The drugs don’t work: chronic pain, the opioid crisis, and a better way forward
In the midst of the COVID-19 pandemic, another epidemic has continued to rage quietly on in the homes of millions of Americans - the opioid crisis. According to the American Medical Association, more than 40 states have seen increases in opioid-related deaths since the pandemic began.
The drug crisis is a pain crisis
You may have heard that we’re now more likely to die from an opioid overdose than in a car accident, and by now we know that chronic pain is often the cause. The most regular users of prescription opioids suffer from musculoskeletal (MSK) conditions, with 63% of regular users reporting arthritis and 59% reporting back pain. Up to 29% of patients prescribed opioids for chronic pain misuse them, and up to 10% of them will develop an opioid use disorder.
How did we get here? In the 1990s, the medical community began thinking of pain as the "fifth vital sign." This led to a movement to decrease or eliminate pain as quickly as possible. When one of your vital signs (temperature, heart rate, breathing rate and blood pressure) is out of whack, your physician will take a two-pronged approach to treating it: medication to bring it back into range quickly, and lifestyle interventions to help you manage it for the long term. For example, if your blood pressure is too high, you’ll be prescribed a medication to bring it down quickly, and put on a diet and exercise regimen to help you keep it down naturally.
Unfortunately, treating pain like a vital sign wasn’t successful, for two reasons: the medications used to bring it down are highly addictive, even when prescribed therapeutically, and many of those treating pain didn’t address the lifestyle factors that were contributing to the pain in the first place. We know that there are many factors that contribute to pain, particularly chronic pain, yet we only tried to treat it from one angle.
Much of the discussion around the opioid crisis in the United States has centered around restricting the availability of the drugs and the rate of prescription, and improving access to treatment and recovery options. This is necessary work to reverse the trend of over-prescribing and help those already in the vice grip of these medications, but doesn’t address the root cause: the rise and rise of chronic MSK pain. If drugs don’t work for MSK pain, what does? And how can we treat this crisis at its root?
Why the drugs don’t work
Opioids aren’t just incredibly addictive, they’re also ineffective at treating chronic pain. This is because they don’t resolve pain at its source, they simply mask the symptoms. Opioids work by blocking pain receptors in the brain. Using them for extended periods can lead to structural and functional changes in your brain that result in tolerance, which means you’ll need to take higher and higher doses to get the same pain-relieving effect. In addition to becoming less effective at pain relief over time, they also have a negative effect on your emotional health. Initially, opioids produce feelings of wellbeing, but with increased use, can cause feelings of depression when the drug wears off.
Opioid use doesn’t lead to better outcomes in chronic pain - instead, it can have a deleterious impact on our ability to manage pain, decrease our quality of life, quash our productivity and send our healthcare costs skyrocketing. Studies have shown that people who end up dependent on opioids due to a work-induced MSK condition are disabled for three times longer than those who don’t.
A better way out
In order to truly end the opioid crisis, we need to solve the underlying pain crisis, by making non-invasive, non-pharmacological treatments the first line of defence for chronic MSK conditions.
The American College of Physicians and the CDC recommend a combination of therapeutic exercise, education and behavioral interventions to relieve MSK pain effectively without the use of drugs. The challenge has been making these kinds of interventions as readily-available and easy to use as medications - and this is where SWORD comes in.
Our programs combine these three pillars of gold-standard care into digital therapy programs that members can perform in the comfort of home, with educational and emotional support from licensed PTs who are available for them whenever they need it. Our programs have proven to reduce pain levels by 50% in just 8 weeks, and among those who are taking medication, almost a quarter (24%) of them stop completely by 8 weeks, and the others reduce their intake by almost half (48%).
At SWORD, we believe that the pain crisis is solvable, and we’re proud to be doing our part. To find out more about how SWORD is helping thousands of members overcome chronic pain and free themselves from the grip of medications, contact us today.
About the author: Dr. Fernando Correia, M.D.
Dr. Fernando Correia is the Chief Medical Officer at SWORD Health, where he leads clinical validation and medical affairs. He is a physician with a specialty in Neurology, and also holds an Executive Masters degree in Healthcare Management.
He co-founded SWORD with the firm belief that technology can lead healthcare into a new era, one where high-quality, evidence-based medicine is available to everyone, not just a select few. He also believes that a more humanistic approach to healthcare is needed, and that technology and the human touch can go hand in hand and make each other better.
Fernando received his M.D. from the University of Coimbra and his Executive Masters from Católica Porto Business School. He trained in Portugal and in the UK (National Hospital for Neurology and Neurosurgery and Great Ormond Street Hospital for Children). He lives in Porto, Portugal with his family, where he enjoys playing tennis, reading all kinds of books and savoring a good glass of wine.