MEDICALIZATION OF CHRONIC PAIN GENERATED THE OPIOID CRISIS, NOW PERPETUATES IT
Decades into the lethal crisis, against CDC guidance, patients under medical care increasingly provided opioids, other interventions that lack evidence of benefit for the non-medical condition of chronic pain
by Clark Miller
Published January 1, 2023
Common, “centralized”, chronic pain –
the vast majority of chronic pain – is not a medical or physical condition instead is psychological, and opioid medications are not effective for it, do not treat it, no more than alcohol, also providing relief, does. That’s what’s been established by the evidence over decades, decades during which, as Sam Quinones effectively described in Dreamland, a collusion of insurance industry, Medicine, Big Pharma, and Media fabricated the instrumental, lucrative lie that chronic pain is physical, with medical and pharmacological treatments. Generating today’s increasingly lethal opioid crisis.
But you wouldn’t know that from reading media accounts including accounts of the behavior of American Medicine, that is of individual, prescribing licensed medical providers (LMP) decades into the lethal crisis and under recommendations from America’s public health research and regulatory institution, the CDC.
This recent headline, for example, appears clearly to point to progress in protecting public health in the context of a raging, decades-old lethal opioid crisis – taken at face value, we can be assured that American LMPs are decreasing their use of the Schedule II controlled substances that generated the crisis, “No Longer Treatment of Choice”, and are helping patients access effective alternatives, “Nondrug therapies”, instead.
That doesn’t suggest at all that against CDC recommendations LMP dispensing of opioids for the non-medical condition of chronic pain would have actually increased over recent years.
Let’s take a look.
One of the CDC’s goals in its notorious 2016 guidance on opioids for chronic noncancer pain appears to have been met, but it wasn’t a reduction in actual opioid prescribing, federal survey data indicated.
In an analysis of Medical Expenditure Panel Survey (MEPS) data from 2011 to 2019, use of nondrug approaches such as physical therapy and chiropractic care increased dramatically beginning in 2017, reported Kevin T. Pritchard, MS, OTR, of the University of Texas Medical Branch in Galveston, and colleagues.
From 2011 to 2016, the percentage of chronic pain patients using nondrug therapies without opioids stayed relatively steady at 20%, but this figure rose rapidly thereafter, reaching 40% in 2019, the researchers noted in JAMA Network Open. The CDC guidance had stipulated that “non-opioid therapy is preferred for treatment of chronic pain.” (A revision published last week still recommends that opioids be kept to a minimum, but with more emphasis on flexibility and individualized management.)
The 2016 guidance, however, was not accompanied by any significant reduction in use of opioids for chronic pain, either by themselves or in conjunction with nondrug treatments. In fact, use of opioids alone rose slightly from 2016 to 2018 (from approximately 10% to 15% of patients) while about 3% to 4% of patients used opioids alongside nonpharmacologic therapies through the entire study period.
[underline added]
Dispensing by America’s LMPs, specifically for the non-medical and non-physical condition of common chronic pain, of the Schedule II opioids that generated the increasingly lethal crisis increased decades into the crisis and after guidance from the CDC and with guidance for non-pharmacologic treatments for chronic pain available.
That result is entirely congruent with evidence described in detail here and establishing that over COVID pandemic conditions –
While pain diagnoses decreased, prescription of opioids increased.
Doctor referrals to non-opioid interventions for chronic pain did not increase.
Doctor referrals to the one non-opioid intervention for chronic pain with strong evidence for effective, durable relief – Cognitive Behavioral Therapy (CBT) -was never significant and became nonexistent.
Opioid overdoses involving prescribed opioids increased over this period
From that previous post –
TUESDAY, Dec. 14, 2021 (HealthDay News) — Pandemic lockdowns may have led fewer Americans to seek pain treatment last year, but folks who did seek help had higher-than-usual odds of receiving dangerous opioid painkillers, a new study says.
And that could lead to a worsening of the opioid epidemic, researchers suggest.
“It is likely that more patients may have become addicted to opioids than would have been the case absent the pandemic,” said study lead author Byungkyu Lee, an assistant professor of sociology at Indiana University Bloomington.
Lee and his team tracked treatment patterns for millions of patients struggling with limb, extremity, joint, back and/or neck pain. They found that prescriptions for highly addictive opioid medications like oxycodone (OxyContin) rose 3.5% during the first half-year of the pandemic compared with the prior year — despite a 16% plummet in pain diagnoses.
