Chronic PainShifting Focus: Non-Opioid Strategies For Chronic Pain

Shifting Focus: Non-Opioid Strategies For Chronic Pain

Non-Opioid Strategies For Chronic Pain Overview

One of the toughest challenges for healthcare professionals and their patients is effectively treating chronic pain. Millions of Americans experience pain daily, and often have difficulty getting relief. Chronic pain affects physical and mental health and functioning, and is conservatively estimated to cost $560 billion to $635 billion in personal and health system expenditures. For too long, an easy remedy was to offer opioids. This is one of many factors that have fueled the opioid crisis. Let’s look at some non-opioid strategies for chronic pain

Non-Opioid Strategies For Chronic PainIn 2016, the Centers for Disease Control and Prevention (CDC) released guidelines for prescribing opioids for chronic pain. Based predominantly on an AHRQ evidence review, the CDC recommended that clinicians consider the full range of therapeutic options for treating chronic pain, including non-drug treatments like exercise, acupuncture, yoga, and massage before initiating opioid therapy.

Today we find ourselves a step further in our efforts to understand the potential of complementary and integrative therapies to relieve pain. A new AHRQ report, requested by the CDC and the Department of Health and Human Services (HHS) Assistant Secretary for Planning and Evaluation, summarizes the existing literature to inform future chronic pain guidelines and to help plan future HHS-level opioid control initiatives.

A 2018 report—Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review—provides important information about the best evidence on alternatives for treating chronic pain. The report examined nonpharmacologic treatment for five common types of chronic musculoskeletal pain, representing the most common causes of chronic pain, by assessing the interventions’ effects on pain and functioning over the short, intermediate, and long terms.

While there is variation in the magnitude and duration of their effectiveness, therapies found to help pain and/or function for at least a month after treatment include:

The AHRQ-funded review found most non-drug therapy effects were modest, and there are limits to the available evidence on the comparative effectiveness of these therapies. Also, there is a need for longer term studies. More research is needed to examine the optimal combinations of these therapies as well as effectiveness in specific populations, including the elderly. Questions remain about the therapies’ effectiveness on long-term function and pain relief when part of ongoing lifestyle modifications. Finally, although adverse events were rare, more research is needed on the potential harms of these approaches.

AHRQ’s report was developed through its Evidence-based Practice Center (EPC) Program, a critical part of the Agency’s efforts to generate research and improve care. EPC reports have informed more than 125 clinical guidelines, health coverage decisions, and government policies and programs, and contribute to greater shared decision making between patients and their caregivers.

Chronic pain is notoriously difficult to treat. As a physician, I understand these challenges. Barriers to non-drug approaches to pain include access and coverage issues. I hope that patients and clinicians will benefit from having more information about the effectiveness of these therapies that will enable an evidence-based multimodal approach to pain prevention and management for improved health and function.

This report serves as an important step in delivering on HHS Secretary Alex Azar’s commitment to finding alternative approaches in the battle to defeat the opioid epidemic.

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  1. This is a bunch of BS telling a chronic pain patient such as myself that I just need more exercise when I can barely walk? More exercise just makes my pain worse. And also prescribing opiates has nothing to do with the opiate overdose crisis. Addicts just changed over to other hard drugs and Fentanyl, they go with what is easiest. When they could get opiates, they took large quantities to get there high many of them taking in a few days what would be my prescription for a whole month of functionality. I’m sick of the myths pushed by these doctors. Also when Medicare starts paying for acupuncture although I’ve tried that and yoga and massage and all of these other expensive modalities well then maybe that will help some people. I have tried everything and the thing that breaks the cycle for me is opiates. I have been cut down half of what I got 4 years ago yet arthritis is worse. Then they try to save it my thinking of suicide is due to comorbidities. Comorbidities my ass, any depression etc what I have is caused by pain! Doctors have just become tools of the government just ready to cut off pain patients yet somehow they all stood up for abortion as Dr patient privilege. I hope they all get their karma, and the evil, corrupt 3 letter agencies with zero transparency as the 2016 guidelines were written not by pain doctors but by addiction specialists with big interests in Suboxone and rehab facilities…


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