Opinion: Chronic pain is too complex and individualistic a problem to ignore complementary care options

By: Myra J. Christopher, Kathleen M. Foley Chair in Pain and Palliative Care; Director, PAINS Project; Center for Practical Bioethics

I recently had a call from a man who told me that he had been through back surgery 17 times and was still in agonal pain although he took large doses of opioids daily. He was contemplating another surgery and wanted to know what I thought. I told him that I am not a clinician; I do ethics and health policy, so I would not be one to ask about another surgery. I said to him, however, that I thought he must be the most optimistic person I’ve ever spoken to. He asked me why I thought that, and I said, “To go through unsuccessful surgery 17 times and contemplate that the eighteenth might be just the trick makes me think you must be the eternal optimist.”

I did ask him whether he had accessed chiropractic care, acupuncture, therapeutic massage, behavioral health, diet and nutrition counseling, etc. – therapies that are often referred to as complementary or alternative medicine (CAM), and he had not – not even chiropractic care, which is the most common CAM – and according to various studies very effective for lower back pain. Like many Americans he expressed a lot of skepticism about and a lack of confidence in any approach outside of traditional biomedical pain care, i.e., opioid therapy, interventional procedures such as nerve blocks, steroid injections, etc., and surgery. I told him that I was not prepared to tell him that another surgery wouldn’t be “just the trick” because I believe in miracles. I’ve worked in healthcare long enough to know that they exist, but they are extremely rare.

Chronic pain is a complex neurologic disease; it is also a very personal/individualistic experience which calls for a complex response that may or may NOT include things in either category, i.e, biomedical or complementary. Comprehensive/integrative pain care, i.e., care that includes therapies from both categories aligned with an individual patient’s health status, functionality and goals of care has been proven to be the most effective approach. We’ve had solid data since the late 1980s that demonstrate this. Interestingly, it is also cost effective.

Those of us participating in the PAINS (Pain Action Alliance to Implement a National Strategy) Project believe that comprehensive/integrative chronic pain care will: improve the lives of millions of Americans, save billions of dollars, and reduce opioid prescribing.

Our country is clearly facing two public health crises – inappropriately treated chronic pain and what the CDC has categorized as an “opioid epidemic”. Although there are no data establishing a causal connection between efforts to improve chronic pain care and the opioid crisis, there is clearly a corollary between these two matters. As prescribing of opioids has increased, so has abuse of and addiction to opioids.

Federal and state governmental agencies have made significant efforts to address the opioid crisis. They have not yet created a parallel strategy to promote comprehensive chronic pain care although in March, 2016 the National Pain Strategy was published by the U.S. Department of Health and Human Services. It is our view that doing so is an essential component of a public health strategy to address the opioid epidemic.

Utah is fortunate to have some of the leading clinicians in both pain and addiction medicine. Two that come to mind are Dr. Lynn Webster, Past President of the American Academy of Pain Medicine and award-winning author of The Painful Truth and Dr. Perry Fine, also a former President of the American Academy of Pain Medicine currently at the University of Utah School of Medicine. I encourage state-legislators, regulators and policy makers to reach out to experts like Drs. Webster and Fine and to develop an integrated strategy to address both these public health issues, including funding for CAM therapies.

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