America is embroiled in an opioid epidemic.  More Americans are dying each year from overdoses of prescription opioids than all illicit (non-prescription) drugs combined.  Opioid addiction affects not only those suffering with the addiction, but the people who surround the addict as well.  On any given day, newspapers and news channels have one or more stories about opioids or issues connected to opioids. Some of the most serious problems our society is grappling with are related to the opioid epidemic.  

In 2010, President Barack Obama outlined a five-year plan to reduce prescription opioids, which included four focuses:

1) Education to healthcare providers and the public

2) Monitoring to attempt to decrease “doctor shopping”

3) Proper disposal of unneeded opioids in the community

4) Enforcement of closing “pill mills”

The Centers for Disease Control and Prevention (CDC) addressed the issue in the Morbitity and Morality Weekly Report (MMWR) March 18, 2016 / 65(1):1-49, which outlines 12 strict guidelines for the prescription of opioids, available at http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm.  

These are all steps in the right direction, but pain still must be treated.  

Pain is a necessary biological response.  Pain receptors are how a person removes their hand from a hot surface without thinking. Biologically valuable pain indicates when something is wrong, such as an injury or infection. Conversely, chronic pain is pain that lasts longer than 3 months and is without biological value or known etiology.  Pain is the fifth vital sign, although it is the only subjective vital sign.  Pain is a personal experience. Two people with the same illness or injury may experience vastly different levels of pain. According to some researchers, as many as 1 in 3 Americans suffer from chronic pain.  Chronic pain can be debilitating, affecting every aspect of a person’s life. Chronic pain has been linked to decreased immunity and depression. Medical providers must always remain vigilant in their response to complaints of pain.  

In the past, both chronic and acute pain has been treated with opioids.  In the future, chronic pain will be more often treated with non-pharmacological interventions and non-opioid medications. Physical and occupational therapies will be applied to assist people with chronic pain whenever possible. Other treatments will be explored as the medical community moves away from prescribing opioids medications for chronic pain.  Acupuncture is a centuries old practice, has been proven effective for some people with chronic pain.  Meditation is another avenue to explore in the treatment of chronic pain.  New treatments are being developed, such as repetitive transcranial magnetic stimulation (TMS).  In this treatment, a magnetic field changes brain activity, which interrupts the pain messages sent to the brain from the affected body part. More research is required into repetitive TMS to prove it is safe and effective against pain long term.  As we evolve away from the use of opioids, many new and exciting changes are taking place pain treatment.  

Opioid addiction is prevalent in the geriatric community as well and LTPAC providers must review their practices to ensure that they are in line with the CDC’s guidelines.