Opioid epidemic. What alternatives are out there?

Posted by on Mar 4, 2019 in Uncategorized | No Comments

According to the CDC on Drug Abuse, every day, more than 130 people in the United States die after overdosing on opioids (1). The abuse of this classification is a serious national crisis that affects public health as well as social and economic welfare. The Centers for Disease Control and prevention estimate the prescription opioid misuse alone in the US is around $78.5 Billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement (2). Roughly 21-29% of patients prescribed opiods for chronic pain misuse them (4). of those between 8-12% develop a opioid use disorder.

10 Alternatives to opioids

Chiropractic care

Chiropractors are specialists focused on neruomuscular disorders, who emphasize manual manipulation of the spine and extremities. Studies have shown to be effective at decreasing pain and improving physical function (5).

Acupuncture

Acupuncture is the Chinese practice that involves and experienced practitioner using hair thin needles into the skin at specific points in the body. Through this they are correcting imbalances in the nervous system and muscles. In the Archives of Internal Medicine a review found that acupuncture relieved pain by about 50% in patients (6).

Physical Therapy

A physical therapist specializes in physical medicine and rehabilitation. They may be able to create an exercise program that helps you improve the function of your body mechanics and decrease your pain.

Massage Therapy

Massage therapy is a great tool in combination with chiropractic, acutpuncture and physical therapy wheather it be acute injury such as a car accident or sports injury or chronic problems like low back pain, neck pain etc.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) can help people practice “acceptance theory”, which can lead to behavioral changes and perceptions, and increase patient confidence and self-efficacy for pain management. In a review published in the American Psychologist found that CBT had small to moderate effect on decreasing pain when compares to patients usual treatment, this option was suggested to be best applied in conjunction with a primary care setting (7).

Steroid injections

Seroid injections are a commonly given pain and inflamation releaver associated with certain joints and conditions. Although fequently used, the long term effects are not well established. The short term effects are are established and show a significant reduction in pain and inflamation, but there is a increased risk of bone thinning with the use of some steroid injections (8).

Non-steroidal anti-inflammatory drugs

NSAIDs are the common drugs wich include asprin and ibuprofen. They are used to reduce inflammation as well as lower fevers. Many NSAIDs can be bought OTC, which means they are easy to obtain and relativly inexpensive. But like all drugs should be taken with care and not for extended periods of time due to the increased risk for heart attack and stroke, as well as gastrointestinal bleeding or other problems.

Diet and life style

Diet and life style are one of the most common ways to self-manage chronic and acute pain. The activities very from person to person as to what will work, you need to find what is going to be best for you and what you enjoy. From power lifting, dance, yoga, to running or even going for a walk around the block. The more we move and the better we eat, the better we will feel, it’s as simple as that eat right, move right, feel right (11).

Electrical Stimulation

Electrical nerve stimulation can provide short-term pain relief, especially for various types of muscle pain, by sending low-voltage electrical signals from a small device to the painful area through pads attached to the skin. While researchers aren’t sure why it works, they think it may either interrupt the nerve signals to the brain or stimulate the production of “feel good” endorphins, the body’s natural painkillers (9).

CBD oil

CBD oils are todays go to for many conditions. They are useful in reducing inflamation, relaxing muscles and reducing pain.

In practice I have come across a variety of treatments for acute and chonic pain. If you are in pain see one or more of the specialist listed above you can usually find one in your area that offers a free consultation to see if you are a good candidite for their approach to conditions. There is hope out there you might have to get out of your comfort zone, but that is where growth tends to happen.

1.CDC/NCHS, National Vital Statistics System, Mortality. CDC WONDER, Atlanta, GA: US Department of Health and Human Services, CDC; 2018. https://wonder.cdc.gov.

2. Florence CS, Zhou C, Luo F, Xu L. The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013. Med Care. 2016;54(10):901-906. doi:10.1097/MLR.0000000000000625.

3. “Trends in Opioid Analgesic Abuse and Mortality in the United States | NEJM.” New England Journal of Medicine, Richard C. Dart, M.D., Ph.D., Hilary L. Surratt, Ph.D., Theodore J. Cicero, Ph.D., Mark W. Parrino, M.P.A., S. Geoff Severtson, Ph.D., Becki Bucher-Bartelson, Ph.D., and Jody L. Green, Ph.D www.nejm.org/doi/full/10.1056/NEJMsa1406143.

4. Center for Behavioral Health Statistics and Quality (CBHSQ). 2017 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2018.

5. Goertz, C. M., Long, C. R., Hondras, M. A., Petri, R., Delgado, R., Lawrence, D. J., . . . Meeker, W. C. (2013, April 15). Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: Results of a pragmatic randomized comparative effectiveness study. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23060056

6. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis. Arch Intern Med. 2012;172(19):1444–1453. doi:10.1001/archinternmed.2012.3654

7. https://www.apa.org/pubs/journals/releases/amp-a0035747.pdf

8. Bicket, M. C., Gupta, A., Brown, C. H., & Cohen, S. P. (2013, October 01). Epidural Injections for Spinal Pain:A Systematic Review and Meta-analysis Evaluating the “Control” Injections in Randomized Controlled Trials. Retrieved from http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1918146

9. M., S., B., A., A., & G. (n.d.). Analgesic effects of transcutaneous electrical nerve stimulation (TENS) in patients with fibromyalgia: A systematic review. Retrieved March 04, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/30029964

10. Joseph, L. H., Hancharoenkul, B., Sitilertpisan, P., Pirunsan, U., & Paungmali, A. (2018). Effects of Massage as a Combination Therapy with Lumbopelvic Stability Exercises as Compared to Standard Massage Therapy in Low Back Pain: a Randomized Cross-Over Study. International journal of therapeutic massage & bodywork11(4), 16-22.

11. Hoon, E. A., Gill, T. K., Pham, C., Gray, J., & Beilby, J. (2015). A population analysis of self-management and health-related quality of life for chronic musculoskeletal conditions. Health expectations : an international journal of public participation in health care and health policy20(1), 24-34.

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