Pain: Are Narcotics the Answer?

Just back fro the annual meeting of the American Academy of Pain Management in Phoenix, AZ. It was a meeting well worth attending, with many experts from a variety of related fields sharing their knowledge and experience. Here is a very brief overview of some of the current issues in pain management.

Approximately 110 million Americans suffer from acute or chronic pain; of these 100 million suffer from chronic pain, which generally lasts more than 6 months. Examples of pain which can become chronic include sciatica, neck strain, myofascial pain, osteoarthritis, knee and hip arthritis, fibromyalgia and migraine headaches. The cost to the economy of chronic pain alone is more than 600 billion dollars a year, almost equally divided between actual medical cost and the cost of loss of productivity. According to an article in The Journal of Pain this is more than the yearly costs for cancer, heart disease and diabetes.

Many people have felt that the mainstay of treating chronic pain is narcotics. Some of the better known ones include Percocet, Vicodin, oxycodone and Oxycontin. But many others exist, Opana, Dilaudid, Duragesic (fentanyl), tramadol, Nucynta, and Butrans, to name just a few.

While the use of opioids is sometimes necessary, this should hardly ever remain the only mode of treatment (an exception to the rule might be the terminal cancer patient). Long term use of opioid medication frequently leads to opioid-tolerance and addiction, and sometimes to dreadful medical and legal consequences. Furthermore, long term use of opioids can, by itself, lead to an increased awareness of pain, where a person begins to have more pain without actually having a worsening of his/her physical condition.

Occasionally, pain becomes chronic because it was not immediately treated. There are numerous cases where pain was inadequately treated just because of a law suit, or just because an insurer refused to allow, delayed, or limited the treatment. Or maybe someone just decided to “drag the case.”

The answer to the treatment of chronic pain is simple in principle. It involves a multidisciplinary approach. There is no one treatment that fits all. Each patient must be individually evaluated, and a course of treatment designed. Treatment may involve one or more elements of physical therapy, massage therapy, acupuncture, chiropractic, yoga, nutrition and special diet design, psychologic/psychiatric support, drug counseling, and the use of non-narcotic medications.

And, yes, as the pain subsides, the use of opioids has to be adjusted. And if tolerance and addiction interfere, then these have to be carefully handled in order to help prevent relapses and uncomfortable narcotic withdrawal.

One great way to treat the opioid addiction is the use of Suboxone. Prescription of Suboxone is by special license. To my knowledge, I am the only internist between Darien and Bridgeport who is licensed to do so. For information about Suboxone click here.