Rapid Shifts In Prescribing Behavior
Due to the increased number of deaths related to opioid misuse, providers have become more cautious when prescribing opioids to patients. In fact, recent reports from the CDC estimated that 19% fewer opioid prescriptions were written in 2017 when compared to 2006 (1). Sadly, external legislative and societal pressures on physicians to curtail opioid-based pain management have left many patients in debilitating pain, which in the most tragic of cases, has lead to patient suicide (2).
The Dangers of Abrupt Tapering
While studies have shown that roughly 3.3 million Americans misuse opioids, the vast majority of patients who use oral opioids regularly do so for appropriate indications. Quite frankly, there is still a role for oral opioids in the realm of acute pain management, cancer pain management, and in some cases chronic pain management. I believe we are moving in the right direction with regards to decreasing opioid use, but regulation needs to keep in mind the severe consequences of abrupt discontinuation and rapid tapering of oral opioid medication.
Fortunately, regulators are aware of this unfortunate truth. In early April 2019, the FDA released a memo warning physicians of the dangers of abrupt tapering off of opiods: (link)
Our goals as a society should be to:
- Prevent inappropriate prescription of opioids when more conservative and effective means exist;
- Adequately explain and educate patients about how to manage pain without oral opioids; and
- Carefully manage and support patients who still require oral opioids for treatment.
Oral Opioid Alternatives
Many patients who require chronic oral opioids have never been told about minimally invasive therapies such as spinal cord stimulation, nerve ablation, and intrathecal pain pumps for pain management. Similarly, physical therapy and mental coping strategies for pain such as neuromuscular reeducation, cognitive behavioural therapy, and acceptance commitment therapy are rarely discussed with patients.
For those who have been prescribed opioids due to a severe pain condition and have found alternative treatments unsuccessful, there is hope. Physicians who have specifically trained in pain management can create custom treatment plans and provide appropriate guidance so patients don’t have to rely on oral opioids. And if it is the case that oral opioids are required, they can help patients understand how to appropriately use these medications to avoid unanticipated misuse.
What Can You Do?
If you are someone who has required opioids to manage your pain and are having significant functional difficulty, seeing a dedicated pain specialist may change your life. There are dozens of great physicians who deeply understand just how hard life is for patients in chronic pain. If you’re interested in learning about the multitude of ways to treat pain, you may have never been told, talk to a PainTheory care coordinator today to get connected with an advocate who can help you navigate your journey to pain relief.