Medication Overuse in Chronic Pain

Abstract

Although antidepressants and membrane stabilization agents contribute to the crucial components for neuromodulation, opioids were frequently designated as a rescue remedy in chronic pain since adjunct analgesics usually do not provide instantaneous relief. The updated CDC guideline for prescribing opioids has gained widespread attention via media exposure. Both patients and prescribers are alerted to respond to the opioid epidemic and numerous complications. However, there has been overuse of non-opioid adjunct analgesics that caused significant adverse effects in addition to concurrent opioid consumption. It is a common practice to extrapolate the WHO three-step analgesic ladder for cancer pain to apply in non-cancer pain that emphasizes solely on pharmacologic therapy which may result in overuse and escalation of opioids in non-cancer pain. There has been promising progress in non-pharmacologic therapies such as biofeedback, complementary, and alternative medicine to facilitate pain control instead of dependency on pharmacologic therapies. This review article presents the current state of medication overuse in chronic pain and proposes precaution to balance the risk and benefit ratio. It may serve as a premier for future study on clinical pathway for comprehensive chronic pain management and reduce medication overuse.

Nonpharmacological Relaxation Technology for Office-Based Rhinologic Procedures

“…The addition of intravenous sedation increases the complexity of appropriate monitoring, and may diminish cost savings [1, 3]. There are also substantial public health concerns about oral opioid and benzodiazepine overuse in the United States [17-20]. Nonpharmacologic adjuncts would therefore be useful in enhancing patient comfort without the cost and safety concerns associated with intravenous sedation and oral pain control and anxiolytics.…”

“…It appears that many rhinologic procedures can be tolerated in the office setting with just local anesthesia in combination with nonpharmacologic adjuncts. This has important implications for avoiding the use of oral opioids and benzodiazepines during a national epidemic of the abuse of these drugs [17-20]. Intravenous sedation is also likely unnecessary and eliminates the need for additional equipment and safety monitoring.…”

“…Intravenous sedation requires additional monitoring personnel and equipment [1] and may diminish the cost-savings associated with office-based procedures [3]. There have also been substantial public health concerns regarding the overuse of oral opioids and benzodiazepines [17-20]. Adjunctive pain and anxiety management with nonpharmacological agents offers the potential to enhance patient comfort for office-based rhinologic procedures while retaining the improved safety and cost-savings of avoiding opioids and sedatives.…”

An alternative approach to solving the opioid epidemic: is there a role for non-pharmacologic analgesic therapies?

“…As suggested in our editorial on the perioperative use of opioid analgesics more than a decade ago, encouraging more liberal use of opioid analgesics in acute and chronic pain management (as well as in hospice care) has directly contributed to the current opioid abuse problem [2]. Changing the opioid prescribing practices after elective surgery and in emergency departments which have contributed to persistent opioid use and abuse is an easy first step in controlling the widespread abuse of opioid medication [31,38,39]. Finally, utilizing an integrative (inter-disciplinary) approach to pain management [41,42] involving more aggressive use of non-opioid analgesics, physical-and psychological-based therapies, as well as novel innovative non-pharmacologic complementary and 'alternative' therapies (e.g.…”

“…Of importance, Barnett et al [38] reported in a recent issue of the New England Journal of Medicine that long-term opioid use was increased in previously opioid-naive patients who received treatment in an emergency department from high (vs. low)-intensity opioid prescribers. Altering the prescribing habits of physicians and their surrogates to emphasize the role of non-opioid analgesic drugs and innovative non-pharmacologic approaches for treating acute and chronic pain would be an important first step in controlling the current opioid crisis [28,39].…”