All indications are that pain care in the United States is in crisis. There is an epidemic of prescription opioid-fueled opioid addiction and overdoses (over a million dead and millions more addicted) as well as an epidemic of chronic pain. Estimates of the prevalence of pain indicate that from 21 percent (2021 National Health Interview Survey) to 56 percent (2021 Harris Poll) of Americans have chronic pain, and about 7 percent have high-impact pain (pain that limits daily activities on most days or every day). Forty percent of doctor visits are due to pain, and chronic pain is the leading cause of disability in the United States.
At the same time, a 2018 systematic review of pain medicine content in medical school curriculums in the United States found that the median number of hours dedicated to pain medicine was nine hours. This was an increase from a 2013 study that found that the average amount of time dedicated to pain education was less than two hours. Surveys of primary care physicians have found that most physicians do not feel competent in their ability to treat pain. Overzealous overreach and prosecution by the Drug Enforcement Agency (DEA) of even legitimate doctors treating legitimate pain patients with opioids has left many doctors fearful of treating pain patients with one of the few tools they have been told is effective. Pain patients frequently complain that they get little help from their physicians, who treat them like drug seekers and frequently abruptly taper or cut them off from opioids without regard to withdrawal issues and without offering other options. When pain patients lose their doctors due to relocation, physician retirement, or loss of licensure, they often cannot find other physicians willing to take them on.
The tools that conventional physicians have access to are primarily pharmaceutical or surgical and fall short for most patients due to poor effectiveness or side effects. Opioid addiction risks are high (10-12 percent of those prescribed), and that is not the only problem. More than 50 percent of patients prescribed opioids find the side effects intolerable or the drugs ineffective. Opioids also lower immune response, contribute to traffic accidents and fatalities, increase the incidence of falls in the elderly, can cause psychosis in vulnerable individuals, and can increase pain levels over time (hyperalgesia).
All other pharmaceuticals prescribed for pain have limitations in terms of ineffectiveness, serious side effects, or risks. Gabapentinoids, including gabapentin and Lyrica (pregabalin), provide pain relief in less than 25 percent of patients, according to patient surveys, while many report intolerable side effects, including fatigue, brain fog, anxiety, depression, mood swings, memory problems, suicidal thoughts, addiction, and more. Recent studies have found that gabapentinoids increase the risk of dementia. NSAIDs can cause life-threatening gastrointestinal bleeding, kidney damage, and an increased risk of heart attacks and strokes with chronic use. Immunosuppressant drugs increase the risk of infections and cancer. Antidepressants have not been shown to be effective for chronic pain, and side effects include drowsiness, dizziness, weight gain, heart rhythm problems, confusion, agitation, hallucinations, insomnia, increased eye pressure, and much more.
Surgical procedures are often misguided and cause harm. This is particularly true of back surgery, often based on a false premise that disc issues such as degenerated, bulging, or herniated disks are the cause of back pain. MRI studies going back as far as the 1990s found that most people, particularly as they grow older, have “disc disease” and often have no pain, leading researchers to conclude that findings of disc abnormalities may be coincidental and unrelated to the pain. Back surgery often makes things worse, resulting in failed back surgery syndrome, often treated with spinal cord stimulators that are often ineffective, poorly tolerated, and cause more harm.
Beyond the issues of ineffectiveness and serious side effects, the problem with conventional pain treatments is that they do not get to the real root of the problem, so patients do not get better. Common causes of chronic pain include nutritional deficiencies, muscle weakness, spasm, stiffness or imbalance, chronic inflammation, poor posture, toxic exposures, chronic stress, or unresolved trauma.
There is growing evidence that alternative pain treatments are effective in treating and often eliminating chronic pain by treating the underlying causes. These interventions include nutritional medicine (provided by functional and integrative MDs, nutritionists, and naturopaths), exercise, mind/body approaches (including meditation, psychotherapy, particularly trauma-informed, biofeedback, and neurofeedback), chiropractic, massage therapy, physical therapy, herbal medicine, cannabis, and more. There are also a variety of noninvasive devices that reduce pain and inflammation and accelerate healing, including red/infrared light therapy, pulsed electromagnetic frequency therapy (PEMF), frequency-specific microcurrent therapy, neuromuscular electrical stimulation (NMES), infrared heat therapy, hyperbaric oxygen therapy (HBOT), Calmare Scrambler Therapy, and more. These interventions tend to be very safe. The only “side effects” are improved overall health and well-being.
By becoming more educated about alternative pain treatments and making appropriate recommendations and referrals, physicians can vastly improve their pain patients’ quality of life as well as improve their own satisfaction with their work.
Cindy Perlin is a social worker.
