It is estimated that 100 million Americans suffer from long-term pain. That’s nearly one-third of the U.S. population. Since the 1990s, physicians have actively prescribed opioids such as oxycodone or hydrocodone to reduce or eliminate constant pain. But there is actually no evidence that opioids help with long-term pain — and yet we still face an epidemic of over-prescription and over-reliance that has led to a national crisis of misuse, overdose and death. Politicians and health care providers are working to end the cycle of addiction and abuse, but the question stands: what can we do right now to manage pain and still reduce the need for opioids?
What alternatives can prescribers and insurers offer?
The Centers for Disease Control’s 2016 guideline for opioid prescribing directs doctors to try non-drug treatments, such as physical therapy and talk therapy, as well as non-opioid treatments before considering opioids. Opioids address pain by blocking the receptors in nerve cells from continuing to transmit pain messages from the body to the brain. In addition to reducing the person’s experience of pain, they also cause pleasurable feelings that make people want more opioids. And they slow breathing, which is why overdoses can kill.
A study in the Journal of the American Medical Association suggests that opioid drugs are no more effective than a combination of non-opioid painkillers in treating acute pain. The U.S. Department of Health and Human Services (HHS) also released a “National Pain Strategy” in 2016 that emphasized many of the same points. The HHS document also called for an approach to treatment that would include mental health, social and work concerns of the patient, and alternative therapies.
Exercise, physical therapy and even talk therapy have proven beneficial in making the body work better and increase the body’s ability to cope with pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are medications usually considered to be the first line of defense for acute pain, especially pain that doesn’t respond to non-drug treatments. NSAIDs also lower fevers and reduce inflammation. Some common examples of NSAIDs are ibuprofen or naproxen, and they’re available over the counter (OTC) or by prescription. But long-term use of NSAIDs can lead to gastrointestinal upset and bleeding, and may increase the risk of heart disease and stroke.
This is the active ingredient in many over-the-counter medications that addresses acute pain like headaches. It’s also found in combination medicines like those for cold and flu. It doesn’t cause stomach or heart problems like NSAIDs, but misuse can lead to liver damage.
Antidepressants is an umbrella term for a medicine used to treat the symptoms of depression. A specific type of antidepressant, Norepinephrine and dopamine reuptake inhibitors (NDRIs), like bupropion has shown promising effects in lessening pain in some people, especially pain caused by nerve damage.
Anticonvulsants such as topiramate, baclofen, selegiline, and vigabatrin are used to address symptoms and conditions like epilepsy, muscle spasms and Parkinson’s disease. Currently, they are being assessed by the FDA for possible use in the treatment of addiction. Some patients have experienced a reduction in pain, while others have received no benefit at all.
Steroids can decrease inflammation, swelling and pain to treat both acute and chronic pain. They are used to treat pain in patients with arthritis, back injuries, nerve pain and cancer. But steroids can cause side effects like swollen feet or legs, high blood pressure and a weakened immune system. Taking low doses short-term and using injections and creams just at the site of pain (instead of pills) can help reduce side effects.
Organizations from the American College of Physicians to the U.S. Department of Veterans Affairs to the Centers for Disease Control and Prevention recommend non-drug treatments as the first course of action for chronic pain. Examples include:
- Physical therapy
- Talk therapy (e.g. Cognitive behavioral)
- Relaxation therapy (e.g. Mindfulness techniques)
It is important to consider each person’s unique experience of pain when discussing solutions around pain management interventions, as effectiveness can only be achieved once root cause is understood. Each of these options has various levels of research and case-by-case testimonial support backing them for people living with chronic pain. What does appear clear is that there are pain management options outside of an opioid prescription that people can be asking about when meeting with their doctors.
Promoting safety and offering education
Preventing the need for any kind of pain management, including opioids, is certainly one key way to fight the opioid crisis. If you don’t need them, you won’t have to take them.
Make an active, focused program to promote workplace safety a priority. Your program may include everything from safe use of tools and machinery on the plant floor, to standing desks to avoid the negative results of too much sitting, to innovative ways to eliminate repetitive stress issues.
Giving employees information on the damage opioids can do and what kind of alternative therapies are available can also help keep them free from addiction or side effects.
Work with your health care providers and insurers, as well as your employees, to find ways to fight long-term pain with a combination of treatments that avoid over-reliance on opioids.
Opioids can still be useful drugs when prescribed properly and monitored carefully. But everyone involved in helping to manage pain — including the employee — needs to look carefully at alternative therapies before making opioids the primary approach.
Find out how Marsh & McLennan Agency can help
If you have specific questions about dealing with the opioid crisis, creating effective plans to handle it, or if you’d like more information about how MMA risk management or claims services can help, contact your local Marsh & McLennan Agency representative.
Read Part One of the series, A Serious Societal and Business Issue
Read Part Two of the series, Opioid Addiction in the Workplace: Managing Behavior Versus Fighting Addiction
Sign up now for the MMA Seminar in the Twin Cities area: The Opioid Epidemic: A Public Health Crisis