Monthly Wellness Update

Atit Shah, MD

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The only person who really knows the extent and severity of your pain is yourself. It is my mission and goal to help alleviate your pain and allow you to gain your life back. I believe if we work together, we can accomplish this mission. – Atit Shah, MD

Prescription opioids, such as oxycodone, hydrocodone, and morphine, do more than block pain. Dr. Atit Shah, MD from Advanced Pain Management explains, “Opioids can have undesirable effects. They can depress the respiratory system which can become dangerous and lethal even when not abused or misused. They can also create feelings of euphoria and lead to dependency.” In fact, one-quarter of the patients on long-term opioid therapy will develop dependency.

The risk of prescription opioid abuse varies widely between people and the incidence varies widely between regions of the US. Risk factors for opioid abuse include:

• Obtaining overlapping prescriptions from multiple providers.
• Taking high daily doses of prescription pain relievers.
• A history of mental illness or alcohol or substance abuse.
• Living in rural areas and having a low income.

Achieving effective pain management presents a challenge. Healthcare providers must strike a balance between the chronic pain management needs of their patients and the risks of longer-term abuse or addiction. Dr. Shah says, “While we need to find solutions to the Opioid Crisis, we do not want to stop focusing on how important pain is to the patient and their health. The solution is not less pain management. Rather, it is better pain management.”

One of the pillars of the Department of Health and Human Services’ strategy to combat the opioid crisis is to promote better pain treatment. Such improvements may come from the development of better opioid medications that act on the specific receptors for pain but ignore the receptors that create euphoria and addiction. Other alternatives are pain-blockers from other drug classes such as anticonvulsants, cannabinoids, anti-inflammatory, corticosteroids, antidepressants, or interventional options.

Dr. Shah says, “A pain treatment does not have to completely replace opioid drugs to help. Any treatment that lowers the patient’s need for opioids is a step in the right direction.” Nerve blockades, for example, help patients use fewer opioids immediately after surgery. Modalities such as electrical stimulation, through the skin or directly to the spinal cord, can lower pain perception. Non-drug treatments, such as cognitive behavioral therapy, physical therapy, yoga, or meditation, may also help liberate patients from opioids.

Another important step in combating the crisis is overcoming the stigma surrounding it. Dr. Shah says, “Prescription drug dependency is often perceived as a criminal issue. Rather, opioid dependence should be a medical issue. Stigmatizing it like a criminal issue makes those individuals suffering from opioid dependence less likely to tell their loved ones and seek help.”

The recognition that pain control is integral to good patient care and medical outcomes has led to an explosion of opioid prescriptions. So much so that it has turned into a crisis of abuse, addiction, and overdose. As we search to resolve the crisis we must avoid minimizing pain and the suffering that occurs with inadequate pain control. Dr. Shah says, “The pitfalls of pain management strategies that over-rely on opioids are becoming more and more apparent. As we shift away from over-reliance on opioids, we must take care to keep our sights set on pain and the effect pain has on patients and their health outcomes.”