The CDC has released new clinical guidelines for the treatment of chronic pain which is a significant problem for today’s patients. It is estimated that 14.6% of adults have chronic pain which is defined as pain lasting more than 3 months or lasting past the time it takes to heal an injury. Often, patients are given a prescription of opioids (also known as narcotics) to help control pain, which is known to work well for acute pain, but may not be as beneficial for longer lasting pain. What evidence does exist points to opioids doing much more harm than good when used for extended periods.
Chronic pain is most likely best treated with behavioral therapy (aimed at reducing anxiety, fear and depression associated with chronic pain), as well as exercise therapy and goal setting. It is important to realize that the primary goal of such therapy is to improve function. This means there will most likely always be some degree of residual pain.
Opioids taken for longer periods have been shown to have significant risks including:
- Slowing the respiratory drive to the point that breathing stops
- Increased risk of motor vehicle injury
(especially when treatment with opioids are first initiated, doses are increased, other depressants are used (ie. alcohol or benzodiazepines.))
Common effects associated with opioids include constipation, dry mouth, nausea, vomiting, drowsiness, confusion, tolerance, physical dependence, and withdrawal symptoms when trying to stop.
Most of the guidelines published here do not really offer much that is new, but rather stress how much good evidence there is for negative long term effects of these medications. The most interesting piece of new information that I learned in this guideline is how goal setting has been shown to significantly increase function and well being in those with chronic pain. I have seen this for myself though that patients who have a positive outlook and try to carry on despite their pain do appear to do better.
As an orthopaedic surgeon, I approach chronic pain from a holistic point of view. Specifically, I want to make sure that my patients who need treatment for underlying / concurrent depression get the help they need. In this type of case I will discuss the benefits of working with a mental health professional and a referral.
It has always been a priority of mine order to decrease the pain and need for pain medications. I will always try to find the underlying source of the pain and then proceed with the best combinations of treatments. For example with arthritis pain, I will usually try cortisone injections and physical therapy. It means more work for the patient and fighting through pain, but it can often lead to significant relief.
Ultimately though if all else fails, surgery might be an option. Through discussion of your goals and circumstances, we will always find the best individual treatments for you. Remember it is a process, it takes time, and there is almost never a ‘magic bullet.’ With time, patience, and hard work chronic pain can be managed without sole reliance on opioids.