As the opioid epidemic in the United States and worldwide continues unabated, doctors in many specialties are trying new ways to treat acute and chronic pain.

The opioid Issue: real or fake news?

Unfortunately, the opioid epidemic in the United States continues to grow. It has being fuelled in part by the overprescribing of opioid pain medications. There are some facts now emerging:

• In 2016, according to the Centres for Disease Control and Prevention, opioids were involved in 42,249 deaths
• 40% of all opioid overdose deaths involved a prescription opioid, usually illegal use
• Represents 46 deaths daily from overdose prescription drugs.
• Age groups greatest at risk are the 25-54 year olds
• Males were more likely to overdose compare to women ( approx. x1.2 times)
• It is important to note that the literature has shown that only 13% of those who overdosed were chronic pain patients.
• While we do not have the same level of data in the European context one can only expect a similar patter will emerge.

Dr. Dominic Hegarty ( Clinical director Pain Relief Ireland) is always looking for ways to reduce the use of opioids to treat pain, both acute and chronic using a combination of options, each one tailored to the need of each individual.

Acute Pain Management

In acute pain, such as that following an accident or surgery, opioid based treatments may be ideal. In fact opioids are often the goal standard for the treatment of severe short-lived pain during acute painful events (such as surgery) and at the end of life (e.g., pain associated with cancer). Currently, no other oral medication offers the same immediate and effective relief of severe pain.

Although opioids can be highly addictive, opioid addiction rarely emerges when opioids are used for short-term treatment of pain, except among a few highly susceptible individuals. For these reasons, International Association for the Study of Pain (IASP) supports the use and availability of opioids at all ages for the relief of severe pain during short-lived painful events and at the end of life.

Dr. Hegarty fully agrees with his approach and believes that gaining control early on is vital to avoid persistent long-term pain. Dr. Hegarty has published research on this issue of persistent post-surgical pain. Dr. Hegarty, also supports the IASP 2010 Declaration of Montreal which states that access to pain management is a fundamental human right. In reality, there are times when there is no substitute for opioids in achieving satisfactory acute pain relief.

Chronic Pain Management

Recently the role of opioids in the treatment of chronic pain has come into question.

We need to be cautious when prescribing opioids for chronic pain. There may be a role for medium-term, low-dose opioid therapy in carefully selected patients with chronic pain who can be managed in a monitored setting.

However, with continuous longer-term use, tolerance, dependence, and other neuroadaptations compromise both efficacy and safety. “Very quickly individuals sense they are experiencing side effects while they on the opioid products but because the pain is so difficult for them they persist taking the product”. Dr. Hegarty also says “when an individual, who has being on opioid for a prolonged length of time comes to see me I usually find that they have continued on the opioid because they are so desperate to get pain relief they will “take anything”. They are also frustrated at not seeing any “light at the end of the tunnel” and have struggled to deal with the psychological implications of chronic pain. When you add to that the burden that chronic pain places on individuals financially, socially and on their personal and family life it becomes obvious that this is a very complex situation.

When an individual come to Pain Relief Ireland we look at the whole picture and try and establish what are the good aspects and work on improving the therapy.

Generally we usually find that individuals have only used one therapy avenue to deal with their pain. Analgesics, such as opioid or morphine based products are common. We get to work immediately at defining what the individuals goals / expectations are and put a treatment plan in place to start this process.

Very quickly individuals sense they are experiencing side effects while they on the opioid products but because the pain is so difficult for them they persist taking the product...

- Dr. Dominic Hegarty (Clinical Director to Pain Relief Ireland)

Typically this plan would include the following 4 elements:

1. Reviewing all past and present analgesics medications to eliminate products that are not working and understand where we can improve using more pharmacologically sensible products. Where necessary a specific weaning off plan will be designed to help reduce the opioid levels.
    
2. Consider using pain interventions, such as injections to specific nerve fibres to help accelerate treatment and reduce the need for opioids in the long-term. This requires knowledge and expertise with clear outcome parameters.
    
3. Recommend rehabilitation plans to increase mobility and functional capacity in line with the other therapy. The key is knowing when to introduce this step
    
4. Explore the role of psychological support structures to continue the good work and ensure that the need for tablets / analgesics is kept to a minimum.

Every individuals pain is unique so a unique plan must be designed to meet each individual’s needs. At Pain Relief Ireland we not only focus on improving your pain but also on improving you work-life balance.
Call Pain Relief Ireland on 021 235 5500 to make an appointment.