Pill Poppin’ Perils


Earlier this year, the Centers for Disease Control and Prevention (CDC) issued opioid prescribing guidelines that recommended rarity and brevity in opioid prescriptions in addition to prescribing as low a dose as possible. The Food and Drug Administration (FDA) followed up the CDC’s guidelines with a requirement for the strongest available warning, a black box warning, on immediate-release opioids. These warnings explain the significant risks these drugs pose for abuse, addiction, and death. Extended-release opioids already carried such warnings.

It’s a pivotal time for pain relief medicine. The most commonly used pain treatments in the US, opioid drugs, pose far too many risks to be widely used.

The cost of opioid prescription has been tremendous—from 1999 to 2014, 165,000 Americans have died from overdoses related to prescription opioids. Millions of other Americans have descended into the hell of addiction, which has taken a toll not only on their own lives but also on their families and communities.

In addition to the risks of opioid therapy, there is no scientific evidence that they benefit patients with chronic pain. The little research that exists, however, indicates that chronic pain patients who rely on opioids to manage their pain have more pain and disability and lower quality of life than similar pain patients who don’t use opioids.

There was more recent bad news about medication treatment for pain. In 2014, the FDA mandated black box warnings on all nonsteroidal anti-inflammatory drugs (NSAIDs) except aspirin, advising that chronic use for more than a few weeks significantly raises risks of death from heart attacks and strokes. Aspirin poses its own serious risks—3000 Americans die each year from gastrointestinal bleeding due to long-term use of aspirin. Even excessive use of acetaminophen puts patients at risk of liver failure, which is fatal without a liver transplant.

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This should be a time when the focus shifts to alternative medicine, including many therapies that are proven safe and effective for acute and chronic pain. These include acupuncture, biofeedback, chiropractic, exercise programs, herbs, low-level laser therapy, marijuana, massage, and mind/body interventions, including psychotherapy, nutritional interventions, physical therapy, and therapeutic touch.

The mainstream medical community, however, has other ideas. Most act as if alternative therapies don’t exist. Prestigious medical journals and respected publications such as the New York Times have printed articles suggesting that patients no longer be treated for pain, that patients be given placebos (since placebos often work), and even that patients no longer be asked about their pain instead of delving into alternative treatments.

A National Pain Strategy (a five-year plan to address the pain and opioid epidemics) quickly followed the release of the CDC opioid prescribing guidelines. Dozens of experts contributed to the National Pain Strategy, which was five years in development. Yet there was no acupuncturist, chiropractor, massage therapist, exercise physiologist, physical therapist, nutritionist, or naturopath on the panel. As a result, despite the enormous potential of alternative therapies to heal pain, these modalities were completely ignored in the proposed plan. Instead, an intensive five-year effort to find better pain treatments was recommended, as well as finding ways to “incentivize” doctors to provide better pain treatment.

Vague references are made in the plan about the more frequent use of physical therapy and psychotherapy without adequately addressing the fact that these therapies, while often effective for chronic pain, are either out of financial or geographical reach for most pain patients. More than 93 million Americans live in areas the federal government defines as mental health shortage areas, where there is less than 1 mental health provider per 10,000 people. Physical therapist shortages are growing, too, with the American Physical Therapy Association predicting a shortage of 40,000 therapists by 2020. Even where physical therapy is available, insurance companies have been allowed to severely restrict the number of visits they will cover and impose high co-pays.

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With the power to decide what pain treatments they will and will not cover, virtually all health insurance companies have elected to favor pharmaceutical and surgical treatments for coverage while looking the other way from splash damage caused to non-physician health care providers. They have done this by freezing fees paid to physical therapists, chiropractors, and psychotherapists for the past 35 years, imposing burdensome paperwork requirements, and restricting the length of treatment. Acupuncturists, massage therapists, nutritionists, naturopaths, and other alternative providers are rarely covered.

Meanwhile, chronic pain patients who have become dependent on opioids are being forced to reduce their prescriptions for opioids while being offered nothing to replace them. Many have multiple pain problems whose causes were never adequately addressed, and thus, their conditions have deteriorated significantly. Many have been harmed by multiple unnecessary and unsuccessful procedures, such as repeated back surgeries.

While some benefit from the myriad alternative medicine options available for pain treatment, the vast majority of the 100 million Americans who suffer from chronic pain are unable to. Most do not have the financial means to pay out of pocket for the multidisciplinary, extended treatment required to address chronic pain. Most do not have the breadth of knowledge necessary to select the best combination of treatments for their specific problems and need the guidance of a knowledgeable healthcare provider.

What we need is an intensive grassroots effort to ensure that everyone who can benefit from alternative medicine to treat pain gets appropriate information and has affordable access to these therapies.

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Please join me in demanding that President Obama and Congress pass legislation that requires doctors to be educated in alternative pain treatments and insurance to cover these treatments at a level that allows affordable access for pain patients and a sustainable income for health care providers.

Cindy Perlin

Cindy Perlin is a licensed clinical social worker, certified biofeedback practitioner, chronic pain survivor, and the author of The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free. // cindyperlin.com

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