2018-05-12 / Viewpoints

Consider opioid alternatives

By Dr. Jordan Klein

(Jordan Klein, MD, is a physician with Premier Medical Rehab in Harrisburg.)

Re: “Opioids aren’t inherently evil” (Endeavor News, April 14), about 80 percent of the global opioid supply is consumed by Americans. Tragically, in 2016 an estimated 42,000 drug overdose deaths in the U.S. involved opioids, with most deaths attributed to prescription drugs. Final numbers for 2017 will be even higher.

The medical community is responding by curtailing opioid prescriptions for many conditions. Understandably, many pa­tients are concerned they won’t get the pain relief they need.

Health-care professionals have a number of alternatives to opioids for short-term, or acute pain, and even for long-term, or chronic pain. Managing chronic pain is an involved and difficult process. As medi­cal practitioners, we tailor patients’ pain treatment plans to their specific illnesses or conditions and determine if opioids might be appropriate.

Opioids are uniquely effective for some conditions. Notably, opioids help patients reduce chronic pain related to cancer. In addition, post-surgical patients with acute pain might be prescribed a short course of opioids. I also see patients with multiple rib fractures who need pain control for maximum respiratory effort to prevent pneu­monia.

Keep in mind, though, that while opioids may temporarily alleviate pain, they don’t treat the condition causing the pain. So, any opioid should generally be accompanied by treatment for the disease (e.g., a medication for rheumatoid arthritis or one for neuropathy).

Increasingly, my colleagues and I recommend viable alternatives: non-opioid medications, physical therapy, exercise, rehabilitation therapy, strength training, yoga, heat or cold therapy, ultrasound, acupuncture and transcutaneous (through-the-skin) electrical stimulation.

Non-prescription pain relievers can work as well as opioids for short-term pain, such as that from broken bones, dental work or kidney stones. A study involving emergency room patients showed that acetaminophen and ibuprofen combined can be as effective as the opioid Percocet.

But even non-prescription medications should be taken only when pain is moderate or severe, not mild. Taking too many over-the-counter pain relievers, such as aspirin, Advil, Motrin and Aleve, can lead to complications, including gastrointestinal bleed­ing and heart attack.

Don’t take more pills than directed, or more often. If you can stop using opioids because you are pain-free, don’t keep your leftover pills.

If you feel you are addicted to opioids, speak with your physician. All of us need to view addiction as the disease it is -- as we do cancer, heart disease or arthritis.

If you or someone you know is struggling with addiction, this 24-hour hotline, staffed by trained professionals, will put you in touch with local services and support: 1-800-662-4357.

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