law and must begin talking about pain as a key driver in the opioid epidemic.

To date, patients, physicians and elected officials have taken several important steps to address many of the fundamental flaws in how we prescribe and administer opioid medication. Yet, in 2017, nearly 50,000 Americans died from overdose deaths involving opioids — a 4.1-fold increase compared to 2002 — and more than 40 percent of these deaths in 2016 were caused by prescription opioids, usually from illegitimate prescriptions, mixing multiple medications, taking alcohol with medications, and counterfeit medications.

This problem starts and ends with how we treat pain, and our civic and academic discourse must reflect this reality if we are to implement meaningful reforms in the future.


Dr. Jay Joshi is the CEO and medical director of the National Pain Centers and a nationally recognized, double board-certified and fellowship-trained anesthesiologist and interventional spine and pain management physician. The views reflected here do not necessarily represent those of the National Pain Centers.

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