Opioid Addiction and Prevention, Chronic Pain
Opioid Addiction and Prevention Chronic Pain
Support for Conservative Care
Treatment for back pain has come a long way. It was once believed that taking pain medication and getting some rest and relaxation were the best course of action for a bout of low back pain, but nowadays research and guidelines3 support first trying drug-free conservative options for pain management while remaining as active as possible during recuperation.
The epidemic of prescription opioid overuse, as well as research showing that even common over-the-counter pain relievers have limited effectiveness in relieving back pain4, has led several respected healthcare groups to recognize the value of a conservative approach to common conditions such as back pain.
Notably, the American College of Physicians (ACP), the largest medical specialty society in the world, updated its back pain treatment guideline in 2017 to support a conservative approach to care.3 Likewise, the Centers for Disease Control and Prevention released updated guidelines for prescribing opioids in 2016 that promote the use of nonopioid and nondrug alternatives first for the treatment of chronic pain.5 The Joint Commission, which accredits every major U.S. hospital, also recognizes the value of non-drug approaches to pain management by including chiropractic and acupuncture in its pain management standard.6
Beyond the risks of overuse and addiction, prescription medications that numb pain may also convince a patient that a musculoskeletal condition such as back pain is less severe than it is or that it has healed. That misunderstanding can lead to overexertion and a delay in the healing process, or even to permanent injury.
Conservative Care Costs Less
With high costs associated with prescription drugs, chiropractic’s conservative approach makes economic sense as well. One study found that spinal manipulation for neck and back pain was cost-effective when used either alone or combined with other therapies first.7 Another study, based on data from Washington state workers, found that 42.7 percent of people who visited a surgeon first for work-related back pain eventually had surgery, compared with only 1.5 percent of those who visited a chiropractor first.8
Pain serves an important function in our lives.
When you suffer an acute injury, pain warns you to stop the activity that is causing the injury and tells you to take care of the affected body part.
Chronic pain, on the other hand, persists for weeks, months, or even years. Some people, often older adults, suffer from chronic pain without any definable past injury or signs of body damage. Common types of chronic pain include headaches, low back pain and arthritis. Unfortunately, there is scant objective evidence or physical findings to explain such pain.
"All in Your Head"
Until recently, some doctors who could not find a physical cause for a person’s pain simply suggested that it was imaginary – “all in your head.” Now, emerging scientific evidence is demonstrating that the nerves in the spinal cord of patients with chronic pain undergo structural changes.
Psychological and social issues often amplify the effects of chronic pain. For example, people with chronic pain frequently report a wide range of limitations in family and social roles, such as the inability to perform household or workplace chores, take care of children, or engage in leisure activities. In turn, spouses, children and co-workers often have to take over these responsibilities. Such changes often lead to depression, agitation, resentment and anger for the pain patient, as well as stress and strain in family and other social relationships.
How is depression involved with chronic pain? Depression is thought to be three to four times more common in people with chronic pain than in the general population. In addition, 30 to 80 percent of people with chronic pain will experience some type of depression. The combination of chronic pain and depression is often associated with greater disability than either depression or chronic pain alone.
People with chronic pain and depression suffer dramatic changes in their physical, mental and social well-being—and in their quality of life. Such people often find it difficult to sleep, are easily agitated, cannot perform their normal activities of daily living, cannot concentrate, and are often unable to perform their duties at work. This constellation of disabilities starts a vicious cycle – pain leads to more depression, which leads to more chronic pain. In some cases, the depression occurs before the pain.
Depression
Depression associated with pain is powerful enough to have a substantial negative impact on the outcome of treatment, including surgery. It is important for your doctor to take into consideration not only biological, but also psychological and social issues that pain brings.
What is the treatment for chronic pain and depression?
The first step in coping with chronic pain is to determine its cause, if possible. Addressing the problem will help the pain subside. In other cases, especially when the pain is chronic, you should try to keep the chronic pain from being the entire focus of your life.
Stay active and do not avoid activities that cause pain simply because they cause pain. Avoiding performing activities that you believe will cause pain only makes the condition worse in many cases. The amount and type of activity should be directed by your doctor, so that activities that might actually cause more harm are avoided.
Relaxation training, hypnosis, biofeedback, and guided imagery can help you cope with chronic pain. Cognitive therapy can also help patients recognize destructive patterns of emotion and behavior and help them modify or replace such behaviors and thoughts with more reasonable or supportive ones.
Distraction (redirecting your attention away from chronic pain), imagery (going to your “happy place”), and dissociation (detaching yourself from the chronic pain) can be useful.
Involving your family with your recovery may be quite helpful, according to recent scientific evidence.
Feel free to discuss these or other techniques with your doctor of chiropractic. They can suggest some simple techniques that may work for you or refer you to another healthcare provider for more in-depth training in these techniques.
Signs and Symptoms
Some of the common signs and symptoms of chronic pain include:
- Pain beyond six months after an injury
- Allodynia – pain from stimuli which are not normally painful and/or pain that occurs other than in the stimulated area
- Hyperpathia – increased pain from stimuli that are normally painful
- Hypersensation – being overly sensitive to pain
Signs of major clinical depression will occur daily for two weeks or more, and often include many of the following:
- A predominant feeling of sadness; feeling blue, hopeless or irritable, often with crying spells
- Changes in appetite or weight (loss or gain) and/or sleep (too much or too little)
- Poor concentration or memory
- Feeling restless or fatigued
- Loss of interest or pleasure in usual activities, including sex
- Feeling of worthlessness and/or guilt
References:
- Rubin Dl. Epidemiology and Risk Factors for Spine Pain. Neurol Clin, 2007; May;25(2):353-71.
- Global Burden of Disease 2015: Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. 2016 Oct 7; 388:1545–1602.
- Qaseem A, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians. Ann Intern Med, 2017;166(7):514-530.
- Machado GC, et al. Non-steroidal Anti-inflammatory Drugs for Spinal Pain: A Systematic Review and Meta-analysis. Annals of the Rheumatic Diseases. Published online first, Feb. 2, 2017; doi: 10.1136/annrheumdis-2016-210597
- Centers for Disease Control and Prevention. “CDC Guideline for Prescribing Opioids for Chronic Pain,” 2016. https://www.cdc.gov/drugoverdose/pdf/guidelines_at-a-glance-a.pdf.
- The Joint Commission, “Non-pharmacologic and non-opioid solutions for pain management,” Quick Safety, August 2018. https://www.jointcommission.org/-/media/tjc/documents/resources/pain-management/qs_nonopioid_pain_mgmt_8_15_18_final1.pdf
- Michaleff ZA, et al. Spinal Manipulation Epidemiology: Systemic Review of Cost Effectiveness Studies. J Electromyogr Kinesiology, Oct 2012; 22(5):655-652.
- Keeney et al. Early Predictors of Lumbar Spine Surgery after Occupational Back Injury: Results from a Prospective Study of Workers in Washington State. Spine, 2013; 38(11):953-964.