According to a recent study from the National Institute of Health, 1 in 3 Americans suffers from some sort of chronic pain issue. Pain in this country amounts to cost of over $500 billion dollars. As chronic pain treatment becomes more prevalent in the healthcare system, so does narcotic treatment.
Unfortunately, what this has amounted to is an incredible and exponential increase in the amount of narcotic prescriptions being handed out for treatment. Eighty percent of these prescriptions come from primary care doctors, and approximately 20% of every doctor’s office visit in this country involves a narcotic prescription.
One of the main issues when treating with narcotics is tolerance. As patients receive treatment chronically for their issue, the same amount of medication may begin to have less of a pain relief effect than previously. The result may be an increased dosing in order to achieve the same pain relief effect.
As this tolerance issue repeats itself, the problem will happen over and over and eventually the patient will be taking extremely high doses of narcotics. Physicians will look at the patient’s size and disease process (e.g. degenerative disc disease), and the dosing will be out of proportion to both.
So what are the ways to decrease narcotic needs in chronic pain patients? Here are 5 ways to do it and a brief description of each below.
- Interventional pain treatments
- Physical therapy, chiropractic, manipulation under anesthesia, spinal decompression treatment
- Substitution with non-narcotic medications
- Topical medications
- Psychological intervention
Interventional pain treatments can help decrease the amount of narcotics necessary for pain relief or potentially just prevent the patient from needing an increase in dose due to tolerance. These will need to be catered to a patient’s pain generator. If the patient is having pain from a degenerative scoliosis condition, there will often be pain in multiple facet joints from arthritis. Medial branch blocks and/or radiofrequency ablation may be able to decrease pain, decrease narcotics, and prevent surgery. It is important for the patient to be open to these treatments, otherwise, they may willingly fall into the trap of needing higher narcotic dosing.
A well rounded treatment plan may allow a patient to decrease pain including physical therapy treatment and/or chiropractic manipulations. Often it is not simply one treatment method that allows pain relief. Manipulation under anesthesia and spinal decompression treatments have showed impressive results for numerous neck, back, shoulder, and pelvic conditions. These will need to be individualized, but more research is showing that better outcomes are produced by pain centers that are comprehensive and include multiple types of treatment, called multi-discipline.
There are quite a few non-narcotic pain medications that can be substituted which will potentially decrease the dependence on narcotics. They may have less side effects and less chance for tolerance issues. Tricyclic antidepressants may help a lot, such as amitriptyline and imipramine. This is especially the case with neuropathic pain. Additional medications for neuropathic pain include anticonvulsants such as gabapentin, phenytoin, and valproic acid. Additionally, there is a non-narcotic analgesic, Ultram, which may substitute for narcotics.
Nonsteroidal anti-inflammatory medications may allow patients to achieve a baseline pain relief that may decrease the amount of narcotics necessary. Acetaminophen may also make a big difference. However, be careful with the amounts of each since NSAIDS may lead to kidney problems and acetaminophen may cause liver issues.
Topical medications may assist with pain relief such as either Lidocaine patches or capsaicin cream. These may provide numbing effect that may decrease the need for narcotics.
Lastly, it is well known that a significant amount of pain is psychological. The same two individuals may have the same pathology, with one being bedridden and the other functional. Treatment with a psychologist may assist chronic pain patients with being able to handle their pain more effectively.