That’s not all that rose, unfortunately
As described two weeks ago in this post, In Maryland, Massachusetts, California, Colorado, Virginia, Florida, and Washington, D.C. trends indicate clear increases in 2020 and 2021 in overdose deaths involving doctor-prescribed opioids compared to prior years, consistent with evidence of continued over-prescribing. And consistent with protective shielding of misprescribing by Media-fabricated distracting cover stories empowering and enabling the lethal practices.
The disturbing news from one of multiple states
is not a surprise, in fact predicted by the failure of all involved trusted American institutions and their watchdog Media to do other than engage in the same collaboration that distorts evidence, protects power, and sacrifices lives and public health to protect established systems.
The report continues,
That may be because, in the face of lockdowns, doctors were less likely to turn to nonmedicinal treatments such as massage therapy and other forms of “complementary medicine” like acupuncture and osteopathy. Scripts for such approaches fell by 6% during the same time frame.
“One reason for rising opioid prescriptions during the pandemic is lack of access to non-pharmacologic treatments that require person-to-person contact,” explained Lee.
“Prescribing opioids for pain is a faster and easier ‘no-contact’ solution than physical therapy or complementary medicine,” he noted. “Opioids can be prescribed through telemedicine, for example.”
. . . In the new study, the investigators examined data from two time periods: January through September 2019 and January through September 2020 (including the first six months of the pandemic).
About 21 million patients were included in each period. In all, the analysis covered about a fifth of Americans with commercial insurance across all 50 states and roughly a quarter of all Medicare Advantage patients, the authors said.
Investigators compared prescription patterns from April to September of each year.
Not only were there higher opioid prescription rates during the pandemic, but they were at higher doses — roughly equivalent to an additional 1.0 morphine milligrams. Also, prescriptions were written for more than one day longer, on average, than pre-pandemic.
“One reason for rising opioid prescriptions during the pandemic is lack of access to non-pharmacologic treatments that require person-to-person contact,” explained Lee.
“Prescribing opioids for pain is a faster and easier ‘no-contact’ solution than physical therapy or complementary medicine,” he noted. “Opioids can be prescribed through telemedicine, for example.”
As we’ll see below, those are lies – overtly, by deception, and/or by pathological level of diminished capacity for competence and critical thought – that threaten public health and safety. Lies, that is, constructed for messaging of the same type that generated the opioid crisis by promoting a medical solution for the non-medical issue of common chronic pain.
Takeaway
As explained and summarized here, below – despite CDC recommendations from 5 years ago (and despite increasing lethality of American Medicine’s opioid crisis including by prescription opioids), medically trained practitioners have not evidenced clinical nor ethical capacity to change practices to protect public health.
The medical prescribers, we are asked to believe, felt compelled to turn to increased dispensing of the opioids that generated the opioid crisis because none of the nonpharmacologic treatments could be provided by telehealth, or while avoiding touch or close proximity to patients over pandemic conditions. But that’s a lie, because the one treatment that is supported by research evidence, in contrast to others noted, as being strongly supported for lasting benefit, CBT, was available through the study period, has always been available, not requiring physical contact or close proximity. It’s the one that wasn’t used by medical providers in the care of their pain patients.
Cognitive behavioral therapy is the one nonpharmacologic treatment whose use by pain patients cared for by medical professionals was never more than a minute fraction of that of the other “treatments”, the ones not supported by research as effective.
Back to the helpful expert comment above that, “Prescribing opioids for pain is a faster and easier ‘no-contact’ solution than physical therapy or complementary medicine,” he noted. “Opioids can be prescribed through telemedicine, for example.”
Here’s some evidence bearing on how that’s been working out –
And more fundamentally, opioids do not treat common chronic pain.
Do not treat that condition any more than does alcohol, both effective
as temporary anesthetics for chronic pain, in the same way: both affecting neurotransmitter activity in the brain resulting in numbing, “forgetting”, otherwise moderating emotion-laden awareness of pain. The research on alcohol as providing this effect is clear and established.
But alcohol is generally not recommended for daily, regular dosing to manage chronic pain, for sound reasons. That can lead to psychological dependence, with risk of overuse and well-known associated problems including problems with judgement; diminished mental acuity, “fogginess”; increased risk of a variety of physical problems including disease states; impaired functioning; and risk of accidental death.
