Opioids work by blocking the neurotransmitter release on nociceptors. Over time, tolerance leads to higher doses of the drug, which triggers the release of inflammatory cytokines from glial cells, including hyperalgesia.
Opioid addiction is a national public health emergency. Some healthcare facilities are fighting back. They’re shifting to opioid alternatives to mitigate pain. In some cases, they are finding that non-opioid treatments are more effective, in addition to not being addictive.
Pain treatment and management affects a staggering number of people:
Until recently, opioids have been the go-to choice for physicians treating some types of pain. That has led, at least in part, to high levels of opioid addiction. In turn, this has challenged the healthcare industry to find new, less addictive ways to treat chronic pain. The Centers for Disease Control and Prevention (CDC) found evidence that alternative pain management strategies, including cognitive behavior therapy, acupuncture, medical message and physical therapy, can help patients.
As the opioid crisis continues, non-acute providers must balance patient needs for pain management with healthcare industry directives to help stop the epidemic. See why non-acute is facing an opioid crisis balancing act.
Some studies as well as some doctors say opioids do a poor job of managing common types of pain. While the drugs treat some pain effectively, different kinds of pain require different kinds of treatment. For example, tissue damage is different from nerve damage and therefore requires a different approach to pain management.
In response to the call for better treatments, providers are working to eliminate the use of opioids for certain surgeries and other procedures. This shift is changing decades’ old approaches to managing pain. For example, Cleveland Clinic is using narcotic alternatives before, during and after surgery. Over the last couple years, Cleveland Clinic initiated a postoperative pain management program that looked at the potential for alternatives to narcotics. The results have been positive.
The strategy involves using a regional or local anesthesia, then prescribing a painkiller like acetaminophen or ibuprofen. According to a recent article in ModernHealthcare, the Cleveland Clinic used to prescribe Percocet or Vicodin for C-section patients, then prescribe opioids when the patients were discharged. Now, patients take Tylenol or Motrin, although they can request an opioid for intense pain. Within the first months of making the change, opioid use for post C-section patients dropped by 70%.
“By minimizing and prescribing appropriate amounts of narcotic medicine—that’s how you fight the opioid crises,” Dr. Eric Chiang, an anesthesiologist at Cleveland Clinic, told Modern Healthcare.
Other providers are also moving away from opioids. A recent article in Becker’s ASC Review showcased how three ambulatory surgery centers (ASC) are countering the opioid crisis. The article featured responses sent to the Ambulatory Surgery Center Association, which asked members to share information on their efforts to curb opioid use:
In response to the call for better treatments, providers are working to eliminate the use of opioids for certain surgeries and other procedures. This shift is changing decades’ old approaches to managing pain.
One barrier to developing new painkillers is not fully understanding chronic pain. Doctors and scientists believe the human body has several pathways to chronic pain. This means there are potentially multiple targets for painkillers, but the challenge is finding proven ways to determine which pathway causes pain for each person.
Drug manufacturers continue to work for pharmaceutical solutions, and some are finding success. For example, the Food and Drug Administration (FDA) fast-tracked the painkiller tanezumab for treatment of chronic pain for patients with osteoarthritis and lower back pain. Other drugs are in development.
For now, the CDC’s latest guidelines for prescribing opioids, from 2016, direct doctors to try nondrug and non-opioid treatments before prescribing opioids. These alternatives can include over-the-counter aspirin, ibuprofen and acetaminophen. While these can be effective in relieving pain, it’s important for doctors and patients to understand the potential side effects of any drug.
After years of doctors prescribing opioids for pain relief, the pendulum is swinging toward alternative treatments. This trend has twofold benefits—it helps eradicate the problem of addiction while helping address chronic pain.
Healthcare providers are also realizing that non-opioids can be just as effective, if not more effective, at treating some kinds of pain. Plus, they have the advantage of not posing the same risk of addiction. This helps both providers and patients.