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Opioid Use for Chronic and Acute Pain

Opioid Use for Chronic and Acute Pain

Don’t fall victim to faulty reporting—learn the facts.

People across the country who are dealing with serious acute and chronic pain issues are becoming increasingly alarmed and confused about whether their opioid prescriptions will remain available. If you are someone who’s looking at a major surgery, such as spinal fusion or a total knee replacement and resulting acute pain; are dealing with chronic pain from conditions such as Crohn’s disease or rheumatoid arthritis; or are in palliative care after battling cancer, you should be aware there’s a lot of misinformation out there.

Unfortunately, docs, pharmacists and patients can fall victim to faulty reporting and make decisions based on what they believe are facts, but which are half-truths instead. That’s why we’re going to set out what is the current info, so you know—or can find out—where you really stand.

We know it’s not easy to be your own best patient advocate when you are in pain, but you need to be aware of what your state—and your insurance plan—allows and be able to clarify that info for your doctor or surgeon if the need arises. To discover what rules apply to you, check out Affirm Health’s State by State Opioid Prescribing Guidelines website (www.affirmhealth.com). And get in touch with a certified pain management specialist you can work with to manage your pain.

Here’s the scope of the regulations that are cropping up to control opioid abuse. Colorado’s 2018 Senate Bill 18-22 Clinical Practice for Opioid Prescribing is very similar to many state bills across the country. On face value it looks like it limits a patient’s initial prescription of an opioid to a seven-day supply, “if the prescriber has not written an opioid prescription for the patient in the last 12 months.” But if you read on, you’ll see the bill continues: “The prescriber may exercise discretion in including a second fill for a seven-day supply. These limits do not apply, if, in the judgment of the prescriber, the patient…. is experiencing post-surgical pain, that, because of the nature of the procedure, is expected to last more than 14 days.” So, you’re able to get the pain management you need, but your pain management specialist, your surgeon and you need to know the local laws—and you want to make sure everyone is aware of the paperwork it takes to move forward.

Fortunately, on a national level, the FDA and others are beginning to recognize that while a person may become dependent on opioids if they are used to control even acute pain, the patient can effectively work with a pain management specialist to taper off the medication as the pain eases. Rapid forced tapering (abrupt cessation) of opioids torments patients and leads to use of illicit pain relievers, risking death from fentanyl exposure and even suicide.

Alternatives to opioid pain therapy
There has been significant progress made in the last few years concerning the number of opioids being prescribed. According to a report published in JAMA Internal Medicine, “since January 2017, the amount of MMEs (that’s a measure of morphine milligram equivalents applied to opioids) prescribed has declined 19.4 percent and the number of patients receiving buprenorphine, an FDA approved treatment for opioid withdrawal, has increased 21 percent. And, says the National Survey on Drug Use and Health, the number of Americans reported to be misusing pain relievers has “significantly decreased.”

In large part, this is due to a raised awareness of how a combination of things can help, such as:

  1. Healthier food choices
  2. Physical, occupational and exercise therapy
  3. Cognitive behavioral therapy (CBT)
  4. Routine stress management practice
  5. Using non-opioid pain medications (which may be even more effective than opioids in the long run at reducing pain.)

So, find out what regulations are in effect in your state, and work with all your docs to develop a pain management plan that incorporates these other pain-management techniques.

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