In the 1990s, a new movement swept through professional medicine that urged providers to not just reduce pain but cure it entirely. Patient groups, academic journals, and the federal government itself made a convincing case that physicians were not doing enough to treat chronic pain. Patients in particular felt like doctors just wouldn’t take their claims of pain seriously.
In the mid-1990s, pain scales with smiley faces and scowls suddenly appeared in doctors’ offices. Medical guidelines urged doctors to get patients as close to the zero — the smiley face — as possible. Some big hospital systems, including the Veterans Health Administration, dubbed pain the “fifth vital sign,” just as important as blood pressure and temperature.
Powerful opioid painkillers, meanwhile, had just begun to roll onto the market. They promised the pain relief that doctors now believed they needed to deliver. “There was a push that we had to get pain to zero,” states one medical doctor in an interview. He recalled, “Hydrocodone worked well at that — too well, because patients became addicted, and kept needing more and more to control their pain.”
In a recent study done in Dec 2017, published by the U.S. National Library of Medicine found that up to 79% of chronic pain patients are unsatisfied with their pain management. This review found that in an assessment of patients' expectations for treatment is mostly limited to outcome. Patients generally have high expectations regarding pain reduction after treatment.
Expectations were higher when expressed as an ideal expectation coming in as patients, expecting 81%-93% relief from their care. With these patient expectations, many doctors find themselves in a difficult position. Pulled between providing fast relief by masking symptoms with a prescription or providing permanent relief by actually treating and correcting a patient’s underlying back issues.
While being interviewed, another doctor expressed his exasperation in trying to steer his patients away from harmful painkillers and opioids. “If you say no, they begin to doctor-shop,” Dr. Beckett M.D. says. “They’ll go somewhere else, to someone who writes more of that medication, or try multiple physicians to try and score different types of medication.”
So, what are the leading treatments used today to handle the symptoms of back pain?
Research shows prescription painkillers are by far the leading choice for treating the symptoms of back pain. This next section will briefly cover the effects of the widespread use of prescription pain killers to address chronic pain, as well as over the counter medications. We will then move into other alternatives for back pain symptom relief and how doctors can begin utilizing these other alternatives in our other blogs.
The Opioid Crisis
Opioid overdoses accounted for more than 42,000 deaths in 2016, more than any previous year on record. An estimated 40% of opioid overdose deaths involved a prescription opioid, taken by a patient who was prescribed the opioid by their doctor. As reflected in the latest mortality data from CDC, deaths from drug overdose are up among both men and women, all races, and adults of nearly all ages.
Opioid-involved deaths are continuing to increase in the United States. More than 3 out of 5 drug overdose deaths involve an opioid.
Use of opiates during pregnancy can result in a drug withdrawal syndrome in newborns called neonatal abstinence syndrome (NAS). There was a fivefold increase in the proportion of babies born with NAS from 2000 to 2012.
What Does Mayo Clinic have to say about handling pain with drugs?
Analgesics reduce pain but not inflammation. Acetaminophen, Tramadol and narcotics which contain Oxycodone and Hydrocodone are the most frequently prescribed pain medications.
- Nonsteroidal anti-inflammatory drugs reduce pain and inflammation but may increase heart attack and stroke risk.
- Disease-modifying antirheumatic drugs for arthritis slow or stop the body’s immune system, which prevents it from attacking joints.
- Biologic response modifiers target protein molecules involved in the body’s immune system.
- Corticosteroids reduce inflammation and suppress the body’s immune system.
- Non-Steroidal Anti-inflammatory Drugs (NSAIDS): Aspirin, Motrin, Tylenol, Advil, Ibuprofen, Celebrex. May cause nausea, headache, constipation, rash, dizziness as well as liver and kidney damage.
Is there an alternative solution for short term pain relief?
With patients expecting a short-term solution to get them by as they move forward with their long-term treatment, this raises the question: “Aside from prescribing a pain medication for my patient, what can I do?”
Contact us today to find out more!
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