Chronic Pain Treatments: Many Options, Poor Results
Imagine you are an employer and only half of your employees show up for work each day and then they are only 30 percent effective. Now a review of chronic pain treatments shows that despite the many options available, only about half of treated patients respond, and their pain reduction averages only about 30 percent.
Chronic pain continues to be…chronic
Chronic noncancer pain, which is associated with conditions such as back pain, fibromyalgia, and various types of arthritis, often has a life-altering impact on people’s lives. When individuals cannot get adequate relief from pain, it can jeopardize their ability to work, have and raise a family, maintain meaningful relationships, and otherwise enjoy life.
Chronic pain is a global and pervasive problem. According to a recent Global Industry Analysts Inc Report, more than 1.5 billion people worldwide suffer from chronic pain, and about 3 to 4.5 percent of the population suffers from neuropathic pain. Among Americans, pain affects more people than diabetes, heart disease, and cancer combined.
How well do treatments for chronic pain work? A new literature review by Dennis C. Turk, MD, and his colleagues from the University of Washington in Seattle highlights the current state of chronic pain treatments, and they report that the results are “sobering.”
The authors surveyed the literature on fibromyalgia, low-back pain, neuropathic pain, and osteoarthritis and noted the empirical evidence for treatment approaches. Their review covered opioids, NSAIDS (nonsteroidal anti-inflammatory drugs), acetaminophen, antidepressants, anticonvulsants, surgery and other invasive procedures, psychological approaches, and complementary methods.
At the top of the list of drugs prescribed for pain were opioids (e.g., OxyContin, Percocet, Vicodin), even though they provide only minimal relief from pain and small improvements in function. Opioids are also one of the most commonly abused/misused prescription drugs, according to the National Institute on Drug Abuse. Misuse of opioids can result in life-threatening side effects and death.
NSAIDs (e.g., ibuprofen, naproxen, celecoxib) are available both over-the-counter (OTC) and by prescription and often used by patients who have osteoarthritis and rheumatoid arthritis. An alternative to NSAIDs is acetaminophen, which has been associated with serious liver and gastrointestinal side effects.
Both antidepressants and anticonvulsants have demonstrated some ability to relieve pain, and the Food and Drug Administration (FDA) has even approved several drugs in these categories (e.g., duloxetine [Cymbalta], milnacipran [Salvella], pregabalin [Lyrica]) for patients with fibromyalgia and neuropathic pain. Side effects remain a challenge with these medications.
Surgery and other invasive procedures, such as epidural steroid injection and lumbar fusion, were reviewed as treatments for chronic low back pain. In the United States, back pain is the leading cause of disability in adults younger than 45 years old. Chronic back pain is one of the main reasons people seek surgery.
The researchers found dissatisfaction with back surgeries, noting that many patients worsened over time after lumbar fusion for back pain, for example. They also observed “high complication rates and repeat procedures are realities of spinal surgery as well.” Psychological approaches may provide “modest benefits,” while the efficacy of complementary medicine practices varies.
Overall, the state of chronic pain treatments is unsatisfactory, as none of the commonly used approaches adequately eliminate pain or improve function in the majority of chronic pain patients. The authors recommend combining various treatment modalities and pursuing more aggressive research that involves “addressing what treatment is effective for which patients, on what outcomes, under what circumstances, and at what cost.”