Over 100 million American adults suffer from chronic pain at a cost of $560-$620 billion annually. In addition to incurring staggering direct medical costs and loss of productivity, these individuals often experience a diminished quality of life. While every age group and demographic in America experiences chronic pain, veterans, especially soldiers returning from active duty, bear a disproportionate burden of this national crisis.
Treating pain in the United States today relies heavily on over-the-counter anti-inflammatory medicines and prescription drugs, particularly opioids. The increased reliance on narcotics – prescriptions increased from 120 million to 220 million between 2000 and 2010 – while appropriate for some, adversely affected many patients, led to dependence for others, and contributed to a resurgence in the use of heroin in Arizona and other states.
In August, the United States surgeon general wrote a letter urging physicians to sign a pledge to “Turn the Tide on the opioid crisis” and reduce the number of opioid prescriptions. He warned that opioid deaths in the United States have quadrupled since 1999, and the marked increase in narcotic prescriptions “are almost enough for every adult in America to have a bottle of pills.”
The epidemic of prescription opioid abuse and heroin usage began with the adoption of sustained release opioids, particularly OxyContin, beginning in the 1990s. Promoted with claims that overstated its safety and effectiveness (in 2007 company executives pled guilty to criminal charges resulting in $634 million in company fines), OxyContin sales grew from $35 million in 1996 to over $1 billion by 2000.
The U.S. Centers for Disease Control and Prevention guideline, “Injury Prevention & Control: Opioid Overdose,” cautions clinicians to start with other therapies before resorting to opioids for treating chronic pain. Unfortunately, non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and other drugs like acetaminophen, present their own health issues, including gastrointestinal bleeding and liver failure that lead to over 100,000 emergency room visits per year. For many patients suffering from chronic pain, neither approach safely addresses the root of the problem.
Pain is an individualized phenomenon. Two people with similar injuries can experience pain with vastly different severity, different sensations and different responses to treatment. Furthermore, the presence of other health conditions, unique psychological reactions to pain, and the social support or lack thereof, present complex challenges for patients and their caregivers.
The Office of the Army Surgeon General’s Pain Management Task Force recommends an integrative approach to treating pain. An integrative approach incorporates a spectrum of evidence-based therapies provided by a multidisciplinary team of licensed practitioners that individualizes treatment for each patient. This can include drugs, but also emphasizes stress management and self-care, movement exercise, such as yoga, massage and spinal manipulation, acupuncture and nutrition. Groups in Arizona are already piloting projects with veterans that integrate medical and osteopathic doctors, acupuncturists, naturopathic doctors, chiropractors, massage therapists, yoga instructors and nutritionists. The goal is not only to measure reduction of pain but to also increase overall health and quality of life.
In addition to the United States Armed Forces, several states have already embraced the integrative approach to pain. In Minnesota, the integrative approach, which incorporates complementary and alternative medicine practices, has decreased high-dose opioid use among veterans by more than 50 percent.
Arizona already licenses the full complement of health professions needed to offer patients an integrative approach to address chronic pain. It is time for health professions to work together for the best interests of our patients. Arizona has the physicians and practitioners needed to be at the forefront in developing integrative approaches to treating patients with chronic pain. Do we have the will to make it a reality?
Michael Cronin, N.D., practices naturopathic medicine in Scottsdale and is former president of both the Arizona Naturopathic Medical Association and the American Association of Naturopathic Physicians. Paul Mittman, N.D., Ed.D., is president of the Southwest College of Naturopathic Medicine in Tempe. Klee Bethel, M.D., practices interventional pain management at the Southwest College of Naturopathic Medicine Pain Relief Center, and is chief of staff at the Arizona Spine and Joint Hospital.
The views expressed in guest commentaries are those of the author and are not the views of the Arizona Capitol Times.