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The Lasting Effect of the Opioid Epidemic on People Living with Chronic Pain Conditions

Managing PsA

May 30, 2023

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Illustration by Brittany England

Illustration by Brittany England

by Elizabeth Millard

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Medically Reviewed by:

Alyssa Peckham, PharmD, BCPP

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•••••

by Elizabeth Millard

•••••

Medically Reviewed by:

Alyssa Peckham, PharmD, BCPP

•••••

•••••

The ripple effect of opioid overprescription and misuse has left some people living with chronic pain without adequate care and carrying the burden of stigma. Experts are looking for adequate alternative treatments, but there’s a long way to go.

When Monique Carusoe-Cheeks, a 42-year-old Texas resident, woke up in excruciating pain in 2015, she had no idea it would be the beginning of a frustrating journey that continues even now.

“I’ve been to countless doctors and specialists in search of answers, but to no avail,” she says.

“Even with pain management specialists, it has been challenging, and the opioid crisis has made things even worse,” she adds. “I often feel like I’m stuck in a never-ending cycle of pain and suffering and having health professionals who don’t believe me.”

Eventually, Carusoe-Cheeks received diagnoses of ankylosing spondylitis and complex regional pain syndrome. While it’s a relief for her to have some answers, she has to brace herself whenever talking with a new specialist or even a different nurse.

She says that she often feels as though she’s being treated as a person with opioid addiction, even when she isn’t asking for opioids.

“Being in chronic pain and then having to deal with this on top of it makes me hesitant to get treatment even when I need it.”

Carusoe-Cheeks’ story is far from unique, according to Kevin Zacharoff, MD, course director for pain and addiction at Stony Brook Medicine in New York.

Chronic pain is often part of a breadth of conditions, including multiple sclerosis, psoriatic arthritis, rheumatoid arthritis, migraine, and others. The ripple effect of opioid overprescription and misuse can leave people with conditions like these without adequate care.

“These patients are caught in the crossfire, and they’re not getting what they need because of it,” says Zacharoff. “Not all of them need opioids, of course, but the whole situation has made physicians and clinics more hesitant to prescribe necessary pain meds in general.

“There’s a lack of education here on the part of politicians, regulators, even some clinicians,” he says. “The lines have gotten blurred between the need to have opioids and becoming addicted to them.”

That’s led to mandates against opioid prescribing, he adds. For example, opioids now come with extensive limitations for professionals, and the Centers for Disease Control and Prevention’s checklist for prescribing opioids for chronic pain includes setting criteria for stopping opioid use even before professionals give them to people.

The National Institute on Drug Abuse released a report about the state of opioid prescriptions and overdose deaths from 1999–2021. They found that prescribing had dropped — due in part to mandates but also awareness around addiction. Yet the number of overdoses is still hitting new record highs every year.

“What this tells us is that the idea of reducing prescriptions as a way to decrease overdoses is incorrect,” says Zacharoff. “If giving out fewer meds worked to curb the problem, the overdose numbers would be dropping instead of steadily climbing the way they are.

“In the meantime, patients are being denied pain meds and stigmatized… when the data shows us there’s a different story happening here,” he adds.

People who come into a doctor’s appointment with chronic pain often feel like they have a “scarlet letter,” he adds. What can worsen that feeling is conscious or unconscious bias on the part of a professional.

“The clinician may not even realize they have this bias, but the outcome is the same,” says Zacharoff. “They might order fewer tests or cut the appointment short or suggest that it’s all in the patient’s head. That leads patients to feel like they have to prove they’re in pain, but how does someone do that? More likely is that they’ll underplay the severity, and that can have a serious effect on mental health.”

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The quest for alternatives

One of the main challenges with veering away from opioids is that they work incredibly well, especially for acute pain, according to Medhat F. Mikhael, MD, a pain management specialist at MemorialCare Orange Coast Medical Center in Fountain Valley, California.

That’s why some healthcare professionals may prescribe them so often after surgery, as a way to reduce pain so recovery is easier.

“They work very well when it comes to short-term pain like you have in many postsurgical situations,” he says. “But if you’re looking for what to use in a chronic situation, you need to keep addiction risk in mind. That’s why it’s important to turn to opioids only when truly necessary.”

Currently, no alternatives are available that may work as effectively and replace opioids to reduce addiction risk. However, that doesn’t mean that statement will always be true. Experts are working on extensive drug development to find a non-opioid solution. For example, researchers are looking at how to inhibit the way nerves function, potentially lowering pain levels.

“Chronic pain truly affects so many aspects of life, and that’s why we have to keep looking for new options for those people having issues,” says Kaliq Chang, MD, interventional pain management specialist of the New York- and New Jersey-based Atlantic Spine Center.

“It’s been decades since we had a real breakthrough, but we may be on the verge of one within the next decade and hopefully sooner. We certainly know a great deal about the pathways of pain signaling and inflammation,” he says. “Now we just need to use that knowledge for more solutions.”

Until that happens, people living with chronic pain will likely have to keep trying different therapies and working with their health professionals and pain specialists. That’s not ideal, Chang admits, but in some cases, using multiple pain strategies — for example, combining anti-inflammatory medications, acupuncture, physical therapy, medical marijuana, visualization, and other options — could have enough of an effect to improve a person’s quality of life.

“Of course, it’s unfortunate that we have this stigma lingering around opioid usage, but the hope is that in the future, we’ll have enough alternatives that opioids may be used only infrequently and for short-term, acute pain,” says Mikhael. “Until then, practicing more self-advocacy in healthcare settings, turning to pain management specialists, and finding providers who listen will be crucial for getting the care you need.”

Medically reviewed on May 30, 2023

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About the author

Elizabeth Millard

Elizabeth Millard lives in Minnesota with her partner, Karla, and their menagerie of farm animals. Her work has appeared in a variety of publications, including SELF, Everyday Health, HealthCentral, Runner’s World, Prevention, Livestrong, Medscape, and many others. You can find her on Instagram and LinkedIn.

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