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Pain Management in an Opioid Epidemic: What is Appropriate, What is Safe

Updated: Jan 8, 2019

Exploring the benefits of SuboxoneⓇ (Buprenorphine) Treatment

Pain Management Opioids

A core principle of the practice of medicine is to relieve suffering, yet the undertreatment of pain has been deemed a public health crisis by the National Academy of Medicine (NAM).

Pain is one of the oldest challenges for medicine, creating a therapeutic dilemma for many pain specialists. Despite advances in evidence and understanding of its pathophysiology, chronic pain continues to burden patients in a medical system that is not designed to care for them effectively. The physician community continues to struggle with uncertainties when managing a patient’s chronic pain in the face of an epidemic of opioid overuse and abuse.

According to the AAFA’s Chronic Pain Management and Opioid Misuse: A Public Health Concern report, opioids have been used in the treatment of pain for centuries, despite limited evidence and knowledge about their long-term benefits, but there is a growing body of clear evidence regarding their risks. As a result of limited science, external pressures, physician behavior, and pharmacologic development, we are seeing first-hand the significant consequences of opioid overprescribing, misuse, diversion, and dependence. Sadly, our current healthcare system is poorly equipped to address the needs of a patient who has chronic pain and/or opioid dependence. Patients can feel abandoned in their care, such as when they are marked with the stigma of addiction, labeled as “drug seekers” by health care providers for opioid misuse.

We need to approach pain management as a compassionate and empathetic field in which we care for the suffering who often have no place to turn and seek help managing these isolating conditions. Pain is a personal, individual, and subjective experience. Pain can be classified as acute or chronic. Acute pain is distinct from chronic pain and relatively more sharp, sudden but temporary, likely a response to some type of bodily injury; it generally lasts less three to six months. While chronic pain is persistent pain that can last for six months or longer. It can have real effects on one’s day-to-day life and one’s mental health without proper pain management.

Pain management does not merely imply treating pain conditions with pills. The response to this crisis must include prevention, early identification, and appropriate treatment of addiction. We need to educate the public and fellow providers. We have seen what has happened as a result of doctors overprescribing opioids over the past

decades and now lives are lost daily due to the consequences of the same. To help stem the epidemic of controlled prescription drug abuse, prescribing doctors, nurse practitioners or physician assistants must be knowledgeable about patient safety, including how to identify patients at risk for opioid misuse and recognize signs of misuse or abuse for better pain management.

For non-cancer pain syndromes, we must embrace a multifaceted, multimodal approach that is designed to address the needs and goals of each unique patient. We include, but do not limit treatment options to, physical therapy/chiropractic care, psychological support, minimally invasive interventional pain management techniques, and non opioid medication options in most cases.

Additionally, some patients may be appropriate candidates for medical marijuana therapy or suboxone therapy for opioid addiction treatment. Treatment plans are constructed as result of collaboration among the patient, the patient's family, and our provider team. Goals of such plans are openly set within the team as well as risks with any treatments.

Under the Drug Treatment Act 2000, specially licensed doctors can prescribe SuboxoneⓇ from their offices, instead of clinics. SuboxoneⓇ treatment entails a medication treatment of opioid abuse disorders. Suboxone is a medication that contains the medications buprenorphine and naloxone. Buprenorphine is considered a “partial opioid agonist,”meaning that it produces a milder form of the effects produced by opioids (which are “full opioid agonists”). It essentially fills the brain’s opioids receptors without producing the same “high” as “full” opioids. Per American Addiction Centers, “one of the advantages of using Suboxone is that it cannot be taken to achieve a full opioid effect, making it more difficult to abuse than other forms of medication-assisted treatment, such as methadone.” The team of expert providers will determine the most appropriate dosage of SuboxoneⓇ for any individual patient. Oftentimes, medication management is supplemented with counseling and therapy.

Under the Drug Treatment Act 2000, specially licensed doctors can prescribe Suboxone from their offices, instead of clinics. Once a stable dose is achieved, and a patient has shown to be compliant to the program, office visits can be reduced from weekly to one visit per month. Patients also don’t have to deal with the inconvenience and stigma of making daily visits to a clinic when they have the benefit of a prescription and support of a doctor, nurse practitioner, or physician assistant.

It is important to couple SuboxoneⓇ therapy with an active addiction recovery program, such as Narcotics Anonymous, that is tailored towards improvement in function. This is critical because many aspects of an addiction recovery program are part of pain treatment as well. Industry publication, Practical Pain Management calls out that addiction treatment and pain treatment must focus on:

  • Education - Pain and addiction triggers, the role of diet, the role of exercise, the role of pacing activities, safe medication use, and education about the role of the body’s own pain relievers (endorphins, norepinephrine, dopamine, and serotonin)

  • Spiritual reconnection—Meditation, support groups (group therapy and NA meetings), meaningful rituals (for example, family, religious, or community activities that reinforce positive contributions and communication with other people)

  • Mind—Sleep, hygiene, relaxation, fear and stress reduction, distraction, repattern thinking, and attitude

  • Social interactions—Improved family interaction, communication, problem solving, improved functioning at work or volunteering

Chronic pain and opioid misuse are important and pertinent health care issues that are imperative to patients seeking pain relief, the medical community, and society as a whole. For more information about addiction education and the advantages of SuboxoneⓇ treatment, please visit National Institute on Drug Abuse and American Addiction Centers.


1. Institute of Medicine Committee on Advancing Pain Research Care and Education. Relieving pain in America: A blueprint for transforming prevention, care, education, and research. Washington (DC): National Academies Press (US); 2011.

2. American Academy of Family Physians (AAFP). Chronic Pain Management and Opioid Misuse: A Public Health Concern (Position Paper).


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