We live in a nation of needless pain! According to CDC data from 2021, over 50 million Americans (21 percent of adults) experienced chronic pain that persisted for more than three months. Among these, approximately 17 to 21 million U.S. adults currently experience persistent, high-impact pain on most days: pain that severely limits daily life or work activities.
Increasing numbers of these patients are being denied pain relief by U.S. health care agency policies that discourage the use of prescription opioid analgesics and penalize pain management doctors or pharmacists who employ them on behalf of their patients. Related to this trend, increasing numbers of patients are being prescribed “or recommended” nonsteroidal anti-inflammatory drugs. Nonsteroidal anti-inflammatory drug prescriptions in the U.S. showed an increasing trend in ambulatory care settings from 2006 to 2016, rising from about 8.1 percent to 9.6 percent of visits, coinciding with opioid prescription declines after 2012. This worldwide trend has continued since.
The hidden dangers of alternative pain relief
In the same period, adverse drug events were involved in about 1.6 million U.S. hospital admissions per year. Nonsteroidal anti-inflammatory drugs accounted for about 10-30 percent of hospital admissions linked to adverse drug events, primarily gastrointestinal bleeds, renal failure, heart failure exacerbations, or bleeding, with ibuprofen as a common culprit due to its widespread over-the-counter and prescription use. Acetaminophen alone (although it is not a nonsteroidal anti-inflammatory drug) is involved in over 56,000 emergency room visits per year and is the number one cause of acute liver failure in the U.S. Roughly 160,000-480,000 nonsteroidal anti-inflammatory drug-linked admissions occur yearly.
Without a doubt, nonsteroidal anti-inflammatory drugs are effective in pain relief for large numbers of people. However, when purchased over the counter rather than under the supervision of a clinician, this class of drugs is highly problematic. When they are effective, patients continue using these medications, often at high doses. One clinician, Dr. Saurabh Sethi, who shares clinical advice online, asserts there are critical reasons he personally avoids excessive use of this medication.
On Instagram, Dr. Sethi shared: “75 percent of people who take them regularly develop gut inflammation, and one in four can develop ulcers. I perform endoscopies regularly, and see these ulcers first hand. Nonsteroidal anti-inflammatory drugs reduce blood flow to the gut, which can harm its lining. I have seen young, otherwise healthy people, come in with gut damage so severe they have ended up in the emergency room just because they did not know the risk of these medications.”
Comparing the risks of opioid analgesics
Contrast this record of disaster against the performance record of prescription opioid analgesics. It is now understood widely that the incidence of valid diagnoses for opioid use disorder among patients treated for chronic pain with opioid analgesics is on the order of one patient per one thousand treated. Similar incidence rates are also documented for treatment of acute pain.
It is said that one can lead a horse to water, but one cannot make him drink. Ironically, this seems to be nowhere truer than when the horse is a government agency bureaucrat who is effectively immune from lawsuits or even effective legislative oversight. It is enough to make a person long for the solution advocated by one of Shakespeare’s characters in A Midsummer Night’s Dream: “Let’s hang all the lawyers,” and a few health care bureaucrats too!
Richard A. Lawhern is a nationally recognized health care educator and patient advocate who has spent nearly three decades researching pain management and addiction policy. His extensive body of work, including over 300 published papers and interviews, reflects a deep critique of U.S. health care agencies and their approaches to chronic pain treatment. Now retired from formal academic and hospital affiliations, Richard continues to engage with professional and public audiences through platforms such as LinkedIn, Facebook, and his contributions to KevinMD. His advocacy extends to online communities like Protect People in Pain, where he works to elevate the voices of patients navigating restrictive opioid policies. Among his many publications is a guideline on opioid use for chronic non-cancer pain, reflecting his commitment to evidence-based reform in pain medicine.
Pat Irving is a nurse.
