The industry is working overtime to find alternative pain solutions.
Photo: Tomas Nevesely/Shutterstock
America is in the midst of an opioid crisis. While it might not seem like something you should be concerned about, it's important to realize that women may have a higher risk for addiction to painkillers, which are often prescribed after routine surgeries. And though they're used to treat chronic pain as well, research suggests that opioids may not help deliver pain relief in the long-term. What's more, though not all people who use opioids become addicted, plenty do, and U.S. life expectancy has decreased as more people die of opioid overdoses.
A big part of the effort to combat this epidemic is determining when opioids are not necessary and finding alternative treatments. Still, many doctors are adamant that opioids are essential in certain pain situations—both chronic and acute. "Because chronic pain is a complex biopsychosocial condition—meaning that it involves the interplay of biological, psychological, and social factors—it's uniquely personal and affects each person differently," explains Shai Gozani, M.D., Ph.D., president and CEO at NeuroMetrix. Opioids are also sometimes needed when someone has acute pain, like right after a surgery or injury. "Given that pain is such an individual experience, treatment methods need to be personalized." Sometimes, that includes the use of opioids, and sometimes it doesn't.
Experts agree that there are also a lot of other ways pain can be treated that carry less risk of addiction. It goes without saying that physical therapy, alternative medicine treatments like acupuncture, and even psychotherapy can help reduce the use of opioids, but another line of defense against the opioid epidemic is the emerging technologies that are being perfected and becoming more widely-accepted. Here are five that could help cut back on opioid use.
Research shows that people generally have pain medication left over after oral surgery, like wisdom tooth extraction, which leaves the door open for its potential misuse. When you consider that that over 90 percent of patients having conventional oral surgery (think: tooth extraction, gum surgery involving stitches) are prescribed opioids, according to Robert H. Gregg, DDS, co-founder of Millennium Dental Technologies and the Institute for Advanced Laser Dentistry, that's kind of a big deal.
That's part of why he invented the LANAP laser, which can be used to perform dental surgery and reduces pain, bleeding, and recovery time. Dr. Gregg says that patients who opt for the laser option are only prescribed opioids 0.5 percent of the time—a huge difference.
Right now, the lasers are being used in 2,200 different dental offices across the country, and Dr. Gregg says he expects that number to grow steadily as people learn more about laser dentistry and understand the downsides of prescribing opioids for oral surgeries.
Slow Release Local Anesthetics
These types of medications have been around for quite a few years, but are being increasingly offered across a wide range of surgery types. The most common is called Exparel, which is a slow release form of a local anesthetic called bupivacaine. "It is a long-acting numbing medication injected during surgery that can control pain for the first few days after surgery, when patients need it most," explains Joe Smith, M.D., an anesthesiologist at Inova Loudon Hospital in Leesburg, Virginia. "This reduces, or in some cases eliminates, the need for opioids. Not only does this help patients avoid the obvious risk of dependence, but also the side effects of narcotics such as respiratory depression, nausea and vomiting, constipation, dizziness and confusion, to name a few."
One of the best things about this solution is that it can be used for so many different types of surgeries, including orthopedic surgeries such as shoulder surgeries, ACL repairs, and many others, Dr. Smith says. It's also used in foot surgeries, c-sections, plastic surgery, oral surgery, and more. Most people are good candidates for it, except for those allergic to local anesthetics and those who have liver disease, according to Dr. Smith.
The only downside? "While long-acting local anesthetics such as Exparel can help reduce the need for postoperative opioids, these are expensive and most patients choose the economy of the opioid option," says Adam Lowenstein, M.D., a plastic and migraine surgeon. Some insurance plans may cover it or partially cover it, but it's definitely not the norm. Still, it provides a useful option to those who are sure they don't want opioids post-op.
New C-Section Tech
"C-sections are a major surgery, so almost all women receive opioids post cesarean," says Robert Phillips Heine, M.D., an ob-gyn at Duke University Medical Center. "Given that cesarean deliveries are the most commonly performed surgical procedure in the United States, it would be beneficial to reduce the amount of narcotic required, as major surgery is a known gateway to opioid dependence," he adds. (Related: Are Opioids Really Necessary After a C-Section?)
