The Evolution of Pain Management
| 4 min read
Dr. William Beecroft, MD, DLFAPA, is medical director of behavioral health at Blue Cross Blue Shield of Michigan. Dr. Beecroft is board-certified in general psychiatry, consultation-liaison and geriatrics specialties. He serves on the Michigan Suicide Prevention Commission.
Beginning of the American Opioid Crisis
- Doctors began using opioids to treat non-cancer patients with chronic pain without considering the behavioral and psychological health of the patient.
- The addiction risk for opioids was downplayed early on by pharmaceutical companies.
- Pain was made the “fifth vital sign” and state governments made it a civil penalty for physicians not to address pain.
Confronting an Epidemic
- Inpatient treatment programs
- Community support groups
- Medication-assisted treatment (MAT)
Management Strategies for Chronic Pain
- Acupuncture and acupressure: For some individuals these interventions can be of assistance.
- Alternative and complementary nutraceutical preparations: These can sometimes complement the use of topical applications or other combinations of interventions. They are worth considering but usually have significant drug interactions and should only be taken under the expert guidance of a medical professional.
- Behavioral health evaluation: Regardless of the cause, individuals with sustained chronic pain have a higher likelihood of developing major depression. Utilization of psychotherapies and, if needed, medications can be helpful to eliminate this portion of chronic pain syndrome.
- Comprehensive evaluations and treatment planning: Primary care providers work in tandem with psychologists who have special training to provide comprehensive evaluations of patients’ pain. It is the best and most effective way to determine a safe and long-term treatment for chronic pain. Part of the evaluation should include an opioid risk tool to gauge if the patient has a higher than normal risk for habituation should the need for opioids arise.
- Injections or local surgical interventions: Where appropriate, a doctor may prescribe injections or permanent nerve disruption to address pain. Correction of underlying anatomy damage can decrease or eliminate the cause of the pain.
- Lifestyle modifications: Weight loss, exercise, proper sleeping habits, a healthy diet, yoga, meditation, relaxation techniques and several other factors can all play into chronic pain intervention.
- Other drug combinations: If approved by a doctor, anti-inflammatory preparations like topical anesthetics or topical steroids can provide substantial relief without systemic effects. In some instances, the use of hot and cold applications can relieve local discomfort. Changing to oral medications such as ibuprofen and Tylenol can provide relief to patients with few side effects and essentially no risk of addiction. It’s critical for patients to talk with their doctor before changing a medication regimen.
- Physical therapy and functional rehabilitation: In certain cases, physical therapy can relieve pain over time through the natural strengthening of the body. Functional rehabilitation also has a psychological care component that’s beneficial to all patients.
- End-of-life care
- Pain related to a cancer diagnosis
- Patients whose pain is not effectively managed through non-opioid treatments
- The Role of Pharmacogenetic Testing in Prescribing Medications
- Supporting Mothers and Children in the Fight Against Opioid Abuse, Misuse and Addiction
- How New Blue Cross Policy is Helping Reduce Opioid Abuse