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Chronic Pain Management: Moving Beyond Opioids

10/05/2017 • Shai Gozani M.D., Ph.D.

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Robert F. Bukaty (AP)

For years, physicians have relied on opioids as the first line of defense to help their patients living with chronic pain find relief. But what if these medications were treated as the last resort?

The FDA recently released proposed changes to its blueprint for educating health care providers on treating chronic pain. In an effort to help patients reduce their reliance on opioids, the updates encourage physicians to consider non-pharmacological therapies – such as chiropractic care and acupuncture – for treatment. Recent advances in neuro- and wearable technologies are providing even more options for pain management.

These changes offer a promising step in the right direction in pain management treatment in the U.S. As it stands, the U.S. spends $600 billion annually on the direct and indirect costs of chronic pain. But for the estimated 100 million Americans currently living with chronic pain, more than half report little to no control over their pain.

Because chronic pain is a complex biopsychosocial condition – meaning that it involves the interplay of biological, psychological and social factors – it’s uniquely personal and affects each person differently. For some, the primary issue is the direct experience of pain or the pain intensity; for others, the impact of their pain is felt through the deterioration of aspects of their quality of life – including sleep, activity, mood and general health.

Given that chronic pain is such an individual experience, treatment methods need to be personalized. This requires looking beyond prescription medication as the single go-to treatment and exploring non-opioid approaches that can deliver needed relief and improve the overall quality of life for those with chronic pain. Compounding this challenge is the increase of government restrictions around opioids because of the opioid epidemic. This is creating an even greater urgency for alternative therapies as the chronic pain community is facing unprecedented barriers to accessing the medications on which they have traditionally relied.

To make alternative therapies more than a “nice-to-have” chronic pain management tool, awareness and education are needed for both physicians and patients so they know what other options are in the marketplace. This begins with the patient feeling empowered to ask what else is available and the physician knowing what non-pharmacologic options are available to suggest to patients.

Why Patients Need to Know to Ask

Many of those living with chronic pain are exhausted from trying so many different treatments and have yet to find anything that has really helped improve their quality of life in a significant way. Treatments may have resulted in side effects with minimal improvements in their pain, so from their perspective, hope that any other option could make an impact is slim. On the other hand, some might have experienced relief with current methods and feel that they have maximized their potential for relief, so the thought of asking the question does not even cross their minds. Patients need to look to their physicians for advice on what other options can help and what alternatives they are aware about.

Why Physicians Need to Know to Offer

The other side of the health care relationship requires physicians to shift how they think about treating chronic pain. Alternative therapies could include wearable neurostimulation devices, acupuncture, cognitive behavioral therapy or even topical treatments. These treatments show promise as safe, effective and easy-to-use complements or even alternatives to pain medications. Even if a patient thinks there is no room for improvement and they are managing their pain, physicians need to make their patients aware of what alternatives are out there that may provide them with the relief they need. This can also help patients reduce their reliance on prescription medication.

While this requires time and effort on both sides, if there is not an ask or an offer, those living with chronic pain are unable to find the relief they’re looking for, and in some cases, unaware of what other options exist. By broadening the spectrum of what physicians are educated on and fostering awareness among patients, reliance on opioids as the single go-to option will decrease. The end result is those with chronic pain regaining greater control over their lives.

 This piece originally appeared in U.S. News & World Report.


About The Author
Shai Gozani M.D., Ph.D.
Shai Gozani M.D., Ph.D.

Dr. Gozani is an expert in non-invasive neurostimulation. He received his M.D. degree from Harvard Medical School and the Harvard-MIT Division of Health Science and Technology. Dr. Gozani earned his Ph.D. in Neurobiology, M.S. in Electrical Engineering & Computer Science and B.A. in Computer Science from the University of California at Berkeley. Following his studies, Dr. Gozani conducted post-doctoral research at Harvard Medical School and MIT. He holds 36 U.S. patents and has authored over 30 articles in scientific and clinical peer-reviewed journals. Dr. Gozani is founder, president and CEO of NeuroMetrix, Inc.; which designs and manufactures Quell.


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