© 2017 by Shawn Wilson 

Multidisciplinary Treatment for Chronic Pain Opioid Users

September 11, 2017

​​​Chronic pain is a debilitating condition that impacts many different areas of a person's life. Those with chronic pain have often tried a variety of treatments and are desperate to find anything that works. About one in five patients with chronic pain take opioid medication to help them manage their pain symptoms.

 

There has been a lot of press coverage in recent years regarding the opioid crisis that America and other countries around the world are currently dealing with. Given that opioids can be incredibly addicting, there is an effort across the country to reduce the number of opioid prescriptions.

 

Indeed, according to the Centers for Disease Control and Prevention, over 40 people die every day due to opioid prescription overdoses. In addition, in 2014 an estimated 2 million Americans had a substance use disorder related to prescription opioids. Keep in mind this is only looking at prescription opioids and not other forms of opioids, such as heroin. 

 

Now reducing opioid prescriptions is not all that helpful for those who use opioids as part of their treatment of conditions, such as chronic pain, unless there is something to replace the opioids with. One program, has been addressing opioid use in chronic pain patients for over 40 years. This program, as reported by the National Public Radio (NPR), is run by the Mayo Clinic's Pain Rehabilitation Center (PRC). The Pain Rehabilitation Center runs a three-week multidisciplinary treatment program for adults and adolescents with chronic pain that uses a biopsychosocial approach.

 

Consistent with this approach, the Pain Rehabilitation Center has specialists in areas such as pain medicine, physical therapy, clinical psychology, occupational therapy, biofeedback, and nursing. In addition, the Pain Rehabilitation Center treats a variety of conditions including chronic back pain, fibromyalgia, chronic fatigue, migraines, abdominal pain, and nerve (neuropathic) pain. 

 

Sounds great right, so what is the catch? The catch is that all of the patients have to agree to completely eliminate their opioid use by the end of the treatment program. That is a pretty big ask for some patients with chronic pain who may have relied on opioids for a number of years to manage their pain symptoms. 

 

While it sounds like a big commitment (and it is),  over 80 percent of those who enroll in the Mayo Clinic's program complete it. In addition, many of these patients are able to remain off of opioids six months after they complete the program.

 

Unfortunately it can be hard for many of the patients to obtain insurance coverage for the treatment program as it is seen as 'medically unnecessary' despite its evidence-based approach aimed at reducing opioid usage and increasing quality of life. Another barrier is that the Pain Rehabilitation Center only has three campuses: one in Arizona, one in Florida, and one in Minnesota. Even worse, only the Minnesota campus offers the adolescent three-week program.

 

Hopefully as the Mayo Clinic has continued success with its multidisciplinary program, many more programs across the country and across the world more broadly become available for patients with chronic pain who want to reduce or eliminate their reliance on opioid medication. If research can demonstrate that these multidisciplinary programs reduce long-term medical costs and increase patient functioning, then insurance companies will be more likely to cover the costs in the future.

 

The intent of this multidisciplinary approach is not to pathologize the use of opioids in general; there are some patients that undoubtedly benefit from opioid usage. One of the problems with opioid use however, is that while opioids can work effectively in the short-term, there are considerably less effective in the long-term. Therefore the intent of these multidisciplinary programs is to instead emphasize that there are also other approaches to treating long-term chronic pain. Indeed given the side effects and high potential for abuse, any amount of unnecessary opioid usage that is reduced should be considered a worthy achievement. 

 

Chronic pain is a debilitating disease that often requires multiple approaches to properly treat. More innovative programs, such as the Mayo Clinic's program, are needed to help treat the variety of problems that accompany the wide array of chronic pain conditions.

 

NPR News Article: http://www.npr.org/sections/health-shots/2017/08/29/546145817/holistic-therapy-programs-may-help-pain-sufferers-ditch-opioids

The Clinically Relevant Insights Blog, part of ShawnWilsonPhD.com, shares news and research regarding psychology and wellness.

 

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