According to recent research published in the journal Canadian Family Physician, family physicians in Canada continue to prescribe opioids because they have few other options to treat chronic pain. The authors argue that inadequate pain management resources and the marketing of addictive pain killers are responsible for the country’s opioid epidemic, reports the Ottawa Citizen. Overuse of opioids is an even more serious problem in the U.S., with overdose of pain killers responsible for more than 28,000 deaths in 2014. Of these, at least half were due to a prescription opioid.
The Canadian researchers maintain that family physicians have been wrongly led to believe that pain drugs are the first line of treatment for chronic, non-cancer related painful conditions before using other techniques such as physical therapy, occupational therapy, psychology and exercise. They recommend that the government should develop a system whereby family doctors can refer patients for such holistic pain management services that are covered by public insurance. This would reduce patients’ opioid dosage and enhance their quality of life, while helping to keep pain levels under control.
In the U.S., leading multispecialty centers in New York provide alternative treatments to help people cope with musculoskeletal pain. The focus is on employing pharmacologic, non-pharmacologic, and psychological approaches to manage pain. Alternative strategies include physical therapy, chiropractic care, spinal decompression, Transcutaneous Electrical Nerve Stimulation (TENS), radiofrequency radio ablation, injections and psychological counseling, as well as administration of anti-inflammatory and neuropathic medications such as analgesics, NSAIDs, and muscle relaxants. These centers focus on providing customized treatment based on detailed patient evaluations and also accept all private and government insurance plans.
Experts in physical medicine and rehabilitation stress that primary-care providers should be better educated about the availability and use of multidisciplinary approaches to pain management. The Canadian researchers even want pain management to become an essential part of the curricula in medical schools, for both undergraduates and specialists.
In its recently released guidelines for prescribing opioids for chronic pain, the US Centers for Disease Control and Prevention (CDC) highlighted the importance of physical therapy and other nondrug/nonopioid approaches as better and safer chronic pain treatment options compared to narcotic pain medications. The Joint Commission also encourages organizations to establish procedures that improve the assessment and treatment of pain without promoting the unnecessary or inappropriate use of opioids.