We Need to Rethink How We Use Opioids and Manage Pain

Financial responsibility for the opioid crisis is finally being meted out – Purdue Pharma is in the midst of settling thousands of opioid lawsuits and Johnson & Johnson has been ordered to pay $572 million for its opioid-related actions. These two pharmaceutical giants are likely just the tip of the defendant iceberg, with more lawsuits still to be filed and decided.

However, as much as some may wish to demonize opioids and their use, it should not be forgotten that opioids and their use are here to stay. Opioids are necessary for many medical procedures – could major surgery be done without opioids? As well, opioids are a necessity for many patients to manage their pain and for their chronic conditions.

Source: US Pain Foundation

Detecting Patients’ Pain Levels via Their Brain Signals

Complicating the treatment of pain is that what is painful to one patient may not be painful to another. There is not a way to measure pain. Consequently, there are some that may say that we just need an objective measure of pain.

With that in mind, Daniel Lopez-Martinez, a PhD student in the Harvard-MIT Program in Health Sciences and Technology and a researcher at the MIT Media Lab, and his colleagues tried “to quantify pain in an objective manner that doesn’t require the cooperation of the patient, such as when a patient is unconscious during surgery.” As reported by MIT News, “In their work, the researchers adapted the fNIRS system and developed new machine-learning techniques to make the system more accurate and practical for clinical use.”

While this and other developments may be encouraging for the establishment of an objective measure of pain, they still beg the question about how to manage pain effectively, with or without the use of opioids.

Pain Awareness Month – #LetsTalkAboutPain

As this is Pain Awareness Month, #LetsTalkAboutPain. According to the U.S. Pain Foundation, here are some important statistics about pain:

  • 50 million Americans live with chronic pain.
  • Of that number, 20 million live with high-impact chronic pain, or pain that significantly limits daily activities.
  • These numbers do not include the millions of children living with pain.
  • Pain costs the United States an estimated $635 billion a year in terms of lost productivity and medical costs.
  • Pain is the number one reason Americans visit the doctor.
  • Pain is the leading cause of long-term disability in adults.
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Opioid Use Must Always be Followed by Opioid Weaning

There are many options for safely weaning patients from opioid therapy. Writes Mary Milano Carter, MS, APRN-BC, RN-BC (Director of Nursing Education, Chronic Pain Service/Anesthesiology, North Shore University Hospital) in “A Practical Approach to Opioid Weaning in the Midst of an Opioid Crisis”:

When initiating an opioid taper, alert the patient that the process typically takes two weeks to six months—and sometimes up to 24 months, depending on opioid usage. The total daily dose of opioids can be reduced 10% to 20% every one to two weeks, and reduced up to 50% at a time if the dosage is low or truly as needed. When the total daily dose becomes very low, it should be reduced by 5% at a time. It is important to monitor the patient closely for withdrawal symptoms, and individualize the plan of care. If the patient is reporting withdrawal symptoms, you can use the Clinical Opiate Withdrawal Scale. 

We Need to Rethink How We Use Opioids and Manage Pain

To improve patient care and outcomes, we need to rethink how we use opioids and manage pain. If an opioid is prescribed, we need to provide better monitoring, treatment, and support for patients, as recommended by Public Health England in its recent report on 5 commonly prescribed classes of medicines.

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