January 31, 2017

Medication, Minfulness and More Alternatives to Opioids for Treating Pain

How alternative treatment options can be more effective and less dangerous while easing chronic pain

By Kylie O'Brien

Pain is the most common reason people seek medical care, according to the National Institutes of Health.

“The prevalence of chronic pain in the U.S. is difficult to estimate, but its impact is profound,” says Daniel Berland, M.D., clinical assistant professor of medicine at Michigan Medicine. “One hundred million Americans suffer daily pain symptoms, and chronic pain is the leading cause of long-term disability in our country. These numbers will only increase as our population ages, amplifying the need for effective, accessible interventions to manage chronic pain and preserve function.”

One common treatment for pain is the use of opioid medications. But these come at the cost of potential worse pain and function, plus dependence or addiction. Opioids sometimes do more harm than good.

“There are a number of patients who have opioid-induced hyperalgesia, or an increased sensitivity to pain,” says Ronald Wasserman, M.D., assistant professor of anesthesiology, service chief for pain medicine and director of the University of Michigan Back and Pain Center. “With hyperalgesia, patients are on a higher dose of opioids but not responding. These patients tend to have more widespread pain, and the opioids are actually causing the increase and spreading the pain. This process and understanding of these brain mechanisms is poorly understood.”

“Clearly we have an opioid epidemic in this country, so our goal for patients is to ease pain and help get them off these high-dose opioids that could actually be causing them more pain.”

The evidence showing opioids to be effective in the treatment of chronic pain is lacking, Wasserman adds, yet numerous studies indicate the significant risks associated with the drugs.

Because of this, Wasserman and Berland, both part of the University of Michigan Comprehensive Musculoskeletal Center, use intervention techniques that do not include prescribing opioids.

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