Introduction
Chronic pain is a widespread medical problem that affects patients’ quality of life and often causes disability. While eliminating the cause of chronic pain is often not possible, managing chronic pain using various treatment options can reduce the effect of the condition on patients’ life and health, thus promoting their well-being. Opioid therapy is the most popular option for managing chronic pain. However, alternative treatments, including spinal cord stimulation and the use of medical marijuana can also be applied to reduce the symptoms. The present paper aims to present a literature review of resources documenting the effectiveness of these three treatment options.
Opioid Therapy
Opioid analgesics are often used for the management of chronic pain and are considered to be effective in relieving symptoms. Sehgal, Colson, and Smith (2013) state, “In the past two decades there has been a massive increase in the number of opioid prescriptions, prescribed daily opioid doses and overall opioid availability” (p. 1201). Opioid therapy is mostly used in the long-term.
Although it is relatively effective in relieving pain, many patients are dissatisfied with the treatment due to numerous side effects (Sehgal et al., 2013). Indeed, the risks associated with the use of opioids are substantial. First of all, opioids are highly addictive, which mediates the effect of treatment on patients’ quality of life. According to Sehgal et al. (2013) patients who receive long-term opioid prescriptions are at an increased risk of drug abuse and overdose. Moreover, opioid therapy may put the patient at risk for harmful drug interactions, which is undesirable given that patients with chronic pain often take a number of other medications. The adverse effects of opioid therapy have led to an increase in the prevalence of opioid overdose deaths, which is also a major concern for this treatment option (Sehgal et al., 2013). Overall, although opioid therapy is moderately effective in reducing chronic pain, it is associated with many important risks, which reduce its benefits for the patient’s life and health.
Spinal Cord Stimulation
Spinal cord stimulation (SCS) is a relatively new method in the treatment of chronic pain. This option includes the use of epidurally implanted electrodes, which deliver electrical stimulation to the spinal cord, thus relieving the pain. There are several forms of spinal cord stimulation available, and new methods are continuously developing. Al-Kaisy et al. (2014) report on the effectiveness of high-frequency SCS on reducing chronic pain in the lower back area. This is one of the newer methods of SCS which involves using high-frequency stimulation instead of traditional tonic stimulation.
As chronic pain is a long-term condition, assessing the effectiveness of treatment after 24 months is beneficial to establishing its actual effects on patients’ symptoms, quality of life, and disability. As reported by Al-Kaisy et al. (2014), 88% of patients agreed that high-frequency SCS was useful in reducing their chronic pain. The reduction of symptoms was also associated with improvements in other variables, including disability and opioid use. The patients also reported an increased quality of life and decreased sleep disturbances, as well as high overall satisfaction with the method (Al-Kaisy et al., 2014). Therefore, the treatment offers numerous benefits to patients with chronic pain.
However, there are also some risks associated with the use of high-frequency SCS, as well as with other forms of this treatment. For example, Al-Kaisy et al. (2014) state that there are a number of contraindications for the use of SCS, including cancer, pregnancy, coagulopathy, and compromised immune status. Moreover, the treatment could lead to complications. These include wound infection, pocket pain, skin erosion, and lead migration (Al-Kaisy et al., 2014). The prevalence of these complications is rather low, but further studies and improvements to the method are required to reduce the possibility of adverse effects.
Medical Marijuana
In states and countries where medical marijuana is allowed, patients with chronic pain have the option to use marijuana regularly in order to improve their symptoms. Hill (2015) reviews clinical trials of the effectiveness of medical marijuana in the treatment of chronic pain and other problems. The author reports that there is a substantial body of scientific evidence supporting medical marihuana treatment of chronic pain. Patients included in clinical trials recorded decreased chronic pain and disability (Hill, 2015). Thus, medical marijuana is a viable option for the management of chronic pain.
Nevertheless, despite proven effectiveness, the use of medical marijuana comes with a number of considerations. For instance, long-term use of marijuana may result in addiction, as well as depression, anxiety, and psychotic illness (Hill, 2015). These risks could reduce patients’ quality of life, thus impairing the effectiveness of treatment. Moreover, the use of marijuana may cause structural changes in the brain if used by young people (Hill, 2015). Marijuana also causes acute side effects, such as impaired short-term memory, poor motor coordination, and impaired judgment (Hill, 2015). Overall, although the treatment is potentially useful for patients with chronic pain, it should be prescribed with caution.
Conclusion
Although the treatments discussed in the review are all efficient in relieving the symptoms, they also have a number of limitations. The use of opioids and medical marijuana could cause addiction and decreased life quality. Spinal cord stimulation, on the other hand, has many contraindications and some possible complications. The choice of treatment should be based on existing risk factors, history of the condition, and information about the patient’s lifestyle. A proper risk and benefit assessment of all treatment options could assist physicians in choosing the most appropriate therapy for each patient.
References
Al-Kaisy, A., Van Buyten, J. P., Smet, I., Palmisani, S., Pang, D., & Smith, T. (2014). Sustained effectiveness of 10 kHz high-frequency spinal cord stimulation for patients with chronic, low back pain: 24-month results of a prospective multicenter study. Pain Medicine, 15(3), 347-354.
Hill, K. P. (2015). Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: A clinical review. Journal of the American Medical Association (JAMA), 313(24), 2474-2483.
Sehgal, N., Colson, J., & Smith, H. S. (2013). Chronic pain treatment with opioid analgesics: Benefits versus harms of long-term therapy. Expert Review of Neurotherapeutics, 13(11), 1201-1220.