The opioid epidemic, officially announced in 2016, has commanded much attention. Now considered a “national emergency,” efforts to address the issue are already underway. As various government institutions, health care facilities, and nonprofit organizations prepare action plans, one trend is clear: physicians will certainly attempt to prescribe less opioids than in previous years. But for the nearly 50 million Americans who experience chronic pain, how will physicians now approach their pain treatment? In a July report to the U.S. Food and Drug Administration (FDA) addressing the opioid epidemic, the National Academies of Sciences, Engineering, and Medicine (NASEM) states efforts to stem opioid abuse will require a “culture change” in prescribing for chronic pain.
Part of this culture change involves “nonpharmacologic solutions” such as acupuncture, spinal manipulation, massage therapy, cognitive behavioral therapy, etc. According to the NASEM report, these treatments are powerful tools that may provide effective pain relief for many patients in place of, or in combination with, pharmacologic approaches.
Major health care institutions such as the Joint Commission, an independent, nonprofit organization that accredits more than 21,000 U.S. health care organizations and programs, have already taken note. In August, the Commission released new guidelines that will become effective on January 1st. These guidelines call on hospitals to provide complementary and alternative medicine treatments or educate patients about them.
The opioid epidemic is helping to bring these natural treatment options to light, not only for the pain, but also for how these safe, noninvasive treatments could be better integrated within conventional medicine for various health care solutions.
Alternative treatments may become more widely covered by insurance.
Alternative medicine treats pain much differently than opioids. Rather than masking the pain, these treatments offer a long-term and preventative approach, treating the root cause of the pain and/or by stimulating mechanisms that allow the body to heal on its own. Alternative medicine also comes with minimal side effects.
While some insurance policies cover alternative treatments, many Americans are still paying for them out of pocket. According to the NASEM report, insurance-based policies have substantial potential to reduce the use of prescription drugs. Therefore, NASEM recommends that “coverage for and access to comprehensive pain management that includes both pharmacologic and nonpharmacologic options should be expanded.”
In fact, the report recommended that the FDA facilitate reimbursement for comprehensive pain management. This means that in addition to covering prescription medication, the FDA should also cover treatment modalities such as acupuncture, spinal manipulation, massage therapy, etc.
Alternative treatments may become a first-line treatment option for pain care.
Alternative medicine, by name, implies that it is a second or third line of treatment. However, in many cases, alternative medicine can be an effective first-line treatment that requires no further intervention. Because alternative medicine emphasizes the use of noninvasive, nontoxic treatments, it can enable patients to avoid the harmful side effects of prescription medications altogether.
Many physicians are currently embracing this approach, particularly in regards to common ailments like low back pain. With over 80 percent of Americans experiencing low back pain at some point in their lives, it is one of the most common reasons medical doctors prescribe opioids. Consequently, on the heels of the emerging opioid crisis, the American College of Physicians (ACP) made a significant update to its guidelines concerning low back pain. The ACP is now recommending alternative therapies that are non-pharmaceutical first, such as spinal manipulation, acupuncture, massage, or heat therapy. Previously, the association recommended medical doctors prescribe medication first, including opioids.
Shortly after those new guidelines were released, a major medical journal, the Journal of the American Medical Association, published a study supporting spinal manipulation therapy for alleviating low back pain. This study along with the ACP’s updated guidelines mark a significant shift amongst the medical community toward alternative care.
The opioid epidemic may change the way doctors study pain management.
Another culture shift called for in the NASEM report is the nation’s approach to mandating pain-related education for all health professionals who provide care to people with chronic pain.
In the past, Congress has criticized medical schools for providing limited education on pain management. A 2011 study published in The Journal of Pain found that pain education for American medical students is limited, variable, and often fragmentary. According to the study, about 80 percent of American medical schools had no formal pain education and many required five or less hours of pain education. A 2017 study in Postgraduate Medicine calls this lack of pain education in medical schools a “dangerous omission” and recommends improving pain education by including a multidisciplinary and multi-professional approach.
This type of education could help more doctors understand how to incorporate complementary and alternative medicine (CAM) including chiropractic and naturopathic medicine, acupuncture, oriental medicine, and massage therapy with conventional medicine for better patient outcomes. Many major hospitals and medical universities have already incorporated this type of integrative care. Going forward, as other facilities adopt this model, doctors will find it easier and more effective to utilize these CAM therapies and practices to help patients.
More funding may become available for research on integrative medicine.
The NASEM report recommends additional research in a number of different areas related to the opioid epidemic. Along with research to better understand pain and opioid use disorder, the NASEM recommends research to better understand the appropriate dosage and delivery for “nonpharmacologic approaches,” that includes complementary and alternative medicine options such as acupuncture, spinal manipulation, massage therapy, and cognitive behavioral therapy, etc.
Additionally, the report recommends more research to identify and develop non-addictive alternatives to opioids for pain treatment. This could possibly include other alternative care like naturopathic medicine. While not mentioned in the report, naturopathic treatment modalities like nutrition and lifestyle changes are effective, evidence-based approaches that can lead to deep wellness and long-term relief for chronic pain.
Opioids may be a quick solution to pain, but physicians are realizing that their risks can greatly outweigh the benefits. For those suffering from chronic pain, the good news is that integrative medicine could become more widely available and may in fact lead to more effective, longer lasting results. As the public and medical community continues to learn about alternative options to pain relief, it could open their eyes to the many other ways complementary and alternative medicine can be used in combination with conventional medicine.
About the Author
Dr. Theodore Johnson, Jr.