According to IMS Health, a company that tracks sales for drug companies, Vicoden, an opioid-based pain killer, is the most commonly prescribed medication in the country, and almost 20 percent of all doctor visits involve a prescription for opioids. Drug companies know that the prescription of opioid-based pills is "the gift that keeps on giving" because once folks start taking them they won't stop because of the physical dependence they create. I think it is fair to say that there have been some pretty successful business plans out there!
Shouldn't the fact that chronic pain sufferers are now getting more access to the strongest pain killers on the planet and at higher dosages mean that we are now doing a better job helping them manage their pain? Guess again. In my 15 years of practice, I have yet to see a scientifically sound study that can show significant benefit from the long-term use of opioid medications for chronic pain in a large patient population.
There are many reasons for this including problems with tolerance, addiction and a newer discovery known as opioid-induced hyperalgesia (OIH) -- where opioid medications eventually cause some to get even more sensitive to pain. That would be akin to insulin shots making your glucose go up instead of down. If you have never heard of OIH, then my guess you is will get an earful about it once a drug company comes up with a supposed pill to treat it. Did you ever hear of ED before Viagra? Unfortunately, statistics can't describe the heartache I see every day from the over-dependence on medications.
In no way are the problems with pain management strictly limited to the misguided use of pills. For example, over the last two decades there has been an exponential rise in the use of spine surgery and interventional procedures for the treatment of lower back pain. Rapid growth has taken place in the use of more complex and costly spinal fusion surgeries, and there is cut-throat competition among the manufacturers of the hardware used in these procedures. Medtronic alone makes $3 billion annually off of its spinal device unit. Again, research has consistently shown that such treatments are no more effective for low back pain than much lower cost alternatives such as aggressive rehabilitation. What the data can't describe is what some patients and their families go through for months and years trying to recover and get their lives back after having these types of surgeries.
For years now, evidence-based medicine and scientific outcome studies have consistently shown that the most effective way to treat chronic pain is through comprehensive interdisciplinary pain programs. In 2006 the American Pain Society'sJournal of Pain published the most comprehensive and thorough review of all chronic pain treatments to date. No matter what criteria they looked at, including improved pain levels, function, return-to-work rates and cost-containment, outcome studies demonstrated that such programs gave the best long-term results. The authors concluded that "the only therapeutic approach that has shown efficacy and cost-effectiveness is a chronic pain program" and "there is unequivocal evidence for chronic pain programs." Sadly, there are very few of these types of programs out there. Having run this type of treatment for ten years now, I could bore you with the details of all of the challenges I have faced trying to "do the right thing," but instead let me focus on the rewards.