Managing Chronic Pain

Managing Pain

OVERVIEW

THE OPIOID CRISIS IS KILLING THOUSANDS OF AMERICANS EACH YEAR

Americans’ dependence on opioids has greatly contributed to the current drug abuse epidemic in this country. The human toll of this epidemic has reached alarming proportions with more than 53,000 drug overdoses in 2016,1 and 33,000 of those deaths were reportedly due to opioids.2 As a result, the government has declared the opioid crisis a public health emergency.

Opioids are a class of drugs that include synthetic opioids such as fentanyl, and pain relievers prescribed by doctors legally, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and others. Additionally, illegal drugs like heroin are a part of this class of drugs.

In many cases, doctors have prescribed opioids to relieve acute pain related to injuries or surgery. However, a dangerous side effect is that these drugs have a high potential for abuse, and prolonged use can lead to opioid addiction and misuse. According to a 2016 survey data from the Substance Abuse and Mental Health Services Administration, 2.4 million Americans have an opioid-use disorder.3

According to the U.S. Centers for Disease Control and Prevention, from 1999-2015, the amount of prescription opioids dispensed in the U.S. nearly quadrupled.4

A recent Council of Economic Advisors report found that the economic cost of the opioid crisis was $504 billion in 2015, or 2.8 percent of the GDP that year—six times more than any recent estimate.4 This figure incorporates increased health care costs related to illicit opioids and prescription opioids misuse, lost worker productivity and lost wages due to addiction and incarceration, additional criminal justice costs, and the value of lives lost to opioid overdoses.4

More than 650,000 prescriptions for opioids are filled each day in the U.S.5,6 and many are consumed for non-medical, abuse-related purposes.

MEDICAL TECHNOLOGY HAS THE POTENTIAL TO HELP FIGHT THE OPIOID EPIDEMIC

Today, there are innovative medical technology solutions available that can help play a role in combatting this national crisis. Solutions that have the potential to reduce our country’s dependence on opioids include implants and other devices, as well as apps and diagnostic tests that facilitate effective pain management and help curb the misuse, abuse, and overdose of opioids. Additionally, medical technology companies are developing innovations that are minimally-invasive, enabling patients to return to routine activities in a shorter period of time while experiencing less pain and discomfort after surgery.

As the Administration and Congress investigate this critical issue, medical technology solutions should be a part of the national conversation. According to Dr. Scott Gottlieb, Commissioner of the Food and Drug Administration (FDA), the agency has approved more than 200 different medical device alternatives that help treat pain.7 In addition, a final report issued by the President’s Commission on Combating Drug Addiction and the Opioid Crisis encourages research and development of new technologies and devices to assist in the opioid crisis.8

Pain affects more Americans than diabetes, heart disease, and cancer combined.9 It is cited as the most common reason Americans access the health care system, and is a major contributor to health care costs.10

TREATING ACUTE PAIN

Millions suffer from acute pain that usually comes on suddenly and is caused by something specific such as surgery, broken bones, dental work, or childbirth. Acute pain typically does not last longer than six months.11

Continuous Peripheral Nerve Block (cPNB)

  • Small catheter is placed at surgical site during procedure.
  • Catheter allows for continuous infusion of fast acting anesthetics using an ambulatory pump, clinically proven to reduce exposure to opioids during and after surgery.
  • Can be used in hospitals, home care settings, and alternative care facilities.
Cryotherapy (Cold Therapy) Treatment
  • Uses the body’s natural response to cold to treat peripheral nerves, immediately reducing pain.
  • In some cases, delivers cold therapy through a portable, handheld delivery system.
  • Reduces opioid use following surgery. 
Peripheral Nerve Stimulation (PNS)
  • Uses a small, wearable stimulator connected to a thread-like wire lead to deliver tiny electrical pulses to stimulate nerves in a manner that is intended to provide targeted pain relief.
  • Delivers pain relief without drugs, implants, anesthesia or incisions.
Portable Pain Relief Systems
  • Part of a multimodal pain management approach after surgery.
  • Provides predictable pain relief.
  • Stimulation produces endorphin release. Endorphins reduce the perception of pain.
  • Reduces postoperative opioid use while achieving pain management.
  • Can also be used to treat chronic pain.
Neuromuscular Electrical Stimulation
  • A form of neuromodulation that uses electrical waveform and pulses to stimulate muscles, improve muscle strength, increase range of motion, increase circulation, reduce edema, and reduce weakness or atrophy.

