My thoughts about opioid therapy

(Updated 09/09/2023)

My most recent article published in Practical Pain Management "We Have a Chronic Pain Problem, Not a Prescription Opioid Problem" explored the efficacy and safety of opioids for chronic pain as well as the need for more pain rehabilitation programs.

Below is some of the original content I submitted that didn't make the published version of the article which helps provide some additional context.

The rise of prescription opioids
In the 1990s and the next two decades, opioid prescriptions became the quickest and least expensive treatment option for chronic noncancer pain.

Their rise in popularity was due to a mix of factors, including:

• Good intentions to improve pain management.
• Pain is positioned as the 5th vital sign with a focus on pain intensity.
• Aggressive, if not, fraudulent pharmaceutical company marketing.
• incentives based on patient satisfaction.
• The desire for a quick and easy fix.
• The structure of our healthcare system and insurance reimbursement.
• A reduction of interdisciplinary pain rehabilitation programs.

With the increase in opioid use came an increase in opioid use disorders and opioid deaths.  Then came a hard push to reduce opioid prescriptions following the 2016 Centers for Disease Control (CDC) guidelines for prescribing opioids.

The 2016 CDC guidelines indirectly led to many chronic pain patients being forced to lower their medicine doses or to stop them completely. Often with little or no tapering and no alternative treatments offered or covered by insurance. Pushing patients to undergo invasive procedures like injections or surgery. And labeling patients as “addicts” for wanting pain relief. Which all led to increased tension between patients and providers, more patient suffering, illegal drug use, or, even worse, suicide.  

Opioid users don’t know what they don’t know – “try it, you may like it”
Unfortunately, there isn’t a crystal ball when it comes to pain treatment. There's no way of knowing how a patient will respond to any specific type of therapy. And tapering can be hard. Chronic pain patients can be weary of tapering opioids for fear of increased pain and the general fear of the unknown. 
 
Patients need to accept the possibility of worse pain and other symptoms during a taper. It’s also important for providers to remember to treat the entire person in pain and not just manage the taper.
 
Transitioning to self-management built around pain rehabilitation takes time. It’s a marathon, not a sprint, and requires work from both the provider and the patient. It’s like the old joke “How do you get to Carnegie Hall? Practice, practice, practice.”
 
Opioid treatment is a decision between the provider and patient
The use of opioids is a shared provider-patient decision based on risk and reward including the history and needs of the patient and should be applied on a case-by-case basis.
 
If the decision is to reduce or stop opioid therapy, tapering should be done with education about the benefits of opioid reduction and provider oversight. If the decision is to use opioids, they should be prescribed at the safest lowest dose. Either decision should include pain rehabilitation and self-management strategies.

Read my article for clinicians about transitioning from passive treatment to active self-management
​Read my blog post about pain rehabilitation
Find pain rehabilitation programs and self-management resources
Read about my experience at the 3-week Mayo Clinic Pain Rehabilitation Center
Learn more about opioids, pain management, and the Compass Opioid Stewardship Program
Listen to my Compass Opioid Stewardship program interview

Personal note
My chronic pain recovery started after I accepted the pain and stopped doctor-shopping to find pain relief and a medical cure (many praises for the Mayo Pain Rehabilitation Center). Through pain rehabilitation, I learned how to self-manage my condition. This process led me to stop the use of medicines including opioids, benzodiazepines, anticonvulsants, muscle relaxers, amphetamines, beta-blockers, antidepressants, and over-the-counter analgesics as well as other passive interventions like supplements and injections for my pain.