It's hard not to notice the urgent and widespread work of preventing, treating, and managing the risk of opioid addiction in the US. From fine-tuning how prescriptions are managed and secured to developing entirely new public and private programs for treatment, it seems appropriate to call it a war. Vast resources have been marshaled to the cause, and we can expect programs, policies and regulations will evolve and improve as we understand what works best, and what's sustainable.
Yet from our vantage-point at BreatheAware, it's hard to conclude that we're doing all we can. Long-term medical use of opioids to treat chronic pain is the largest risk factor in addiction and overdose, yet few crisis-produced resources are focused on mitigating the broad societal impact of chronic pain and funding research into alternative treatments and medications. There are signs this may be changing, which is great: if we better control the primary risk factor, we'll better control the epidemic.
Opioids have made life bearable for millions, but until a few decades ago they weren't even widely available, and certainly not in their current pill-based delivery form. So, what did people do for pain 'way back when'? For that matter, what do people do now when opioids lose effectiveness after long-term use? Certainly there was - and is - suffering, but modern research shows that most people can significantly improve pain symptoms via physical therapy, movement, cognitive therapies, and other non-pharmacological approaches like breathing and mindfulness. When a multi-modal approach is used - including non-addictive drugs - results are even better. It's not always possible to eliminate pain completely, with or without opioids, but they should be the very last option for non-cancer chronic pain, not the first, as is recognized by the CDC.
"Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain...multimodal therapies and multidisciplinary biopsychosocial rehabilitation-combining approaches (e.g., psychological therapies with exercise) can reduce long-term pain and disability compared with usual care and compared with physical treatments (e.g., exercise) alone. "
- Centers for Disease Control, Guideline for Prescribing Opioids for Chronic Pain
In some ways, society is better prepared than ever to act. Physical therapists are more accessible than ever, and often covered by insurance. Gyms, yoga studios, swimming pools, and other preventative or mind-body resources are available in most geographies, and high quality resources are increasingly available online -- for anyone, anywhere, anytime. BreatheAware's Pain program fits into that category.
In other ways, our society is unprepared and disadvantaged. Modern life leaves little room for consistent and time-consuming recovery or management activities, and these are often not covered by insurance. Many resources remain geographically difficult to reach, or unaffordable over the long-term -- which is the time perspective needed for most pain management. And cultural factors also create impediments to broader adoption of pain reduction alternatives.
We can and should meet these challenges now. Employers and insurers can recognize, provide time and help pay for sustained non-pharmacological pain treatment. Just because it isn't a pill or surgery, doesn't mean it can't be 'just what the doctor ordered'. For a fraction of the cost of treatment programs we an also accelerate delivery of preventative and educational programs to all ages of our citizenry, starting with youth engaged in injury-prone athletics. These programs can go beyond addiction risk awareness to teach practical self-care & pain management skills that are acceptable to all people, of any cultural background. Last, it's time that regulators shift focus from limiting the mostly responsible medical professionals who use opioids as an important tool in their arsenal of care, and focus instead on enabling or funding new approaches that make not using opioids a realistic, sustainable and primary approach for most people with chronic pain.