To Manage Chronic Pain, Use the Whole Toolkit, Not Just Opioids
Opioid addiction, abuse, and overdose are at the forefront of our national dialogue. But by casting opioids as the villain, this important conversation is missing an essential element: how best to treat the chronic pain that afflicts 100 million Americans, including many of our wounded warriors. Chronic pain is a multifaceted problem with a range of causes and solutions, not a two-dimensional condition that can only be treated with opioids.
Last fall, while on an extended trip to Washington, D.C., I realized that the opioid addiction crisis has spawned a fundamental misunderstanding about pain management. A conversation with a senator from a Midwestern state crystallized the problem for me. When I mentioned that I ran a pain management center at Stanford University, the senator shook his head sympathetically. It’s a shame, he said, that all we can offer people in pain are addictive opioids that destroy lives.
Nothing could be further from the truth.
For people in pain, opioids are just one leg of a chair. The other three legs — which are often missing from the debate on opioid addiction — can support equal weight if the right medical expertise and infrastructure are in place.
The American Society of Anesthesiologists calls this approach multimodal analgesia. It’s the foundation for my work at Stanford Medical Center and the affiliated VA Palo Alto Health Care System, and for other pain management specialists around the country. It is also part of legislation to be reviewed tomorrow by the House and Senate Opioid Conference Committee.
For chronic pain, the first leg of the chair is nonaddictive over-the-counter pain medications, such as acetaminophen and ibuprofen. Often overlooked, these are remarkably effective for many people and can be available in higher doses by prescription. But they don’t work for everyone, nor do they provide the kind of extended relief that some patients need in order to function… Read More>>