Alternative Chronic Pain Management Options to Help Battle the Opioid Epidemic

Pharmacy Times interviewed Rita Roy, MD, CEO of the National Spine Health Foundation (NSHF), on some alternative treatment plans for chronic back pain to help address the opioid epidemic.

Alana Hippensteele: Hi, I’m Alana Hippensteele with Pharmacy Times. Joining me is Rita Roy, MD, CEO of the National Spine Health Foundation, or NSHF, who is here to discuss some alternative treatment plans to chronic back pain to help address the opioid epidemic.

So, Dr. Roy, how many opioid prescriptions are given to patients suffering from back pain?

Rita Roy: Thank you for having me on. I got to tell you—the numbers are staggering. We know that 1 in 5 patients who experienced back pain are prescribed opioids as a long-term treatment, which we know can lead to an increased risk of addiction down the road. Second to patients [with cancer], opioids are most frequently prescribed to those experiencing neck or back pain.

We also know that 100 million Americans suffer every year. So when you put those numbers together, it's a staggering number. The CDC reports that in 2020, over 142 million opioid prescriptions were dispensed in the United States.

Alana Hippensteele: Those numbers are remarkable. How effective are opioids in helping patients manage chronic back pain?

Rita Roy: Yeah, so opioids can be effective for patients looking to manage acute pain—pain, which lasts more than 2 weeks—or for those in the post-operative phase just recovering from surgery. But opioids really shouldn't be part of an effective long-term treatment plan for people who experience chronic pain. That's because the risk of addiction is so high—as we know, these are highly addictive medications. So there are many alternative treatments and pain management tools that are available for patients that are in constant pain.

Alana Hippensteele: So, what are some examples of alternate treatment plans to decrease patients’ debilitating symptoms outside of treatment with opioids?

Rita Roy: Yeah, it's so important to know what these alternative treatments are. Non-drug related treatments for spine patients can include things like physical therapy, dietary modifications, lifestyle modifications, and importantly, including smoking cessation—a lot of people don't realize the connection between smoking and back pain—that smoking disproportionately affects the discs in your back. So, those are some of the non-drug related things that people can do.

Then we think about alternative pain management techniques, which believe it or not, can include meditation, acupuncture is very helpful for a lot of people, massage therapy, myofascial release, and electric nerve stimulation. We [also] know that core strengthening activity can not only help prevent pain, but can help treat pain and reduce pain.

I can share a personal anecdote on this. I suffered a ski injury in my back and develop a spondylolisthesis, which is essentially a broken vertebrae. I managed pain in my back for 10 years with a very regular yoga practice. Yoga was not something I had ever done. I thought it was for, I don't know, alternative folks that I didn't think that I was [since I was] more in traditional medicine. But I really learned yoga and I learned the important value that it can bring for core strengthening and managing spine pain.

Alana Hippensteele: What is NSHF doing to increase awareness of alternative pain management methods among patients and physicians?

Rita Roy: So the National Spine Health Foundation focuses on 3 things: patient education, research, and patient advocacy. As the country's only patient-focused spine health nonprofit, we offer a variety of opportunities to educate.

We have a private Facebook support group [and] we have a platform called Spine Talks. [We have] 50 of the nation's leading spine experts on our medical board, and they participate in Spine Talks, answering frequently asked questions in layman's terms.

Then we offer a podcast where we invite folks who we call Spinal Champions—people who've overcome their neck or back challenge to share their story and, in this way, give hope to others that they can find a path to recovery.

We are leading some industry research on a very important project called Enhanced Surgical Recovery. These are protocols that are in the hospital that really revolutionize spinal post-operative surgical recovery. This includes better pain control, eliminating the need for IV medication, and really reducing the reliance and need for opioids after surgery. We know that a lot of times people become addicted after surgery. So if we can get folks off the opioids after their surgery sooner, there's less likely a chance of an addiction taking place.

Alana Hippensteele: Right. What should pharmacists know about opioids and back pain?