MANAGING CHRONIC PAIN

Chronic pain is defined as ongoing pain that lasts longer than one month.12 A study by the National Institutes of Health found that one in 10 Americans experiences pain every day for three months.13 Many people accidentally become addicted to opioids while trying to treat their debilitating pain. However, several medical technology alternatives have been proven to reduce or eliminate pain altogether.

Pain in Numbers
In the United States, 70 million patients are prescribed opioids for postsurgical pain each year. Of those patients, one in 15 will go on to experience long-term use or abuse.14
72 percent of patients would choose non-narcotic pain medication for post-surgical pain management.15

Implantable Intraspinal Drug Infusion Pumps
  • Neuromodulation treatment that involves administration of medications directly to the body’s nervous system.
  • Delivers pain medication directly to the fluid surrounding the spinal cord.
  • Patients receive about one percent of the drug previously taken orally, greatly reducing the number of opioids needed to treat pain.
Deep Transcranial Magnetic Stimulation (TMS) therapy
  • Performs magnetic stimulation of brain structures and networks related to chronic pain.
  • Stimulates superficial cortical regions of the brain.
Pulsed Electromagnetic Field (PEMF) Therapy
  • Uses dual-field electric and magnetic energy to effect a more natural expression of genes and proteins.
  • Pain pathways are affected in two ways: Increasing the body’s naturally-occurring pain-relief mechanisms, and reduction of inflammation and swelling.
  • Treatment is non-invasive and typically sensation-free.
  • Patients can be treated in the outpatient setting or at home.
Radiofrequency Neuroablation
  • Uses a minimally invasive procedure to heat up a small area of a nerve or tissue, blocking pain signals traveling from the pain area to the brain.
  • Performed as an outpatient procedure and usually does not require general anesthesia.
  • Useful for the management of chronic back pain, neck pain, and pain associated with arthritis of the knee and hip.
Spinal Cord Stimulation (SCS)
  • Neuromodulation treatment that involves stimulation of the body’s nervous system.
  • Uses electrical signals to block pain signals from reaching the brain.
  • Can help to manage chronic pain of the neck, back, arms and legs, often after spine surgery, or for other neuropathic conditions.
  • Minimally invasive and is trialed for efficacy before a patient receives a permanent implant.

Draining the Health Care System
Cases of chronic pain are the leading cause of long-term disability in the United States. This pain also adversely affects mental and emotional well-being, impacting a person’s ability to work, and their quality of life.16

 

Chronic pain alone costs up to $635 billion each year in medical treatment and lost productivity.17

Download Full Report (PDF)


References

[1] The Altarum Institute, The Potential Societal Benefit of Eliminating Opioid Overdoses, Deaths, And Substance Use Disorders Exceeds $95 Billion Per Year, November 16, 2017.

[2] The Council of Economic Advisors, The Underestimated Cost of the Opioid Crisis, November 19, 2017.

[3] Substance Abuse and Mental Health Services Administration, Substance Use Disorders, October 27, 2015.

[4] Centers for Disease Control and Prevention, Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. Available at http://wonder.cdc.gov.

[5] Help, Resources and Information, HHS, viewed January 29, 2018: https://www.hhs.gov/opioids/.

[6] Prescribing Data, Centers for Disease Control and Prevention (CDC), viewed January 29, 2018: https://www.cdc.gov/drugoverdose/data/prescribing.html.

[7] U.S. House Committee on Energy and Commerce, Hearing: Federal Efforts to Combat Opioid Crisis: A Status Update on CARA and Other Initiatives, October 25, 2017.

[8] The President’s Commission on Combating Drug Addiction and the Opioid Crisis, Final Report, November 1, 2017.

[9] National Institutes of Health, Pain Management, https://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=57.

[10] Ibid

[11] Cleveland Clinic, Acute vs. Chronic Pain. Available at https://my.clevelandclinic.org/health/articles/acute-vs-chronic-pain.

[12] Guidance for Industry Analgesic Indications: Developing Drug and Biological Products: https://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformat....

[13] The Good Body, Chronic Pain Statistics: Facts, Figures and Research, 2017.

[14] Becker’s Spine Review: Mary Rechtoris Nov 3, 205: Reducing Opioid Dependence: Available From: http://www.beckersspine.com/spine/item/27948-reducing-opioid-dependence-....

[15] Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003 Aug; 97(2):534-540.

[16] American Chronic Pain Association, ACPA Resource Guild to Chronic Pain Medication & Treatment, 2015.

[17] American Pain Society, Chronic Pain Costs U.S. Up to $635 Billion, Study Shows, 2012.