Painkillers: The “Fast Food” of Pain Relief
July 8, 2014
While painkillers are an essential tool in care and treatment of injured patients, two studies released this week reveal an urgent need to rethink their use in our military and civilian health care systems and invest in a broader tool set to help patients mitigate chronic pain.
In a study released in JAMA Internal Medicine on June 30, Dr. Toblin and co-authors revealed that in one of the Army’s leading units 44 percent of the soldiers had chronic pain and 15 percent regularly used opioids. These rates are much higher than the general civilian population (26 and 4 percent respectively) and underscore a crisis in chronic pain among our service members and an overreliance on drugs to mitigate that pain.
The issue extends to the civilian population at large. Just a few days after the JAMA Internal Medicine report on opioid use in the military, the Centers for Disease Control (CDC) released a report on opioid use in the U.S. that found physicians wrote 259 million prescriptions for painkillers in 2012—enough for every adult in the country to clutch a bottle of pills.
Opioids and other pain drugs are the “fast food” of pain treatment. Widely available, and marketed, easy to prescribe and take, the country is flooded with these drugs and so they are widely consumed. Also, like fast food they are only meant to be consumed sparingly and for short periods, primarily for the treatment of acute pain. These are powerful drugs with serious side effects, risks of dependency and are potentially life-threatening when misused. The same CDC study attributed 46 deaths per day in the U.S. to prescription pill overdose and linked the increase in prescriptions as a key driver in the increase in painkiller deaths.
Physicians and healers must examine their role in this issue and drive for a change in culture-in their practices, hospitals and health care systems. In a commentary I wrote with Lieutenant General (retired) Eric Schoomaker, M.D., PhD, to accompany the JAMA Internal Medicine Study, we advocate for a major shift in spending to improve our evidence base for “self-care” and drugless options in pain management. This recommendation has already been made by the Institute of Medicine, who in 2011 called for a “cultural transformation" in how we address pain in America.
Earlier this year, Samueli Institute published the findings of a large series of systematic reviews on self-care for pain in a special supplement to the journal Pain Management. The document also lays out a research blueprint for determining the value of non-pharmacological approaches to treating chronic pain, including options such as yoga, tai chi, and music therapy.
With these two recent studies, the continual recommendations of experts to use fewer drugs and now a research map available to show us where we need to invest, we have no excuse not to act. It is essential that we strive to expand the options available to service members, their families and the country at large and assemble a more versatile toolkit for healers to choose from when addressing a patient with chronic pain.
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Wayne B. Jonas, MD
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