Pain management: reducing the risk of opioid dependence

cChronic, sometimes debilitating pain afflicts millions of Americans, including cancer patients. Over the past two decades, powerful drugs known as opioids have been widely prescribed, but the drugs, while useful in preventing pain, come at a significant cost to patient health, increasing the risk of dependence and abuse. Now, opioid addiction and overdose deaths in the United States have risen to unprecedented levels as the federal government has declared a public health emergency, prompting many doctors to reassess the way they treat pain. In cancer care, where an estimated 50 to 70 percent of patients experience uncontrollable pain at some point in their cancer journey, pain management professionals strike a delicate balancing act: They monitor close to patients who may benefit from opioid therapy and rely on Growing on alternatives such as pain pumps. and nerve blocks.

“Chronic pain can affect a person’s quality of life. This is why interventional treatments to reduce or relieve pain are essential.” – Nathan Neufeld, DO – Chief of Pain Management at Cancer Treatment Centers of ^America® (CTCA)

What are opioids?

Opioids (oxycodone, hydrocodone, fentanyl, and others) are narcotics prescribed to control moderate to severe pain. They work by sending signals to the brain that block pain and produce a calming effect. In the 1990s and early 2000s, drug companies began aggressively marketing opioids as an effective method of pain control. Long-term use can cause a number of side effects, ranging from constipation to hyperalgesia, and increased sensitivity to pain. Dr. Neufeld says that the drugs’ addictive properties and long-term consequences for patient safety are the side effects of most concern to the medical community. This is why the current approach to treating cancer-related pain uses opioid analgesics with greater caution. Pain management professionals have found that other treatments can control pain with fewer side effects than oral narcotic medications, says Dr. Neufeld.

Lidocaine, a local anesthetic, for example, can temporarily prevent pain when injected into a joint or spine. For long-term relief, doctors may recommend a neurological block, which involves injecting a neurolysis agent near certain nerves. The drug is designed to reduce pain impulses as they flow from nerves to the brain. Sometimes, says Dr. Neufeld, the nerves regenerate and the pain returns, but the procedure can be repeated as needed.

What other options are there?

Some patients may also feel relief with a pain pump, which is a small device that is surgically implanted and delivers small amounts of medication to the spinal cord, allowing the dose to be adjusted using a handheld device. This minimally invasive procedure can be used to relieve back, neck, extremity, abdominal or pelvic pain and for certain types of headaches.

These and other treatment options are often used in conjunction with supportive care therapies, such as physical therapy, mind-body medicine, and acupuncture, and can provide a more comprehensive pain management strategy than opioids, says Abdel-Rahman, MD, MSc, Interventional Pain, PhD. in medicine from our hospital near Chicago.

Because all patients experience pain and respond to treatment differently, pain management and management strategies must take into account a number of factors specific to them, including their level of pain tolerance, health history, other medical conditions, and the source and severity of the pain. pain. .

With a record 15.5 million cancer survivors in 2016, effective management of disease-related pain is more important than ever. “The goal is for the patient to be in control of the pain, not the other way around,” says Dr. Rahman. “Combining traditional and integrative pain management strategies provides a more balanced approach.”