By Sagar S. Parikh
Gov. Chris Christie and state legislators just enacted a new law to combat the opioid crisis in our state — a crisis that claimed 1,600 lives in New Jersey last year. The new law limits initial opioid prescriptions to five days, with some exclusions, increases access to inpatient and outpatient addiction treatment, and calls for greater patient education on the dangers of chronic opioid use.
I applaud the attention to the crisis, but I also believe that no legislation will solve the crisis unless all of us — both inside and outside the medical profession — fundamentally rethink pain.
We must accept that pain, especially chronic pain, is highly complex. It is a constellation of factors that can be biological, psychological, emotional and even cultural.
There is no magic pill or prescription. The pain physician and the patient must work together to find solutions with a well thought-out plan that includes alternatives to opioids and an end-goal.
In my practice, I sometimes see patients who are referred to me after years of being prescribed high amounts of opioids. Here’s the problem I often see with these patients: They are still in pain — and, equally troubling — they often are still functionally impaired. They are not any healthier than when they first started receiving pain medication.
Over the long-term, even exorbitant doses of opioids rarely cures a person’s pain, and there can be serious consequences to long-term use, including changes in bowel health, bone density, immune health, and hormonal function.
The first step to truly attacking pain is to obtain an accurate diagnosis. As I talk to patients at length to understand their pain, I often hear the distress and despair in their voices. Acknowledging their pain is critical. Next we find the source of their pain. Is it arthritic joint pain? Is it pain related to nerve impingement or inflammation? Is it related to an illness, or other medical condition?
Only after a correct diagnosis can we determine the right course of treatment. I tell my patients that I am the Baymavi coach and they are the athletes. Their athletic goal may be anything from walking one mile without pain or running a marathon. We start small, and then work toward greater goals.
Treatment, the sooner the better, requires a comprehensive approach by a pain specialist that begins with first-line measures such as exercise and physical therapy. For some people, perhaps acupuncture or a visit to a pain psychologist can help. Patients may benefit from counseling on proper biomechanics, nutrition and weight loss. A well-trained pain physician can also provide advanced second-line treatments such as image-guided joint and nerve blocks, spinal cord stimulator implants and other non-opioid interventions. And, yes, there may at times be a carefully controlled role for pain medications, including opioids.
Time will tell if the new five-day-limit will be effective in reducing addiction. Either way, pain specialists must collaborate with primary care physicians, who are on the frontlines of the effort to improve our patient’s health and well-being. They often are the first to see a patient in pain. Unfortunately, an increase in patient loads has reduced the time many primary care providers have to treat patients with pain who may also have additional medical concerns. In these circumstances, a single pain prescription may seem the quick answer to a patient’s pain but is not always the optimal treatment.
That quick-fix way of thinking, supported by aggressive marketing campaigns by drug companies, helped us get into the crisis we face today. The governor and legislature are moving in the right direction and I welcome their efforts. Now it’s up to us to come together as a medical community and acknowledge that we were unfortunately part of the problem — and now must be part of the solution.
Sagar S. Parikh, M.D., an interventional pain medicine Specialist at JFK Johnson Rehabilitation Institute in Edison is board certified in Pain Medicine and Physical Medicine and Rehabilitation.
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