Over-reliance on opioids is due to poor training of physicians in manual medicine and injection techniques. What techniques? – look at my blog and at the proliferation of chiropractors. Most of chronic pain has a major myofascial component that is simply ignored. Recently there was an article published on the major trend to opioid abuse in the USA.
Anaesthesia. 2013 Dec;68(12):1210-5.
Pain policy and abuse of prescription opioids in the USA: a cautionary tale for Europe.
Kotecha MK, Sites BD. no abstract
- 1990’s – opioid abuse was thought small and pain treatment began to be acknowledged as a human right. Chronic pain became the “5th vital sign”
- standards were set to include opioid prescriptions
- past 2000 – a large increase in elicit opioid use and increase in deaths from opioids
- opioid abuse beats cocaine, hallucinogens, inhalants and heroin combined – considered an epidemic
- Long term opioids not associated with “long term efficacy” – what exactly do they expect? – it only reduces the pain by 20-35%.
Comment – along with this overutilization of opioid has been the tremendous lack of training physician have in orthopaedeic medicine. People write me about various issues and I suggest they see their physician about getting certain shots – like steroid injection for iliocostal impingment – These people write me back saying they wasted their money seeing a “pain expert” who said he doesn’t do those shots – ie doesn’t know how… Back in 2008, doctors were getting 11 hours of training in “pain medicine” – work is being done to encourage more, but this is driven by opioid perspective groups only. Back in the 1990’s when opioid use came into acceptance thanks to the push from pharmaceutical companies, I thought all my manual medicine, nerve and trigger injections and muscle work would no longer be necessary. However, some of my patients came back needing just as much. People in this country can wait 2-3 years to see a pain clinic – by that time the pain has completely centralized.
Along with that, new techniques are evolving quickly, and the medical profession is very slow to adopt. Two randomized control trials have shown frequent B12 shots can reduce pain by 13-25% over placebo, yet all Cochrane would say was they needed to MRI all their chronic back pain subjects (never going to happen without pharma help and there will be none).Simple skin injections above tender nerve tracts will gradually reduce peripheral pains but will probably not be generally done in my lifetime…
Do we have a crisis in opioids? – maybe – but more we have a crisis in orthopaedic medicine – some doctors still don’t believe that rib levels can hurt unless they are broken…