Since opioid misuse became the focus of urgent national attention, mitigation efforts have been primarily directed toward opioid prescribing practices, emergency care in the event of overdose, and access to substance abuse treatment. While these measures are important, they are not adequate to address unnecessary opioid prescribing. Patients, including the 1 in 3 Americans who experience a chronic pain problem that is inadequately or inappropriately treated, need better, accessible pain management options.
Fortunately, solutions exist and current clinical guidelines and related reports are clear: patients need access to non-pharmacologic and integrative approaches to treating pain.
The opioid misuse epidemic has brought a sense of urgency to the conversation about the value of complimentary and integrative healthcare (CIH) in hospitals and health systems.
Efforts to improve pain management in the US and combat the opioid misuse crisis should include the following:
Rethinking first line treatments for pain
According to the Center for Disease Control and Prevention (CDC), clinicians should recommend appropriate noninvasive non-pharmacologic approaches as first line treatments for chronic pain. Depending on the patient, this could include self-care advice, exercise therapy, chiropractic spinal manipulation, acupuncture and massage. These interventions, commonly used by CIH providers, are more likely to result in better patient outcomes, with fewer side-effects. Care pathways and health systems that steer pain patients toward effective non-drug options first limit exposure to high-risk therapies like opioids and other narcotics, injections, and surgery.
Creating alternatives for at-risk populations
The misuse of prescription pain relievers and self-medication with illicit drugs are common ways in which individuals can develop opioid addiction. Studies show that individuals with back pain are more likely to use substances such as cocaine, methamphetamine, and heroin compared to those without back pain. Individuals who are already struggling with substance addiction often continue to experience pain. Inadequate pain relief not only hinders their path to substance abuse rehabilitation but also complicates the recovery process, creating a persistent risk for relapse.
A significant portion of the US population has experienced addiction in the past. Further, several other patient groups are considered vulnerable and at higher-than-average risk for adverse outcomes with opioid use, such as the elderly, pregnant women, children, and adolescents. Improved patient access to non-pharmacological therapies and safer pain management options may be especially important for these at-risk populations. CIH helps support coordinated and personalized pain management that considers a whole-person approach to wellbeing and aims to reduce exposure to opioids and other high risk, low value therapies.
Supporting recovery for Opioid Use Disorder
CIH can play a crucial role in preventing relapse among individuals with a history of addiction who require surgery, suffer from acute injuries, or need long-term pain management.
By increasing awareness and access to non-drug pain treatment options, individuals can initiate rehabilitation, be supported during the rehabilitation process, and offered an additional preventive measure against relapse. CIH providers play a crucial role in addiction teams, employing a multi-model approach to address both addiction recovery and pain management together. By incorporating CIH providers into the care team, individuals can benefit from a comprehensive treatment plan that considers various measures to address addiction and pain management effectively.
While much of the focus on pain management is enmeshed with the opioid misuse epidemic, it has never been more timely to increase access to CIH and non-pharmacological interventions, in an effort to improve pain management and reduce exposure to opioids.
Dr. Michele Maiers
Dr. Michele Maiers, is Executive Director of Research and Innovation at Northwestern Health Sciences University.
Dr. Maiers has a Doctor of Chiropractic from Northwestern Health Sciences University, a Masters in Public Health from the University of Minnesota and a PhD from the University of Southern Denmark.
Dr. Maiers is the Executive Director of Research and Innovation at Northwestern Health Sciences University in Minneapolis, Minnesota. In her role, Dr. Maiers leverages high quality research to inform healthcare policy and innovation initiatives on local, regional and national levels.