Demand More From Your Doctors When Their Treatment Plan Is Opioids

Imagine if we treated tooth pain the way doctors are treating physical discomfort—would patients happily walk out of a dentist's office with pain medication but no information about treating the cause?

The emergency room at Mount Sinai Hospital in New York City. Eric Thayer/Getty Images

Here in America we are quick to throw powerful chemicals like opioids at problems without considering the cause, leading many to a road of addiction and risk of death without knowing whether a much more benign treatment like a simple orthotic might cure rather than camouflage the pain.

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I was experiencing shoulder pain for several days. My primary care physician was too busy to see me and instead told me to go to a local emergency room. The waiting area was packed. The crowd included several people pleading for pain medications and an elephant in the room.

One woman near me was demanding pain relief for her grownup daughter with so much agitation that it seemed a few times like she might attack someone. When I got into an examination area I explained that I was having pain but managing it with Ibuprofen and Acetaminophen. The physician’s assistant almost immediately offered me “something stronger.” After a cursory examination and a few tests I was again offered “something stronger,” and two opioids were named. I never saw the physician on duty, but there was no doubt that I could have gone home with a license for something like Percocet or Oxycontin. I was eventually released with a copy of some test results and no treatment offered other than drugs.

Of total emergency room visits, about 45 percent are due to patients experiencing pain. And while this statistic has remained steady for decades, the percentage of those pain patients who leave with an opioid prescription has increased significantly, and is now close to 80 percent. Drugs certainly help patients manage pain, but they do not fix the pain.

Imagine the same patients experiencing toothache. None of them would be satisfied by a dentist handing them an aspirin and sending them home without fully diagnosing the cause of the toothache. Any patient would expect a full exam and would be prepared for whatever drilling or other invasive procedure would cure the source of their discomfort.

And yet patients In ERs and on primary care examination tables are completely satisfied with only short-lived relief. Many fixes suggested for the opioid crisis—
like less addictive pills, smaller dosages and shorter duration prescriptions—are feel-good salves that do not fix the essential problem. When it comes to most types of non-cancer-related pain, patients and providers are surprisingly reliant on the hope that the pain will go away before the pills run out. Yet neither doctor nor nurse nor patient knows what the cause of the pain actually is—that’s the elephant in the room.

Emergency rooms are not the only, or even the worst offenders in overprescribing of opioids. Almost half of all opioid prescriptions are written by primary care providers with only a small fraction of the opioid-related training of pain specialists. Of course there are many types of pain where the use of opioid is indicated, such as some cancer cases and severe traumas incurred in war or accidents, but the vast majority of opioid prescriptions are given for pains that can be managed with non-opioid treatment modalities.

The current result is that 1,000 people are treated in U.S. emergency rooms daily for opioid misuse, and opioid overdose deaths now exceed 150 per day.

In the course of history, massive overuse of opioids available through licensed prescribers is a very recent phenomenon, and so there is a long history of non-opioid approaches to relieving and treating pain, practiced today mainly in so-called “alternative” forms of treatment.

“Most of my new patients are experiencing pain, and are looking for a solution that is not pharmacological,” reports Dr. Sherry McAllister, a practicing chiropractor and executive director of the Foundation for Chiropractic Progress. “Understanding the pain our patients experience helps us understand the state of their health. Pain is always an indication of an underlying problem. Sometimes the cause is a disease. But often it comes from a musculoskeletal impairment. Years of sedentary lifestyle and poor posture can habituate us to misalignments that lead to pain. As a chiropractor my goal is to help restore alignment and balance, not just temporarily, but as a lifestyle.”

Does it work? Looking at one example, researchers from the University of Illinois and the National University of Health Sciences studied 225 patients suffering from the most common pain diagnosis, chronic lower back pain. The non-control study participants were treated with Foot Leveler custom orthotics, with or without weekly chiropractic treatments. After a few weeks, the orthotics-only group showed a 40 percent reduction in back pain. A group that was treated with the Foot Levelers plus chiropractic treatments also experienced 30 percent improved function. The numbers demonstrate that these readily available treatments provide meaningful pain relief without the risks associated with addictive drugs.

How embarrassing for opioid prescribers to consider that they might have had a more therapeutic and effective result from improving posture and decreasing pressure on the back and spine. Yet how much better for patients would those considerations be?

Demand More From Your Doctors When Their Treatment Plan Is Opioids