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Opioids and Pain Management

The near epidemic opioid addiction and overdose issue has become major news and a legislative priority as the U.S. Senate recently passed an extensive anti-addiction bill aimed at fighting the crisis with prevention, treatment, and recovery options. Unfortunately, no funding was allocated in the legislation.

More Americans now die from drug overdoses than car crashes or gun fatalities. In all, opioid overdoses killed 29,000 people in the U.S. in 2014, the latest year for which data is available. That’s 80 deaths per day, on average. Opioids include prescription pain medications as well as illegal drugs like heroin, which some turn to after becoming addicted through legitimate prescriptions.

On a positive note, drug market research firm IMS Health reported in 2014 that prescriptions written for medications such as Vicodin, OxyContin, and Percocet fell by 11 percent from 2012 to 2013, a 5 percent reduction.

While public health campaigns have had some success in reducing the number of people who take these medications, another recent study suggests that patients who are prescribed the drugs are getting more of them and using them for a longer time. According to a 2014 report from Express Scripts, a prescription management company, almost half the people who took these painkillers for over 30 days in the study’s first year were still using them three years later, a sign of potential addiction. The report also found that nearly 60 percent of patients taking painkillers to treat long-term conditions were also being prescribed muscle relaxants or anti-anxiety drugs that could cause dangerous reactions.

Opioids work by blinding opioid receptors in the body and preventing them from sending pain signals to the brain. The versions of these drugs vary in strength and duration. The result of the receptor being blocked is that more dopamine is allowed to flow to the brain circuits that have been prevented from receiving pain signals. Over-stimulating this system results in the euphoric sensation that can lead to addiction and abuse. These medications also impact all opioid receptors in the body, even those that are not part of the source of the pain being treated, sending the dopamine pleasure signals to areas of the body not in pain.

Researchers have been searching for alternatives to these drugs that restrict treatment to just the part of the body in pain that will deliver equal or better pain relief without the negative side effects and risks of opioid treatment. One promising area is in the medical device world of neurostimulation. Neurostimulation works by using electronic signals to interrupt the pain signals sent from the source of pain to the brain. Devices can range from external, handheld, or wearable units that a patient can apply directly to the area in pain (severe headaches are one application), to implantable devices that block pain signals on the specific nerves known to be the pathways for pain for common conditions such as severe back pain.

In 2013, the Neuromodulation Appropriateness Consensus Committee (NACC), an international group of more than 60 leading pain specialists, created the first consensus guidelines for the use of neurostimulation for chronic pain. The guidelines affirm that neurostimulation is an established area of pain therapy to treat nerves with electrical stimulation rather than with drugs. The NACC guidelines address provider training, patient screening, and treatment recommendations for neurostimulation therapies. The guidelines noted that “A reduction in opioid use among patients treated with spinal cord stimulation was shown in several studies, notably a 2005 randomized controlled clinical trial led by Dr. Richard North under the auspices of the Johns Hopkins University School of Medicine”.

Spinal Cord Stimulation (SCS) has to date been the most common form of neurostimulation used for pain control. In addition to reducing the need for opioids, it has been shown in studies to be more beneficial than repeat surgery when spinal surgery fails to eliminate chronic pain.

Pain management has always involved uncertainty and risks. Pain is subjective, difficult to measure, and treatment options range from mild topical ointments to powerful pharmaceuticals. Opioid pharmaceuticals are effective but dangerous. For some patients, neurostimulation offers a safer, more effective treatment option.