Opioid Epidemic and Chronic Pain Within the United States

Turk and colleagues (2008) emphasized that within an interdisciplinary approach, the cognitive-behavioral perspective is generally used for educating patients on understanding and treating chronic pain, as CBT currently has the greatest empirical support [49].

Based on this empirical support, CBT has become one of the most commonly used treatments for chronic pain [52]. The treatment of pain can often prove to be challenging due to the subjective nature of pain. The only way we can understand another person's experience is by asking, observing, and making inferences about their behavior.

The underlying basis of the cognitive-behavioral approach assumes that people believe their pain causes their inability to function and that they are helpless to improve their situation.

The goal of CBT is to teach the patient to recognize that they have the capability to manage their problems associated with pain, and to develop skills that can be used even after the treatment ends. Some of the major skills that CBT emphasizes include stress management, problem solving, goal setting, pacing activities, and assertiveness – all of which can be incorporated within a comprehensive rehabilitation program. Additional techniques, such as biofeedback, relaxation, meditation, guided imagery, and hypnosis, can also be incorporated with CBT to provide patients with a sense of self-control. A successful CBT approach should help patients develop a sense of hopefulness, resourcefulness, and the ability to change their typical maladaptive feelings of hopelessness, stress reactivity, and passivity [49].

A successful approach for treating chronic pain has shifted away from a biomedical reductionist model in favor of a more holistic biopsychosocial model. This model aims to describe the complex and influential roles of health conditions, such as chronic pain, in physiological, psychological, and social terms. These factors may even worsen one another, resulting in a more negative health outcome [53].

Functional restoration (FR), an interdisciplinary pain program, attests to this model and incorporates various clinicians who center their goals on "restoring physical functioning capacity and psychosocial performance"[53]. FR has consistently shown significant improvements in the overall treatment of chronic pain compared to other approaches [54]. Furthermore, the overwhelming success of FR has been consistently documented across various socioeconomic conditions and cultures, including the U.S. military [54, 55].

Conclusion and Future Perspective

The evidence is quite clear that the massive economic and societal consequences resulting from the misuse of prescription opioids require immediate attention. Despite the evidence for the ineffectiveness of opioids in the treatment of chronic pain, prescribing habits by physicians reveal a fundamental misunderstanding between research and practice. Unfortunately, even if the long-term prescription for opioids may be warranted, the prescribed use of opioids could potentially develop into several consequences, including dependence or addiction.

As more research into chronic pain continues, healthcare researchers must find alternative methods of treatment to curtail the negative health effects of prescription opioid misuse among chronic pain patients associated with the opioid epidemic. The issue of chronic pain is complex, requiring an interdisciplinary approach that applies the biopsychosocial model to produce the least invasive treatment with the best possible outcomes.

As the U.S. population begins to rise and live longer, the problem of chronic pain will continue to grow. Biomedical approaches are limited in their effectiveness in treating chronic pain, while evidence continues to show the benefits of biopsychosocial approaches implemented within interdisciplinary programs. It is safe to predict that these psychosocial forms of intervention, which place a greater emphasis on treating the source of the pain rather than just the symptoms, will begin to take hold in education programs for general physicians. Greater awareness of the biopsychosocial model among all branches of the medical field will encourage a biopsychosocial approach to treating chronic illnesses. Hopefully, this will result in better overall health and stability of the general population.

Practice Points for Clinicians:

When a patient reports experiencing chronic pain, these are the steps a healthcare provider should consider for proper diagnosis and treatment options:

• Assess the location and severity of the chronic pain: it is important for determining what kind of physical exercise interventions can be used to reduce this pain.
• Use a biopsychosocial approach to assess the extent to which chronic pain hinders the patient's daily activities. Ask questions if the patient has trouble regulating mood or if they have difficulty maintaining their occupational and social responsibilities. This should constantly be monitored throughout the treatment plan.
• If the patients present additional psychological and social problems caused by their pain, consider any comorbid conditions the patient may have.
• Provide patients with resources to psychotherapists or psychologists who can provide psychosocial treatment, whether it be within the facility or outside it.
• Since patients with chronic pain are more likely to present comorbid conditions, take great care when considering opioids for their pain. Psychiatric comorbidity could result in potential abuse and non-medical prescription opioid use (NMPOU).
• The patients may have developed NMPOU from a previous treatment plan or even through self-medication to treat their chronic pain. If this is the case, it is important to assess the level of their dependency or addiction, if any. Careful consideration should be taken as to whether a pharmacological treatment should be implemented, and whether the patient presents any psychiatric comorbidities that may make this option unsuccessful. Otherwise, psychosocial interventions should be emphasized along with a physical exercise regime.
• Functional restoration, which utilizes an interdisciplinary approach, appears to be widely successful for patients with chronic pain. The psychosocial methods of treatment in this program can be effectively used for those with opioid abuse issues. If you do not have the capability to provide your clients with an interdisciplinary program, make sure to provide your patients with appropriate resources in order for them to utilize other specialized healthcare providers, thereby maximizing treatment outcomes.

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