In addition to anesthetic options like Exparel, there's also something called closed incision negative pressure therapy that could reduce the need for opioids after a c-section. "Closed incision negative pressure therapy protects the incision from external contamination, helps hold incision edges together, and removes fluid and infection materials," Dr. Heine says. "It is a sterile dressing applied to a surgical incision and attached to a pump that delivers continuous negative pressure and remains in place for five to seven days." This was originally implemented to prevent infection post-surgery, but doctors discovered that it also caused a reduction in the amount of pain medication needed by women who had it. Right now, this approach is mainly being used in patients who have a high risk of infection, such as those with a BMI over 40, since those are the patients research demonstrates benefits for, Dr. Heine says. "If more data becomes available that suggests it prevents infection and/or reduces narcotic use in lower-risk patients, it will likely be used in that population as well."
We know that addiction is partially genetic, and researchers believe they have isolated some of the genes that may predict whether someone will become addicted to opioids or not. Now, there's an at-home test you can take to assess your risk. One of the most popular is called LifeKit Predict, which is manufactured by Prescient Medicine. According to research published in the Annals of Clinical Laboratory Science, new testing methods used by Prescient can predict with 97 percent certainty whether someone is low risk for opioid addiction. Though this study was relatively small and some doctors involved with the company were part of the study, it does seem to show that the test could be worthwhile for someone concerned about their addiction risk.
It's very important to note that this test certainly cannot guarantee that someone will or will not become addicted to opioids, but could provide useful information for those who are making a conscious decision about whether to use them. The test is covered by some insurance plans, and though you don't need a prescription to take it, Prescient highly recommends consulting with your physician about the test and the results once you receive them. (Related: Does At-Home Medical Testing Help You or Hurt You?)
If you've only ever heard about stem cells in reference to cloning, you might be surprised to find out that they're being used increasingly in medicine as a way to deal with pain. Stem cell therapy is part of a larger practice called regenerative medicine. "Regenerative medicine is a revolutionary approach to treating many degenerative diseases and injuries," explains Kristin Comella, Ph.D., Chief Science Officer of American Stem Cell Centers of Excellence. "It is continually growing, and includes a variety of different techniques, such as stem cell therapy, to harness your own body's natural healing mechanisms." Whereas opioid medications address pain symptoms, stem cell treatment is meant to address the underlying cause of the pain. "This way, stem cell therapy effectively manages pain and may mitigate the need for pain relief via opioids," Comella says.
So what exactly does the therapy entail? "Stem cells exist in every tissue in our bodies and their main function is to maintain and repair damaged tissue," Comella notes. "They can be isolated from one location in your body and relocated to another part that needs healing, to address pain in various locations." Importantly, stem cells are only used from your own body in this treatment, which eliminates some of the ethical connotations that come along with the term "stem cells."
Sometimes, stem cell therapy is combined with platelet-rich plasma therapy (PRP), which Comella says acts like a fertilizer for stem cells. "PRP is an enriched population of growth factors and proteins obtained from one's blood. It enhances the healing cascade produced by naturally occurring anti-inflammatory stem cells," she explains. "PRP is most successful for treating pain resulting from new injuries because it boosts the healing stem cells that are already cultivating as they are naturally going to the injured area." And, the treatment can also be used to accelerate anti-inflammatory pain relief for more chronic issues like osteoarthritis, Comella says.
It's worth noting that stem cell therapy isn't exactly mainstream, nor is it FDA-approved. While the FDA (and most medical researchers, for that matter) acknowledges that stem cell therapy is promising, they don't believe there's enough research about it to approve it as a treatment. Long story short: It's not so much that the FDA doesn't think that stem cell therapy is effective, it's more that we don't have enough information to use it safely or reliably. By only doing outpatient, general-anesthesia-free procedures administered by doctors using patients' own cells, though, stem cell clinics are able to operate within the FDA's guidelines.
While regenerative medicine might not be recommended by your doctor—and certainly won't be covered by your insurance—it's still a fascinating look ahead into what medicine might be like decades from now.