Those of you who have experienced pain, especially gnawing, chronic pain, know that it affects your happiness, outlook and ability to function.
In the past couple of years, the treatment of chronic pain has undergone an earthshaking as opioid addiction continues to claim 鈥� and ruin 鈥斅爈ives.
Many primary care doctors no longer liberally prescribe opioid painkillers such as oxycodone, fentanyl and hydrocodone for back pain, migraines and other chronic conditions. Instead, they are increasingly turning to alternative medications and non-drug options such as acupuncture and physical therapy.
鈥淢ost primary care doctors are afraid to do pain management because of the opioid backlash,鈥� says Michael McClelland, a health care attorney in Rocklin, Calif., and former chief of enforcement for the state Department of Managed Health Care. 鈥淓ither they don鈥檛 prescribe anything, and the patient remains in pain, or they turn them over to pain management specialists so someone else is writing that prescription.鈥�
As a result, McClelland says, 鈥減eople in genuine pain are going to find it more difficult to get medicine they may well need.鈥�
Anita A., who asked that her full name not be used to protect her family鈥檚 privacy, says that happened to her father, Fred, when they moved from Maryland to the Sacramento area in November.
Her father, 78, suffers from back pain that two surgeries did not alleviate. For more than a decade, he took opioid medications under the supervision of pain specialists in Maryland. He has tried 鈥渆very other medicine,鈥� in addition to acupuncture, nerve block injections and more, but the opioids worked best to control his pain, she says.
鈥淗e doesn鈥檛 take more than he needs and he鈥檚 not seeking to take more,鈥� Anita says.
But in California, two pain specialists declined to see her father, saying his case was too complex. Finally, a primary care physician referred him to a different pain specialist, who saw him in January, three months after starting the quest.
鈥淚t鈥檚 frustrating,鈥� Anita says. 鈥淵ou get the sense that they鈥檙e looking at everyone as a potential addict.鈥�
A year ago, the Centers for Disease Control and Prevention issued new for primary care doctors prescribing painkillers for chronic pain, which did not apply to patients receiving active cancer, palliative or end-of-life care. recommend doctors first prescribe non-opioid medications, such as ibuprofen and acetaminophen, and urge non-drug treatments such as physical therapy.
When opioids are used for acute pain, such as that caused by injury, the guidelines suggest doctors prescribe the lowest-effective dose for the shortest-possible time 鈥斅爋ften three days.
In California, a statewide database known as 聽records opioid prescriptions. , Gov. Jerry Brown signed a bill that requires prescribers to check the database to see if their patients have received these drugs from other doctors.
Opioids are highly addictive, and over time patients need higher dosages to achieve the same pain relief because their bodies develop a tolerance to the drugs.
鈥淲e don鈥檛 have any evidence to support the use of daily opioid therapy beyond about three months for chronic, non-cancer pain,鈥� says , an anesthesiologist and pain management specialist at the University of California, San Francisco. 鈥淎ll of these individuals who have been on opioids for years and years have been doing so without any support from medical literature and science.鈥�
Long-term use also comes with a plethora of possible and unpleasant side effects: constipation, confusion, low testosterone, difficulty urinating, weakened bones and more. And in a counterintuitive twist, opioids can make patients .
In some specific circumstances and at a low dosage, opioids can be used over the long term for chronic conditions when 鈥減atients have improved quality of life and function, no side effects and no concerns about misuse, abuse or addiction,鈥� Naidu says. But in those cases, he requires his patients to take a 鈥渧acation鈥� from opioids every two to four months.
As the CDC guidelines recommend, pain specialists are now looking to non-opioid medications plus a variety of non-drug treatments to help patients with chronic pain. These include acupuncture, massage, yoga and visits to pain psychologists.
Penney Cowan, founder and CEO of the , based in Rocklin, worries that some doctors aren鈥檛 treating their patients as individuals with unique needs. She鈥檚 hearing from members whose primary care physicians are simply refusing to refill their opioid prescriptions.
鈥淭he doctors are afraid,鈥� she says. 鈥淚t鈥檚 not good that a lot of people are being cut off cold.鈥�
Liz Helms, president and CEO of the , believes some people in chronic pain should be able to get opioids, as long as their use is carefully managed by physicians. She had to rely on them in the past after jaw surgery and again after she snapped her back in November, she says.
鈥淭hat doctor-patient relationship is key to ensuring that someone stays out of pain so they can function,鈥� Helms says. 鈥淭o take people off a pain medicine that allows them to work and live with a good quality of life is inexcusable.鈥�
Clearly, there鈥檚 disagreement between some doctors and patients on this. If you end up stuck in the middle and in pain, I have a few suggestions:
First, you鈥檒l probably need to accept that drugs, especially opioids, aren鈥檛 going to be the cornerstone of your pain management. Be open to other options, whether alternative medications or other therapies.
鈥淚t鈥檚 harder work. It鈥檚 not the quick fix opioids are. But in the long run, they are better for your health,鈥� says an assistant clinical professor at Stanford Medical School who specializes in addiction medicine.
Second, be honest with your doctor and ask questions. If your doctor wants you to quit opioids, ask her to explain how she plans to taper you off.
And if you haven鈥檛 already seen a pain management specialist, request a referral. Cowan suggests talking with your pharmacist as well. 鈥淧harmacists are the most accessible of all,鈥� she says. 鈥淭hey can鈥檛 prescribe, but they can provide useful information about medications.鈥�
Check out of the American Chronic Pain Association鈥檚 website for more resources, or call 800-533-3231. Ask about the support groups it sponsors.
You also can call the California Chronic Care Coalition at 916-444-1985 or visit its My Patient Rights website at .
Finally, , clinical instructor of pain medicine at UCLA Health, wants you to know that she and other pain docs are on your side, even if you don鈥檛 agree with their decisions to change your treatment plan.
鈥淚f I tell you I have to taper your opioids or that I can no longer prescribe your opioids for you, it鈥檚 not because I want to make you hurt or that I don鈥檛 care,鈥� she says. 鈥淢y primary job is to keep you safe, and I have a lot of evidence now to suggest that the prescribing habits of 10 years ago were not in patients鈥� best interest in the long run.鈥