The Opioid Epidemic
Patients are predominantly prescribed opioids to relieve acute pain related to injuries or surgery. While these medications are effective in treating pain, they carry the dangerous side effect of a high potential for abuse with prolonged use often leading to opioid addiction and misuse. According to 2016 survey data from the Substance Abuse and Mental Health Services Administration, 2.4 million Americans have an opioid-use disorder and that number has continued to increase in recent years.
Estimates indicate that over 650,000 prescriptions for opioids are filled per day across the nation with many being consumed for non-medical purposes. Per the Centers for Disease Control and Prevention, the number of prescription opioids dispensed in the United States approximately quadrupled between 1999 and 2015.
Need for Non-Drug Pain Interventions
The Foundation for Chiropractic Progress (F4CP) warns about worsening pain and drug overdose fatality trends in the United States, highlighting the need for safe, effective care and solutions for drug-free pain management. The latest evidence points to alarming public health trends; a recently published 17-year study revealed “extensive escalation of pain prevalence” across adult men and women in the United States aged between 25 and 84. There have been steep increases in prevalence over the studied period with 21% higher levels of joint pain, 16% higher levels of neck pain, and a 15% increase in low back pain cases. These findings support the need for broad research on and interventions for the worsening pain problem within the United States as well as across the globe.
The second alarming trend is an increasing rate of drug overdoses across the population. In December 2020, the Centers for Disease Control and Prevention (CDC) issued a press release linking mental health and economic disruption caused by the COVID-19 pandemic to a record number of deaths with the upward trajectory continuing unabated.
“These concerning trends are further indicators that a pharmacological approach to non-cancer, musculoskeletal pain is not just ineffective, but also dangerous,” Sherry McAllister, DC, president of the F4CP told PRNewswire in an interview. “While the nation is hopefully emerging from the COVID-19 pandemic for good, our progress combating the opioid epidemic is faltering while pain continues to debilitate more Americans than two decades ago. Fortunately, evidence continues to emerge that safe and drug-free chiropractic care can help more people find the relief they need without the risks associated with opioids and other addictive pharmaceutical drugs prescribed for pain, such as benzodiazepines.”
In the context of widespread recognition of the global burden of pain, the pace of innovation in the pain medicine sector continues to accelerate due to a confluence of technological and scientific developments.
Innovations in Pain Treatment
Today, there is a variety of innovative medical technology solutions available on the market that can help combat the national crisis and reducing the dependence on opioids. Implants and other devices, as well as applications and diagnostic tests can now help facilitate effective pain management while curbing misuse, abuse, and overdoses related to opioids. Furthermore, the development of minimally-invasive innovations has enabled patients to return to routine activities in a shorter period of time with less pain and discomfort post-surgery. Some of the innovative strategies for the treatment of both chronic and acute pain are outlined below.
Continuous Peripheral Nerve Block (cPNB)
This increasingly popular alternative consists of a percutaneously inserted catheter placed at the target nerve during a surgical procedure. Clinically proven to reduce exposure to opioids during and after surgery, the catheter allows for the continuous infusion of fast-acting local anesthetics that can provide prolonged pain blocking and may be titrated to reach the desired effect. Continuous peripheral nerve blocks can be used in hospitals, home care settings, as well as alternative care facilities and have been found to decrease both the incidence and severity of post-surgical pain.
Peripheral Nerve Stimulation (PNS)
Delivering pain relief without drugs, peripheral nerve stimulation involves placing a small electrical device next to one of the peripheral nerves. The electrode then delivers rapid electrical pulses to stimulate nerves for targeted pain relief and allows patients to control the level of stimulation as needed.
Deep Transcranial Magnetic Stimulation (TMS) Therapy
This method performs magnetic stimulation of brain structures and networks related to chronic pain, stimulating superficial cortical regions to provide pain relief. Deep TMS has been proven safe and effective in depression, obsessive compulsive disorder, and chronic pain.
Pulsed Electromagnetic Field (PEMF) Therapy
Pulsed electromagnetic field therapy utilizes dual-field electric and magnetic energy to stimulate cellular expression boosting overall health and wellness. This technique modified pain pathways by increasing the body’s naturally-occurring pain-relief mechanisms while reducing inflammation and swelling. PEMF is a non-invasive, sensation-free therapy that can be used both in the outpatient setting as well as at home.
Cryotherapy
Recently rising in popularity across the globe, cryotherapy utilizes the body’s natural response to extreme cold to treat peripheral nerves and immediately reduce pain severity. It can be delivered using a portable, handheld system or larger, stationary cryotherapy chambers that treat the entire body. Cryotherapy treatment has been found to reduce opioid use following surgery and also carries other significant health benefits, including improved mental health and wellbeing, decreased inflammation, and muscular healing.
Botox
Frequently used for the treatment of TMJ, Botox injections have been increasingly prevalent in pain medicine as research reveals that it may offer temporary relief. Emerging studies have shown promising results in patients with thoracic outlet syndrome using Botox as an alternative for rib-removal surgery. Further study is needed to determine the full extent of the clinical applications of Botox for pain relief.
Alongside radiofrequency neuroablation and spinal cord stimulation, there are many other innovative pain interventions that can greatly reduce discomfort without the use of drugs. Furthermore, the pain management innovation pipeline is robust with clinical trials underway across the globe aiming to develop novel methods for treating acute and chronic pain while ameliorating the opioid epidemic and its drastic population-wide effects.
Key Takeaways
Chronic pain rates along with the prevalence of opioid addiction have continued to rise to levels that demand an immediate focus on drug-free pain care. Innovations in pain management and alternatives to prescription opioids are plentiful and increasing rapidly as the medical and scientific communities work diligently to provide safe and effective solutions to millions of patients suffering from acute and chronic pain.
