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Home > Why Opioids are not First-Line Treatment for Chronic Pain in our Practice

Why Opioids are not First-Line Treatment for Chronic Pain in our Practice

Raj N. Sureja, MDJenny L.F. Andrus, MD

Raj N. Sureja, MD   Jenny L.F. Andrus, MD

Although we’ve often talked about the hazards of opioids in articles we have authored, and shown data that opioid use isn’t effective for long-term treatment of chronic pain, we thought it appropriate to specifically outline why we choose to exhaust all other pain treatment options before considering opioids in our interventional pain management practice at OSC.

A medical history lesson might be helpful in understanding how we got to this point.  During the 1970s and 80s, physicians were quite careful with prescribing narcotics (opioids) to their patients, even for post-surgical pain.  Remember, at this time in medical history, surgeries were not minimally invasive, but instead featured long incisions, with significant tissue and bone cutting, lengthy hospital stays, and much less effective nerve blocks, if any.  Patients were not prescribed opioids, but expected discomfort after surgery, knuckled through it in a week or two and got better.

Opioid medications were typically reserved for patients who had cancer with severe pain, or who were terminally ill.

But. thinking about pain in medical circles began to change and a movement started that would revolutionize its treatment.  In 1995, Dr. James Campbell addressed the American Pain Society and urged healthcare providers to recognize pain as the 5th Vital Sign and to understand that pain was being under-treated by physicians.  This prompted a massive pendulum swing among Primary Care Physicians, who, believing they were doing the right thing, started asking patients about their pain levels at every visit.

Vital signs, such as blood pressure, heart rate, and temperature, can be objectively measured by a calibrated instrument designed specifically for that purpose.  Pain is subjective and varies from patient to patient, day to day, minute to minute.  It cannot be measured in any objective way.  Using a 1-10 numerical system that moves from: a smiley face (1), to a neutral face (5), to a frowny face (7), to a crying face (10) is not the best scientifically objective measurement.  But it is what physicians use to measure a patient’s pain.

As is the case with many medical issues, the government and the pharmaceutical industry soon became involved in “the 5th vital sign” issue.  Physicians were urged to prescribe opioid painkilling drugs to address any kind of pain patients were experiencing, not just cancer pain or that from a terminal illness.  Pharma reps began handing out samples of opioid medications in massive quantities to physicians to give to patients “to try”.  Advertising told Americans that we weren’t supposed to have ANY pain, at any time, whatsoever, because we could just ask our doctor for a pill to make it go away! What was once rare became commonplace, and as prescribing of opioids rose, so did rates of addiction.

We are all now aware of the issue of opioid addiction in the United States and the devastating effect it has on our communities and families. Americans consume 80% of the world’s supply of opioids, when we make up only 5% of the world’s population.  In fact, in 2016 the American Medical Association (AMA) voted to stop using pain as the 5th Vital sign, saying it contributed to the opioid epidemic.

Multiple studies show that long-term, daily opioid use actually increases pain – a condition called hyperalgesia.  Studies also show that these patients tend to do worse physiologically, with increased rates of cardiovascular events, fractures, chronic constipation, or bowel obstructions, are at greater risk of early death from accidental overdose, have depressed respiration or other breathing issues and suffer from depression, anxiety, and other mental issues, more often.  This is without considering the greatly heightened risks for abuse or addiction, as well as diversion of the drug for secondary gain.

As Interventional Pain Management Physicians our goal is to help our patients achieve the best possible quality of life while effectively managing their chronic pain.  We develop a special relationship with our patients – a partnership, if you will, where we work together closely to find the best possible pain relief solution for their specific needs.

As the word in our title suggests, “intervention” in the pain cycle is very important to what we do.  We search for the root cause of pain and attempt to intervene in how signals are sent to the brain and interpreted as pain.  Often, we can have great success with a multi-modal medication program, that utilizes various forms of medication including anti-inflammatory drugs, nerve calming drugs, anti-depressants, and Tylenol, without using opioids.

We also employ a wide variety of interventional procedures, that we do in-office to give our patients the best chance at reduced pain without opioids.  Epidural steroid injections, facet joint injections, nerve blocks, radio frequency ablations, and spinal cord stimulation (neurostimulation) are just a few of the pain-reducing procedures we provide.

As a rule, we exhaust all other options before ever considering opioids as a pain management tool.  Then, we only allow their use sparingly, as a bridge medication, for times of especially intense, severe pain.  We find that our patients do much better physiologically and have better overall pain control when we take this approach.


If you are considering OSC for Interventional Pain Management care, please know that we will be happy to review your case for care.  If you are accepted into the practice for interventional pain management, please be advised that we will not prescribe opiates for you on the first visit.  We appreciate your understanding and look forward to providing care for you.





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