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Two Things To Consider With Opiate Pain Management

Posted by Mike Pringle on Nov 12, 2015 10:16:47 PM

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Chronic non-cancer pain affects almost 20% of adults (Moore, Derry, Taylor, Straube, & Phillips, 2014; Rolfe, 2014). Persistent pain adversely impacts a person’s quality of life, employment status, and their use of health care resources. Activities that most of us take for granted such as walking, shopping, recreational activities, dressing, and maintaining intimate relationships, as well as many other activities become difficult or impossible to participate in.

Absenteeism from work often rises as a result of chronic pain (Moore et al., 2014). Gainful employment may not be possible in the presence of chronic pain. Employees that do return to work with pain may be less productive, have an overall reduced functional capacity, and have to contend with the constant distraction of pain; a phenomenon called presenteeism.


The use of health care resources increases with chronic pain. Moore et al. (2014) reported that patients with chronic pain visited more physicians than those patients without chronic pain, and the number of physician visits increased by 10 visits perRising Cost of Medications annum compared to patients devoid of chronic pain. Gaskin and Richard (2012) reported that approximately 100 million people in the United States in 2008 were dealing with chronic pain. Gaskin and Richard further stated that the total cost of chronic pain in the United States in 2010 ranged from $560 to $635 billion. The cost of lost productivity for the same time frame ranged from $299 and $355 billion (Gaskin & Richard, 2012).

While the use of opiate medications has become the norm, their use has proven to be a poor long-term strategy for chronic pain management. Lethal overdoses from opiates have hit record highs in several population centers. Insurance carriers, employers, and patients are burdened with the costs of chronic pain. Medical providers are more hesitant to prescribe opiates due the potential for misuse, side effects, and addictive properties (Rolfe, 2014). Unfortunately, a dichotomy exists with chronic pain and the requirement for narcotic pharmacological therapies. Medical providers and insurance carriers desire to use less opiate medications, but simply weaning a patient off opiates cannot be done unilaterally. A patient’s pain must be adequately controlled prior to any opiate taper.


  1. Pain must be marginalized through interventional and other therapies

  2. The opiate load must reduced

Removing only the opiates without adequately addressing pain is myopic. The aforementioned task is not simple. Claims adjusters, utilization review bodies, and state level industrial accident boards must be receptive to trying nontraditional treatment strategies such as message therapy, yoga, and behavior therapies, as well as more controversial measures such as the utilization of cannabinoids to combat chronic pain. Authoritative agencies that govern industrial accident care must develop treatment guidelines (not mandates) that allow for less traditional treatment strategies to be explored.


Gaskin, D. J., & Richard, P. (2012). The economic costs of pain in the United States. The Journal of Pain, 13(8), 715-724. doi:

Moore, R., Derry, S., Taylor, R. S., Straube, S., & Phillips, C. J. (2014). The costs and consequences of adequately managed chronic non-cancer pain and chronic neuropathic pain. Pain Practice, 14(1), 79-94 16p. doi:10.1111/papr.12050

Rolfe, A. (2014). Management of chronic pain. Education and Inspiration for General Practice, 7(6), 356-362. doi:10.1177/1755738014525141

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Topics: Pain Management

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