Anita Gupta

Chronic pain represents an astounding public health burden. Even with research and technologic advances in pain management, chronic pain is grossly undertreated in the United States. Many pain patients are frustrated with their treatment regimens, and disparities exist in pain treatment for minorities and for socioeconomically disadvantaged and elderly patients.

Many doctors feel inadequately trained to treat chronic pain. Despite research and technologic advances in pain management, chronic pain remains grossly undertreated in the United States. More than one in five people (21%) living with chronic pain are dissatisfied with their current pain management care. Less than one-third of patients (30%) with chronic pain believe that prescription medications work well to address their pain. Of patients with chronic pain treated with opioids, more than half (51%) reported feeling that they had little or no control over their pain. One in five people suffering from chronic pain does not even notify a physician.

Complicating the matter is that if you have pain, you are likely to have other illnesses that can impact your overall health. According to a 2006 survey from the American Academy of Pain Medicine, almost two-thirds of people living with chronic pain have reported a decrease in overall happiness and 77% reported feeling depressed. Pain can affect your daily functioning, resulting in decreased concentration, diminished energy levels, and difficulty falling or staying asleep.

The problem is likely to only get worse. Chronic pain costs the U.S. more than cancer, heart disease, and diabetes. Health economists estimate that the cost of chronic pain may be as high as $635 billion a year, according to a report published in the Journal of Pain. We can only guess how many people have been limited in their professional advancement because of pain. A comparison of two cross-sectional studies of adults in England conducted in the 1950s and the 1990s revealed a 2- to 4-fold increase in musculoskeletal pain. In a survey of adults living in North Carolina, the prevalence of chronic low back pain increased from 3.9% in 1992 to 10.2% in 2006. Further, chronic pain, particularly neuropathic pain, is highly prevalent among the elderly, a rapidly growing segment of the population.

New research also has led to the development of medications that can decrease nerve irritation and depression caused by pain. Some of these new medications are being designed using nanotechnology or medications that may reverse an opioid overdose such as naloxone. With the advent of new wearable technology and smartphones, there are endless options for individuals to monitor their health and function when living in chronic pain. Moreover, the increasing use of genetic testing for personalized medicine may make crafting a effective pain regimen easier for doctors. One of the most promising research areas involves harvesting stem cells from a patient’s bone marrow and injecting them into an area that has become painful. The hope is that the stem cells will build new, healthy tissue and relieve pain for good.

The most commonly prescribed medication for pain is opioids. These include morphine, oxycodone, codeine, hydrocodone, and many others. Therapeutic opioid use for chronic pain is a particularly challenging issue for both physicians and patients. Further complicating opioid use for chronic pain is the growing epidemic of opioid overdoses in the United States. On average, 44 people in the United States die each day from prescription opioids and over 80% of those deaths are unintentional. Emergency room visits due to prescription opioid emergencies have nearly quadrupled over the past seven years. Drug poisoning deaths, driven primarily by prescription drug overdose, are now the leading cause of accidental death in the United States, surpassing motor vehicle collisions.

Accidents with prescription opioid pain medications can happen to anyone taking them. Low public awareness of life-threatening side effects associated with prescription opioid medications, coupled with the stigma that we know exists around this type of discussion, can deter open conversation. Improvement in this dialogue is needed, including learning more about opioid emergencies and how to be prepared to quickly intervene if an overdose is suspected. It’s time for America to Start Talking about the safe use of opioids and quick intervention in the event of an emergency such as accidental overdose.

America Starts Talking is a new campaign designed to prompt discussions about the safe use of prescription opioid pain medications, including how to recognize and respond to an opioid emergency such as accidental overdose. Because accidents with prescription opioids can happen to anyone who takes them, our goal is to de-stigmatize and inform conversations between patients and their healthcare providers, families and friends to help people stay safe when taking their medications.

The program discusses many options for the safe use of opioids, including taking medication as directed, being aware of interactions with other medications and/or alcohol, learning the signs and symptoms of overdose, and having naloxone, an opioid antidote, in the home so that family or loved ones can rapidly intervene in the event of an opioid emergency. Of course, the best thing to do is prevent the emergency from ever occurring, but if it does, it’s important to have naloxone on hand for emergency intervention.  

If you are one of the millions of people lacking an effective remedy for your pain, a trained pain medicine physician may be able to help you achieve your pain management goals. Long-term care professionals should be cognizant of these issues that face individuals with pain and this is why being prepared for an opioid emergency is a priority.

Anita Gupta, PharmD, DO, is vice chairwoman and associate professor at Drexel University College of Medicine.

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