Chronic Pain?

More people die every year from overdose of prescription drugs than car accidents? The Associated Press reported that in San Francisco, more people died from drug overdose than COVID-19 in 2020.    "A record 621 people died of drug overdoses in San Francisco so far this year, a staggering number that far outpaces the 173 deaths from COVID-19 the city has seen thus far." [12/21/2020]

• Hydrocodone
•  Oxycodone (OxyContin)
• Morphine
• Fentanyl (Duragesic)
• Hydromorphone (Dilaudid)

When combined with acetaminophen, hydrocodone and oxycodone are prescribed under the brand names Vicodin and Percocet.  Opioids are available in pills, liquids, shots, patches, and suppositories.

At Medical Pain and Spine Care of Indiana, we offer a comprehensive pain management plan, which will sometimes include prescription opioids for pain relief. 

Opioids are a class of narcotic drugs that are derived from morphine. They work with opioid receptors to disrupt pain signals sent to the brain by the nervous system to offer pain relief.  In general, opioids are most effectively prescribed for short-term, episodic pain relief from injury or illness. Conditions for which opioids may be prescribed include:

• BACK PAIN -- including degenerative disc disease, ruptured or herniated disc, spinal stenosis, and vertebral compression fractures
• CANCER PAIN -- especially in late-stage cancer patients
• FIBROMYALGIA
• HIP PAIN -- with osteoarthritis and fractures as the most commonly treated with opioids
• INFLAMMATORY BOWEL DISEASE -- such as Crohn’s disease and ulcerative colitis
• MIGRAIN AND TENSION HEADACHES
• NEUROPATHY -- including diabetic neuropathy and any other types of nerve pain
• SURGICAL PROCEDURES

While some patients benefit tremendously from opioid therapy, recent research into the effectiveness of opioids on chronic pain has shown that opioids may do more harm than good when it comes to treating chronic pain. In 2015, an analysis by the National Institute of Health (NIH) looked at existing studies regarding the effectiveness of opioids for long-term chronic pain and found no evidence that opioids were effective at treating long-term pain. This same study found evidence that indicated a high risk of dose-dependent, serious side effects including abuse and dependence, bone fracture, and myocardial infarction.

As of 2014, an estimated 1.9 million people in the U.S. had a substance abuse disorder involving prescription opioids. From 1999 to 2008, opioid addiction rates and opioid prescription rates rose in parallel with the death rate from overdose increasing 400% during the same period. Opioids are powerful narcotics that change the structure of the brain such that it adapts to the dose and gradually requires more to feel the same pain relief. Even when taken as directed, long-term use can result in dependence.

Opioid-induced hyperalgesia, or increased pain sensitivity, is also a possibility with long-term use of opioids for chronic pain. Previously, opioid-induced hyperalgesia was thought to be a byproduct of opioid withdrawal, but new research has shown that it can occur at any stage of opioid use.

Other lesser-known side effects of long-term opioid use can include:

•  IMMUNOSUPPRESSION making patients more vulnerable to other health issues. This can be especially difficult for those patients with other chronic, immune-related illness. 
• DECREASED LIBIDO -- For men, long-term opioid use can result in lower levels of testosterone production (hypogonadism). In women, this same long-term use can disrupt hormone production, causing amenorrhea (lack of menstrual cycle). In both cases, this can result in a decreased sex drive. 
• OSTEOPOROSIS developing in both men and women. 

We believe the risks associated with long-term opioid use warrant caution and restraint when it comes to prescribing these medications. Our pain management specialists focus on a comprehensive pain diagnosis and management options. To that end, we look at other treatment options before prescribing opioids.

Conventional treatments may include prescription non-steroidal anti-inflammatory drugs, antidepressants, anticonvulsants, and steroids. We may also look at minimally-invasive procedures, such as nerve block procedures, or more invasive techniques such as intrathecal pain pumps, spinal cord stimulation, or radiofrequency ablation. Our pain management specialists believe in a holistic approach to chronic pain and also recommend many complementary and alternative options for pain relief including physical therapy, as well as psychological and behavior interventions available at our office in Noblesville.

While we strive to utilize all other pain-relieving options prior to prescribing opioids, we recognize that for some patients in specific circumstances, opioids may be their best option for relief. Medical Pain and Spine Care of Indiana follows strict prescribing and monitoring guidelines as set forth by the federal government and works closely with patients to resolve their pain in other ways before utilizing opioids.

Part of working closely with our patients includes discussing and signing a pain management agreement form. This form follows the Centers for Disease Control’s updated opioid prescribing guidelines and includes the following provisions:

1. The agreement acknowledges that opioid therapy is just one part of a patient’s comprehensive treatment plan. 
2. Patients are to follow all parts of the holistic, comprehensive pain management plan designed with their doctors to include a number of different therapies. This may mean making lifestyle changes as well as undergoing counseling and other complementary therapies tailored to each individual patient. 
3. Our pain management specialists prescribe the lowest effective dose and will not increase the dose without thoroughly re-evaluating the patient. 
4. Patients agree to regular follow-up visits, monthly urine screenings, and pill counts within 24 hours if requested by the doctor. 
5. Doctors and patients work closely together with all other specialists and physicians to avoid over prescription or concurrent benzodiazepine or opioid prescriptions. Each part of this opioid agreement form was designed to protect the patient while undergoing opioid therapy. 

Our goal at Medical Pain and Spine Care is to develop the best possible pain management plan for every patient that improves their quality of life. We work as a pain management team to provide comprehensive diagnostic and therapeutic services. We utilize an extensive array of treatment options specifically designed for each patient. When one of these options is opioid therapy, we provide the support and guidance needed for safe, effective pain relief.

For more information on all of our pain management options, including opioid therapy, please call 317-776-7028 to schedule an appointment.