The effort announced by the Obama administration to address the growing opioid abuse problem misses the mark on why people become addicted to opioids. The real reason for the increase in opioid use is not about addiction, but rather about chronic pain.
Thus, the March 27 front-page article (“Taming the pain without the pills”) on an innovative approach to help opioid-addicted patients with chronic pain is important and timely.
While major efforts are underway to prevent most other major health conditions, preventing chronic pain remains an enigma, overlooked by the public, neglected by the health care system and generally ignored by the scientific community. Chronic pain is the “elephant in the room” of health care, and we need to prevent it.
The Institute of Medicine (2011) and the National Pain Strategy (2016) state that chronic pain conditions are the No. 1 reason for the use of opioids, the No. 1 reason for seeking care, the No. 1 cause of disability and the No. 1 driver of health care costs — costing more than cancer, heart disease and diabetes. It costs the United States alone over $700 billion in health care and lost work. This is equivalent to 25 percent of total health care costs and nearly 5 percent of the U.S. total gross national product.
The personal impact in terms of suffering, loss of function, disability, depression, addiction, overdoses and more is incalculable.
The Obama administration strategy suggests that we need to wean thousands of people off these powerfully addictive substances or avoid distributing them in the first place. However, this assumes that people are taking them for nonmedical reasons. In the vast majority of cases, people have been prescribed opioid medications to manage chronic pain.
If we want to reduce opioid addiction and overdoses, we must focus more effort on preventing chronic pain without opioids. Pain conditions in the back, neck, head, face and other areas are caused by physical disorders of the muscles, joints, nerves and other tissues that may begin with an injury or strain and that then may persist due to the lifestyle risk factors that increase sensitization of the nervous system. Repetitive strain, poor sleep, stress, maladaptive postures, emotional problems and other factors can delay recovery. The majority of those with pain over one month in duration still have pain years later despite the use of opioids, pharmaceuticals, implanted devices, surgeries and other innovative treatments.
It’s time we shift the focus to preventing chronic pain. We spend billions on advances in pharmaceuticals, devices, surgeries and other innovative treatments for chronic pain, yet we fail to deliver long-term relief, primarily due to the lack of educating patients in self-management strategies to reduce these risk factors and enhance protective factors.
The Institute of Medicine states that the primary role of the health professional in caring for chronic pain requires guiding, coaching and assisting patients with day-to-day self-management, in addition to evidence-based medical treatments. However, most health professionals lack the time to perform this role and find little support and reimbursement for doing so. They rely on the patient to do so, but this often does not get done. The opioid epidemic is just one of many consequences.
We need to change our health care system. Solving the chronic pain problem requires changing our health care model from a passive model of doctor-centered care to a patient-centered transformative care model. Transformative care brings together evidence-based treatments with self-management training to reduce risk factors and enhance protective factors in each aspect of a person’s life. It helps people shift the balance from illness to health. Embracing patient-centered health care paradigms such as self-responsibility, education, personal motivation, social support, strong provider-patient relationships and long-term change are the key.
We also need to train health professionals and patients on how to prevent chronic pain and opioid addiction. One innovative example of this is the massive open online course (MOOC) titled “Preventing Chronic Pain: A Human Systems Approach” (www.coursera.org/course/chronicpain). This course provides free online education to help those who want to prevent chronic pain and opioid addiction. Course evaluations found 93 percent believed that the course made a difference in their lives and that 85 percent of health providers believe that it made a difference in their patient care. As one participant stated, “Absolutely fascinating and enlightening. This information should be part of every health care educational program!”
Patients and health care professionals can shift the balance from a passive, dependent role to one of being empowered, engaged and well-trained to not only prevent their chronic pain, addiction and disability but also to enhance health and well-being. Ultimately, this will best prevent the opioid problem, improve the quality of health care and significantly reduce health care costs. The “elephant in the room” will finally get addressed. Why not support this?
Dr. James Fricton is a professor and specialist with the HealthPartners Institute for Education and Research, the Minnesota Head and Neck Pain Clinic and the University of Minnesota. Dr. Alfred Clavel is a neurologist with the Minnesota Head and Neck Pain Clinic and department chair in pain management at HealthPartners. Dr. Mark Weisberg is a clinical psychologist with the Minnesota Head and Neck Pain Clinic and the University of Minnesota.