One of the big stories in the news media today is the opioid epidemic. The problem transcends demographics and politics. Many celebrities have perished from overdoses, and just about everybody can point to a friend or family member struggling with addiction. Some State Attorney Generals are even suing pharmaceutical companies for contributing to the crisis.
We have seen the impact of opioid addiction in many of our clients. In the early 1990s, physicians liberally prescribed opioid medications to manage chronic low back pain. Some neurosurgeons were aggressive with surgery. We worked with a few clients who experienced one failed surgery after another, only to end up even more disabled with a diagnosis of “failed back surgery syndrome.” This was the norm, but things have changed.
A recent series of medical journal articles estimates that over 500 million people worldwide suffer chronic lower back pain, and this number will only increase. The study sites a few reasons. In developing countries, people are moving into urban centers, and their lifestyle is becoming more sedentary. Overall, the population is aging, and more people must contend with degenerative disc and joint disease.
Another factor contributing to chronic back pain, the studies contend, is that many well-meaning doctors continue to prescribe treatments that are not effective. Several factors, including genetics, obesity, insomnia, and psychological and social factors cause low back pain. Medical researchers are just learning how these various factors interact with each other. Many of the typical treatments, like medication, bed rest, physical therapy, and injections only work a small percentage of the time becuase it is a "one size fits all" approach. Other studies show that a psychological approach, including behavioral and cognitive therapy, can be much more effective. Pain, after all, is a psychic experience.
We are seeing a slow but steady shift away from these traditional modes of treatment for chronic low back pain. Many of our workers’ compensation and Social Security disability clients treat with the North Coast Pain Center with good results. Neurosurgeons are now more conservative about recommending surgery, which is viewed as a treatment of last resort. Pain management clinics take a comprehensive approach to treatment. Patients will often see a physical rehabilitation doctor, a physical therapist, and a psychologist, all in the same clinic. The various practitioners in a pain clinic meet and work together to develop a treatment plan.
Some of the resistance to a psychological approach to pain management may be the continuing stigma associated with mental health conditions. Another may be that health insurance plans do not cover newer, more alternative treatment modes. Still, we see great progress in our clients with newer "evidence based" approaches to pain management.
