Chronic Pain, The Opioid Epidemic, and Alternatives to Opioids
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Chronic pain is a national crisis in the United States. More than 100 million Americans live with chronic pain, and it’s a leading cause of disability. The marketing and use of opioids for chronic pain is so pervasive that almost all Americans are familiar with the names OxyContin, codeine, and other opioid derivatives even though these medications may not help with pain in the long term, and have even caused massive addiction and dependency issues. People and healthcare providers must begin to understand and use alternatives to opioids for chronic pain, which will be explained later in this article.
History of the Opioid Epidemic from the 1990s
Chronic pain management and opioids have gone hand in hand for decades now leading to what we now call the opioid epidemic. The opioid epidemic has been in the news for years, but there are still many people who are unaware of how it began and how it continues to plague our society.
Marketing of opioids as safe
The origins of the opioid epidemic can be traced back to the early 1990s when pharmaceutical companies, especially Purdue Pharmaceuticals, manufacturer of OxyContin, owned by the Sackler Family, began aggressively marketing opioids as a safe, effective treatment for chronic pain. The The American Pain Society and even including the Joint Commission agreed to recommend that physicians consider using opioids to treat chronic pain and that they were safe and not additive. This coincided with an increase in medical malpractice lawsuits against physicians who prescribed opioids and a corresponding increase in physician fear of being sued or facing regulatory penalties if they did not comply with the AMA’s recommendations. In response, many physicians began prescribing opioids without fully understanding their risks or how best to use them.
Poor prescribing guidelines
This trend was further exacerbated by poor prescribing guidelines issued by organizations like the United States Department of Veterans Affairs (VA) and others, which recommended that veterans with chronic pain receive opioids even if they were not experiencing breakthrough pain or had only mild pain symptoms. These guidelines also discouraged non-pharmacological treatments such as physical therapy and acupuncture unless they were ineffective after 3 months or more of drug therapy. In addition, some states implemented policies that required health insurance companies to cover long term opioid prescriptions despite little evidence that they were effective at treating chronic pain. This led to a dramatic increase in the number of patients being prescribed opioids, as well as an increase in prescriptions for high doses and long-term prescriptions that were not indicated by evidence based guidelines.
Intentional deceit by Purdue Pharmaceutical and the Sackler Family
According to reports, Purdue pharmaceuticals was aware that its drugs were causing harm and chose to keep that information from the public. The Sackler family, which owns Purdue and other companies, has also been accused of fueling the opioid crisis by contributing to the overprescription of painkillers.
The report details how Purdue knew that their products were dangerous as early as 2001. The company engaged in a cover-up through misleading marketing and downplaying the risk of addiction. In 2007, Purdue received an indictment for misbranding OxyContin with intent to defraud or mislead. The company pleaded guilty and paid $600 million in fines.
The Sackler family has also been accused of contributing to the opioid crisis by funding educational programs that encouraged doctors to overprescribe opioids and contribute millions of dollars to organizations that supported their efforts to sell more drugs despite knowing they were harmful.
Research showed opioids actually caused greater harm in the end
For instance, researchers found that opioids did not appear to improve function in individuals with musculoskeletal disorders (MSDs) such as low back pain or osteoarthritis (OA). In fact, opioid use worsened outcomes in these patients: they experienced greater disability over time, had dependency issues, and even had more pain, a state called Opioid-induced hyperalgesia (OIH).
Alternatives to Opioids Including
Combining Psychotherapy and Ketamine
Chronic pain management without using opioids is key to helping people live with chronic pain, and there are several options for those who would prefer not to use opioids for their chronic pain management.
Alternative treatments include acupuncture and massage therapy, physical therapy, hypnotherapy but the following has been shown to be very effective for chronic pain management, especially when combined together.
Psychotherapy, Hypnotherapy, and CBT for Chronic Pain
Psychotherapy, hypnotherapy, and CBT are talk therapy alternative to opioids for chronic pain management. Studies have shown that psychotherapy can help reduce the amount of time people spend in pain by 74%. It also reduces their use of medication and improves their quality of life.
Psychotherapy for chronic pain management works by helping the patient manage their emotions, thoughts and behaviors. This can be done through cognitive behavioral therapy (CBT), which teaches patients how to change their thoughts and behaviors to reduce their pain.
In CBT, the therapist helps the patient identify negative beliefs about themselves or their condition that may be causing them to feel worse or make it harder for them to cope with their pain. The therapist then works with the patient to replace those negative beliefs with positive ones. This may involve challenging some common myths about chronic pain, such as “it’s all in your head” or “you’re weak if you can’t just get over it.”
Hypnotherapy is also effective in the same way as psychotherapy for chronic pain and works similarly in that the hypnotherapist will help guide the patient and help them change their response to pain.
The therapist may also help the patient develop effective coping skills so they can better manage stress and keep themselves focused on getting better instead of feeling sorry for themselves or dwelling on negative feelings like sadness or fearfulness toward their condition.
Ketamine for Chronic Pain Management
In recent years, ketamine has been studied as a treatment for depression or anxiety disorders, or for those who are suicidal. It is also used to treat pain from injuries or surgery and can be helpful for those who have suffered from trauma or abuse because of its ability to block the NMDA receptor in the brain. The NMDA receptor is responsible for sending signals from the spinal cord to the brain and vice versa; when it’s blocked by drugs like ketamine, this stops pain signals from reaching the brain.
Researchers have found that ketamine can reduce chronic pain in patients with major depressive disorder and fibromyalgia without causing significant side effects like addiction or dependence on other drugs like opioids (which have addictive properties).
How ketamine works
Ketamine works by affecting the brain’s glutamate receptors in different ways than traditional antidepressants do—and this allows it to have increased neuroplasticity and a rapid onset of action without taking weeks or months before having an effect on your symptoms like other medications might take longer periods before working effectively enough for you to notice any real difference.
Neuroplasticity refers to changes in the brain’s structure and function that occur over time as a result of experience and learning. These changes in the brain cause physical changes in how neurons communicate with each other—and when we learn something new, like how to play an instrument or speak a foreign language, we’re actually changing our brains.
Combining Ketamine, Psychotherapy, and other alternatives to opioids is very effective for pain management
To help with chronic pain management, it has been found that combining psychotherapy and ketamine and other forms of alternative to chronic pain management can be very effective together because of the inherent properties of ketamine and increased neuroplasticity. Having increased neuroplasticity makes the psychotherapy even more effective in the long run.
In conclusion, Purdue Pharmaceuticals and the Sacklers have been found legally partially responsible for their negligence and role in the opioid epidemic. Unfortunately, this epidemic has been and is still causing significant addiction problems and other physical and mental harm. As a result, healthcare providers are being educated on the alternatives to opioids for chronic pain management and must recommend these alternative routes to manage chronic pain. These include combinations of ketamine, psychotherapy, CBT, DBT, physical therapy, hypnotherapy, and acupuncture.
*Please note Clear Mind Treatment is a mental health treatment program specializing in depression, anxiety, alternatives to chronic pain management, bipolar disorder, and PTSD. Clear Mind Treatment is not a pain management clinic. If you are in severe immediate pain or danger, please see your provider or call 911.
We are located in Los Angeles, Torrance, Tarzana, Scottsdale and can treat people via Telehealth all over the states of California and Arizona.
Contact us anytime for consultation.