opioid crisis

An Alternative to Opioids? Other Interventions Show Significant Improvements in Pain and Physical Function For Disadvantaged Populations

By M2|2018-04-10T19:27:24+00:00April 10th, 2018|Chronic pain, Evidence-Based Medicine, Health Disparities, Insurance, Social Determinants of Health, Uncategorized, What do we pay for and why|

An Alternative to Opioids? Other Interventions Show Significant Improvements in Pain and Physical Function For Disadvantaged Populations

Pain is a common, yet difficult to treat condition; it is one of the top reasons people go to the doctor. Opioids are commonly prescribed to treat pain; opioids are quite effective but addictive. The use of cognitive behavioral therapy (CBT) is known to be efficacious in addressing chronic pain; however, its benefit in disadvantaged populations is not well understood.

To help shed light on this question, a team led by Beverly Thorn, University of Alabama, conducted a study to evaluate the efficacy of literacy-adapted and simplified group CBT versus group pain education (EDU) versus usual care.

The randomized controlled trial enrolled 290 adults with chronic pain symptoms. Most had incomes at or below the poverty level, and about one-third read below a fifth grade level. Many participants were taking opioids at the beginning of the study.

Both the CBT and EDU were delivered in ten weekly 90-minute group sessions. Participants in all three groups reported their pain levels and physical functioning via questionnaires at baseline, ten weeks, and six months.

The study, funded by the Patient-Centered Outcomes Research Institute and published in the Annals of Internal Medicine, found that patients in the CBT and EDU groups had greater decreases in pain intensity scores between baseline and post-treatment than participants receiving usual care.

However, while treatment gains were still present in the EDU group at six-month follow-up, these gains were not maintained in the CBT group, Thorn, et al., say.

Regarding the secondary outcome of physical function, those in the CBT and EDU interventions had greater post-treatment improvement than patients who received usual care; this progress was maintained at six-month follow-up. Changes in depression, another secondary outcome, did not differ between either the CBT or EDU group and those receiving usual care, the researchers state.

This study highlights the fact that when done correctly, i.e., when materials are adjusted and tailored to a patient’s reading level, there are non-opioid interventions like behavioral therapy and education that work. While it is probably easier to prescribe opioids for pain, given the increasing severity of the opioid addiction epidemic, insurers really should consider these effective alternative treatments which positively impact pain. Why NOT prescribe effective, non-addictive treatment whenever possible?

Opioid Abuse: State Prescription Drug Monitoring Programs Help Reduce Overdose Death Rates

By M2|2017-10-09T01:57:06+00:00April 10th, 2017|Uncategorized|

Opioid Abuse: State Prescription Drug Monitoring Programs Help Reduce Overdose Death Rates

In 2015, the director of the National Institute on Drug Abuse, Dr. Nora Volkow, “told a group of Kentucky journalists and others at the Foundation for a Healthy Kentucky Health Journalism Workshop” that it is “possible to decrease the over-prescription of opioids, but” she said, “the solutions aren’t ‘sexy.’”

For example, to address the opioid epidemic in the U.S., some states have implemented policies to curb inappropriate opioid prescribing. These policies include, for example: mandatory provider use of prescription drug monitoring programs (PDMPs), and pain clinic laws that feature requirements such as registration of pain clinics with the state, physician ownership of the clinics, prescribing restrictions, and record-keeping requirements.

A recent study published in Health Affairs found that “combined implementation of mandated provider review of state-run prescription drug monitoring program data and pain clinic laws reduced opioid amounts prescribed by 8 percent and prescription opioid overdose death rates by 12 percent.”

The study results “suggest that some opioid prescribing policies had intended effects on opioid prescribing and overdose death rates.”
“We found that mandated review of prescription drug monitoring program data combined with pain clinic laws was significantly associated with both decreased amounts of opioids prescribed and with decreased prescription opioid overdose deaths,” the authors state.

As for potential effects of these policies on heroin overdose death rates, the study notes that “publications in mainstream media and in the scientific literature have advanced the idea that opioid prescribing policies have unintentionally driven demand for heroin (a drug with similar effects) as people search for ‘a cheaper, more accessible high.’” However, the study “did not find any evidence to support the concern that these opioid prescribing policies result in increased heroin-related overdose deaths. However, additional factors, including increased heroin supply, a population already widely exposed to prescription opioids, and increased mixing of highly potent illicitly manufactured fentanyl with heroin, are likely to continue to pose daunting challenges to the prevention of heroin overdose deaths.”

“This combination of policies was effective, but broader approaches to address these coincident epidemics are needed,” said Deborah Dowell, senior medical advisor at the Centers for Disease Control & Prevention’s (CDC) National Center for Injury Prevention and Control.

One step forward is better than none, boring and unsexy as those solutions might be.