Rita Roy: I'm so excited to be talking to pharmacists. Today, the National Spine Health Foundation works really at the forefront of patient education, helping individuals who are suffering from neck and back pain to get back to their lives. We think pharmacists have a unique opportunity to transform the way we inform patients about opioid use, while helping to set people on the sort of successful path to pain free recovery.

We all know the FDA requirement for pharmacies to distribute warnings, recommendations to medications are stapled onto the white bag you get when you pick up your medication. But we think patient education shouldn't stop there. I would be thrilled to see pharmacies provide more practical and more easily digestible information when it comes to taking opioids and encouraging people to learn how to wean themselves off these highly addictive drugs after surgery. Even signs that that a patient might be relying too heavily on these pills, we could think about intervening there. These could be steps as simple as stapling a QR code, or a pamphlet with a QR code to the prescriptions at that point of sale when patients are picking up their medications so that they can have these resources right in their hands, once they're at home, and perhaps surrounded by their support system that can talk about methods to get to a pain-free life without using the opioids.

Alana Hippensteele: What are some other potential methods of helping to address concerns about increased opioid prescriptions for those suffering from chronic back pain?

Rita Roy: As I mentioned earlier, opioids can be very helpful in an acute setting. But opioid prescriptions, really, we say should be a last resort for people struggling with neck or back pain. Doctors and patients should consider alternative treatments, such as over-the-counter medications.

We know that oftentimes people don't take their [non-steroidal anti-inflammatory drugs (NSAIDs)] correctly. So there's an opportunity to educate. You don't just take one Motrin, right? That's not how anti-inflammatory medications work and physical therapy—very, very helpful for many, many people.

Then, there are new treatments in the regenerative medicine arena. Stem cell therapy is showing incredible results for the right patient. Acupuncture is really helping a lot of folks. So there's a range of treatment options out there that people really ought to think about and try before turning to opioids. So the opiate should be sort of the far end of the spectrum of things that people should try before they get there.

Alana Hippensteele: Right. Why might issues relating to the opioid epidemic be critical to address right now?

Rita Roy: We're in a national crisis. There is an opioid epidemic in the United States. I don't think that comes as a surprise to any of us listening today.

CDC reported that last year, 140,000 people died from opioid use. [That’s] 140,000 people [who] died. That's just a staggering number.

From 2019 to 2020, drug overdose deaths increased by 30%. I don't know if that has anything to do with COVID, but that's a very interesting number. It raises concerns that we're moving in the wrong direction.

We've been talking about the opioid crisis for several years now. But we continue to see continued opioid related deaths rising in the United States, and we've got to act. We need to take immediate action. At the spine foundation, we're doing our part by educating patients and physicians about alternative pain management methods. Truly, the innovations are happening so quickly that it's hard to keep track. It's hard to keep up with, and this is confusing information.

So, at the National Spine Health Foundation, we try to get the educational content out in easy-to-understand ways. We create community, we have people that you can talk to, and to get the information that you need, so that we can try to help combat this scourge that's facing our country.

Alana Hippensteele: Absolutely. What are your hopes for the future of our country’s relationship with opioids as a treatment for back pain?

Rita Roy: Yeah, I think first and foremost, I want patients struggling with chronic neck and back pain to know there is hope. There is hope. And the power of knowledge brings hope, right? I mean that's where the power is—to educate yourself on treatment options, and to know that you can get out of pain and back to your life. That doesn't necessarily mean surgery, or narcotics for pain control. So there's hope, and there are choices, and you've got to educate yourself. You've got to be your own self advocate to take back your life.

Secondly, I would say, my hope is that pharmacists and physicians would open the line of communication and work together to end the opioid epidemic through patient education and through this ongoing research, using it for an evidence-based approach to looking at what works, looking at the numbers. Let's drive that research together.

I'd say if this is something that any viewers are passionate about, I encourage you to come get involved in the work that we're doing at the National Spine Health Foundation. This is going to take all of us. It's going to have to be a multidisciplinary way of battling this problem. And we've all got to work together to face it.