Pain management in 2020 isn’t just about not taking as many opioids as prescribed, like we’ve been doing for decades. Combinations of different therapies is the preferred way to go.
Doug Englebert, pharmacist and chairman of the Wisconsin Controlled Substances Board, says that prescribing opioids like oxycodone and morphine “became too much the norm without good data behind it.” Those trends started in the early 1990s, but the problems connected with them weren’t taken seriously until deaths started skyrocketing in the 2010s.
We kind of forgot that age-old techniques are still effective. All opioids really do is numb pain. They cannot fix the cause, like other treatments are proven to do. “Physical therapy, heat, ice, chiropractic, acupuncture, massage – that all still works,” Englebert says. “What’s happening today is, after some sort of procedure, people are getting a lot less opiates for a lot shorter period of time.”
One of the issues with pain is that it’s so tough to diagnose, even if it is localized to a specific area like your knee or back or neck. “Pain in general is not like someone who is taking medication for blood pressure. … You don’t have a lab value or a blood pressure reading to check,” Englebert says. “You need to trust the patient to tell you what’s going on with them.”
And even when a patient is being honest and cooperative, there can be plenty of other barriers that lead to inconsistent treatment, especially if it’s a new patient who doesn’t have a relationship with the prescriber or if there’s a language barrier.
That nebulousness contributes to some doctors just prescribing happy pills and walking away. That’s a problem since about 1 in 4 Americans prescribed opioids misuse them, and then 8% to 12% of them end up developing an opioid abuse disorder, according to a 2015 study published in the journal Pain.
Studies in California and in Wisconsin have shown that white people (and especially white men) have historically been more likely to be prescribed opioids – a strong correlation that partially explains why the opioid crisis has affected white people more severely than any previous U.S. drug epidemic.
That’s why there needed to be a total mindset shift about how opioids are used. Right after surgeries, for example, opioids are still generally believed to be OK to prescribe. But medical professionals are turning away from prolonged prescriptions for opiates.