Wait . . . that sounds familiar, or should. Long-term use of opioids, as prescribed, poses essentially the same risks. In a 10-year retrospective cohort study, long-term opioid use among patients with chronic non-cancer pain (CNCP) compared to patients with CNCP and not using opioids increased risk of all-cause mortality by a factor of 1.21, (hazard ratio: 1.21, 95% CI: 1.13, 1.31; P<0·001) with a database of more than 19 million patient records. Mortality risk was also higher specifically for cancer (HR 1.19, P = 0.041) and circulatory disease (HR 1.26, P<0.001).
The two temporary numbing agents are comparable, with similar and slightly different risk profiles: for opioids development of dependence, misuse, infectious disease, accidental overdose; for alcohol liver and other disease states, accidental physical injury.
Both provide a temporary cognitive and emotional deadening of the experience of pain, the pain reliably returning after the effects wear off, and often worsening over time. Because, of course, the source of that pain is not treated or addressed in any way. Instead, patients are diverted and disincentivized from engaging in the evidence-based treatments for the cause of chronic pain – psychotherapy and therapy support for changes in activity and movement – diverted by the effective, concerted efforts of medical and pharmaceutical industries instilling in them the lie that a medication can treat chronic pain. With lethal epidemic as outcome.
Opioid provision for chronic pain makes no more sense and is no more clinically and ethically responsible than recommendation for daily use of alcohol to numb chronic pain.
Back to the current (2022) study, published in JAMA and summarized in MEDPAGETODAY, heralding that “Nondrug therapies increased markedly in wake of 2016 CDC guidance”, the nondrug therapies – chiropractic, massage, acupuncture, physical therapy – are almost the same as those looked at for the 2021 JAMA survey described above, based on 21 million patient care records across 50 states.
In both studies, the treatment not referred to or utilized by patients under medical care, or not even included in the analysis – Cognitive Behavioral Therapy – is the one treatment with an evidence base for effective, durable relief from common chronic pain.
Here, from the 2022 JAMA report, is the interesting explanation for why the single evidence-based treatment for common chronic pain was excluded from study:
“Previous studies often measured access to intervention techniques instead of to the licensed health care professionals (24) who treat pain in the clinical setting. (22,23,25-27) Therefore, we defined nonpharmacologic treatments based on a policy brief (24) that identified the licensed health care professionals (acupuncturists, chiropractors, massage therapists, occupational therapists, and physical therapists) specialized in treating pain. (18,19) Operationalizing the workforce, instead of intervention techniques, helps establish a clear process for patient referral.”
And here is that cited (24) policy brief in which the “licensed health care professionals” providing CBT are identified, along with other providers, as qualified to treat chronic pain –
“Health care occupations in addition to the traditional medical providers (physicians, nurse practitioners and physician assistants) able to deliver evidence- based non-pharmacologic pain management include physical therapists and assistants, occupational therapists and assistants, massage therapists, athletic trainers, chiropractors, psychotherapists (licensed psychologists, licensed therapists/counselors and clinical social workers) . . .”
It turns out – explained here, here, here, here, and in other posts – that the nondrug treatments identified in these studies as effective treatments for chronic pain (including chiropractic, massage, acupuncture, and physical therapy) in fact are not, do not have an evidence base that supports effectiveness.
Just as the SSRIs used to flood America’s collective brain for decades for depression never have had an evidence base.
Just as opioids for common chronic pain never did, their uncontrolled dispensing by American Medicine generating the increasingly lethal crisis.
Just as substitute opioids – suboxone and methadone – as “treatment” for the lethal epidemic created by medical lies never did, instead are fueling the continuing epidemic.
Lies like those emerging that were required to hide U.S. medical funding for gain of function research that almost certainly created the COVID virus. And required as rationalization to shut down communities and schools unnecessarily.
These results – trapping vulnerable , trusting Americans under medical care for the non-medical condition of common chronic pain in sham medical and physical “treatments” at best ineffective and at worst lethal – of course were entirely predictable as an outcome of the established pathology and lethality of the collaboration of America’s top medical and public health experts, institutions, medical and research journals, and major media.
Pathological levels of incompetence and of diminished capacity for integrity, for ethical behavior, for research literacy, for critical thought.
Pathological, increasingly lethal, and protected.
