By John Prunskis
August 23, 2018 at 5:00 am ET
It is no secret that the opioid epidemic has destroyed families, torn apart communities and taken countless American lives. According to the Centers for Disease Control and Prevention, more than 200,000 people died in the United States from overdoses related to prescription opioids from 1999 to 2016, and more than 40 percent of all U.S. opioid deaths in 2016 involved a prescription opioid.
Acute pain and chronic pain impact millions of Americans every year, and back pain is the leading cause of disability in Americans under 45 years old. Persistent pain, especially neck and back pain, leads to lower workforce productivity, physical and emotional distress and other health complications. This poses problems for all Americans, including veterans, retirees and workers in applied trades.
Over the years, medical research has proven that prescribing opioids alone doesn’t fix the problem. One 2015 article published in the journal of Anesthesiology and Pain Medicine summarizes it best: “Opiates [for lower back pain] do not have much convincing evidence and compared to interventional therapies, they have fewer efficacies not only in controlling pain but also improving function.”
Another study published in 2011 in Pain Medicine examined over 4,200 epidural injections performed in nearly 2,000 patients. In the course of this seven-year study, not a single patient encountered serious complications from their procedure. In another study published in the 2012 Journal of Pain Research, nearly 80 percent of patients who received lumbar interlaminar epidural injections experienced significant pain relief and improvement of bodily function.
Rather than simply reducing opioid prescriptions to patients, we need to encourage multifaceted treatment regimens that use non-opioid alternatives when possible to alleviate pain. These include interventional pain management procedures, physical therapy and, where necessary, non-opioid prescription medication and sometimes opioid medications in appropriate doses.
That’s why more Americans and their physicians are relying on epidural steroid injections, facet joint injections and other site-specific injections to relieve back and neck pain. During these interventional procedures, doctors precisely inject medication into the spine area. This allows physicians to reduce inflammation and locate the exact location of an individual’s pain, helping them to fix the problem rather than concealing it with an opioid medication.
When administered properly by a residency- and fellowship-trained physician, these procedures significantly reduce neck and back pain for patients who are suffering. These procedures are performed on millions of Americans every year with diagnoses of intervertebral disc herniations, spinal stenosis, arthritis, peripheral nerve problems and other disorders.
Unfortunately, there are some individuals who would rather we return to an era where opioids were prescribed as the main treatment for most painful conditions. For instance, occasionally an article surfaces that mischaracterizes the value and positive impact of interventional pain management procedures by focusing on how these procedures can, in very rare instances, lead to adverse complications for patients. Sometimes, these negative articles narrowly focus on one specific drug, a rare instance of complications or poorly trained physicians or providers. This perspective is unhelpful to patients seeking safe solutions to alleviate pain and disregards decades of medical research that illustrate the benefits of these procedures.
As we seek evidence-based methods to provide patients with the highest quality of care while also tackling an opioid epidemic, we must have a robust conversation about how to include pain intervention procedures. Physicians should promote safe procedures that provide relief to Americans suffering from painful conditions, and whenever possible, should fix the source of an individual’s pain rather than just masking it with opioids.
John V. Prunskis, M.D., F.I.P.P, is medical director at the Illinois Pain Institute, a clinical professor at the Chicago Medical School and a member of the Department of Health and Human Services’ Pain Management Best Practices Inter-Agency Task Force.
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