Beyond opioids: moving towards evidence-based interventions for chronic pain
During the late 1990’s the idea that pain was being undertreated gained traction, leading to the coining of pain as the 5th vital sign.  Alongside this new understanding, pain was given status as a human rights issue. This meant that the denial of pain medication became the denial of a person’s human rights. At the time, opioids had been prescribed for acute pain and cancer pain. However, one publication in a major medical journal stating opioids as safe for chronic pain patients (based on unverified research) changed prescriber attitudes. Subsequently opioids were being prescribed to anyone in ‘pain’. To further lay the groundwork for an opioid crisis, governing agencies began to use patients’ pain control as a measure of the hospital’s success.2 The funding and government reimbursement of hospitals depended on their success and thus the pressure to prescribe opioids for pain was significant.
It is now 2019 and we have a definitive evidence-base proving that long-term opioid therapy has little to no benefits for chronic pain patients, instead being fraught with risks of misuse, dependency and overdose. While opioids can play a useful role in acute pain, cancer pain and in a palliative care setting, the evidence suggests that long-term opioid use decreases quality of life and provides unsustainable pain relief as the body becomes tolerant to the substance. Regardless of the undeniable harms of addiction, opioid use is an “independent risk factor for depression, and in some patients can paradoxically worsen pain”.  This worsening of pain is called opioid induced hyperalgesia. It is now understood that classical opioids (e.g. codeine, morphine, oxycodone, fentanyl) activate a neuro-immune response which amplifies the transmission of pain signals in the spinal cord and brain. These medicines can provide short-term relief whilst slowly making overall pain experience worse over time.
Furthermore, pain is now understood as a biopsychosocial experience, meaning it comprises of biological, psychological and social factors. To suggest a one-size-fits-all approach to managing pain is to neglect vital contributing factors to that person’s pain. Yet, chronic pain is still one of the most cited reasons for opioid prescriptions, reflecting a time-poor and overburdened medical system where pressures for quick fixes are strong. Alarmingly, the opioid crisis is growing in Australia, as the rates of opioid related deaths have almost doubled between 2007 and 2016 (from 3.3 to 6.6 per 100,000), with more than three-quarters of these deaths involving prescription drugs. 
Given the current opioid epidemic, it is critical that the medical field utilises opioid-sparing therapies that are effective and evidence-based for the long-term relief of chronic pain. At this time, many innovative and effective therapies are available at Metro Pain in alignment with each patients’ pain management plan. Our treating teams are multidisciplinary and can address and relieve pain from biological, psychological and social aspects to help our patients live better. Treatment options such as nerve blocks and neuromodulation (a therapy in which electrical currents interrupt pain signals) have been revolutionary in how we view and treat chronic pain globally.
While there are many novel and innovative treatments that are proven and more effective than opioids for long-term chronic pain relief, the epidemic is likely to continue for now. Unfortunately, until these treatments become affordable and accessible on a larger scale we will continue to see overburdened medical systems opting for quick-fix solutions to the long-term detriment of society and people suffering chronic pain.
These reasons amongst others, drive our passions at Metro Pain Group to find better ways than prescribing pills to help our patients suffer less, function more and live better.
If you would like your current pain management plan reviewed, or for more information, please fill out the form below:
 Morone, N. E. and Weiner, D.K. 2013. Pain as the 5th vital sign: exposing the vital need for pain education. Clinical Therapeutics, 35(11), pp. 1728-1732.
 Rummans, T.A., Burton, C.M and Dawson, N. 2018. How good intentions contributed to bad outcomes: The opioid crisis. Mayo Clinic Proceedings, 93 (3), pp. 344-350.
 Juurlink, D.N. 2017. Rethinking “doing well” on chronic opioid therapy. Canadian Medical Association Journal, 189 (39), pp. E1222-3
 Roxburgh, A., Dobbins, T., Degenhardt, L and Peacock, A. 2018. Opioid-, amphetamine-, and cocaine-induced deaths in Australia: August 2018. Sydney: National Drug and Alcohol Research Centre.