Introduction
Pain relief is an excellent attribute of modern history that humanity is lucky to enjoy. In the United States, almost one in five adults suffers from chronic pain that interferes with day-to-day life (Wong, 2016). However, pain reduction can be controversial: for example, opioids – frequently used as painkillers – are abundant in many countries. While most states do not have access to opioid pain relief options, the United States demonstrates that the country’s epidemic fails to fight successfully. Nevertheless, in both cases, the idea of seeking nonopioid alternatives seems like a rational replacement or, at least, an addition. Overcoming opioid addiction, the American society needs to look for other options, considering that the alternatives: from exercises and diet to psychotherapy – are proven to be effective. If the United States manages to overcome the political challenges of introducing the policy of nonopioids popularization, this success may significantly contribute to increasing the level of care provided to patients.
Speaking of the urgency of the issue, the use of an opioid is currently extremely widespread in the United States. In 2017, more than 11 million individuals misused the prescribed addictive pain medications (Center for Disease Control and Prevention, 2020). Moreover, those prescriptions were involved in 35 percent of all overdoses that year that constituting 17 000 death cases (McCance-Katz, 2018). The picture becomes even more extreme when one draws their attention to the tendency: since 1999, more than 300 000 people overdosed with the prescribed opioids (Center for Disease Control and Prevention, 2020). Furthermore, according to the Center for Disease Control and Prevention (2020), more than 1 000 individuals misuse their prescriptions and end up in emergency rooms every day. In other words, the problem of opioids appears to be multilevel and extremely urgent: not only are they addictive, but their overdose is lethal, and, hence, their usage is a high risk. Hence, the United States faces a double challenge of stopping the opioid epidemy while relieving the pain and needs to switch from the opioid-centered approach.
Meanwhile, there is another level of the problem: the so-called burden of pain is hugely presented in the United States. Some scholars point out that previously, the issue was essential in the context of military battles – they were a stimulus for painkillers’ invention. Even though the assessment of pain, especially in the case of noncancer chronic pain, the importance of the issue appears to be noticeable (Bonnie et al., 2019). Chronic pain “prevalence estimates for chronic pain vary wildly, ranging from 11% to 40%” (Bonnie et al., 2019, p. 31). In a word, the burden of pain has historically been presented in any society; however, currently, the problem of pain control has changed its primary dimension in American society.
Policy’s Effect on Clinical Practice
To begin with, the introduction of nonopioid alternatives can make contemporary clinical practice more effective. As Agency for Healthcare Research and Quality (2018) study claims, nonpharmacological treatment can significantly improve pain management in case of chronic back and neck pain, knee, and hip osteoarthritis, and tension headaches. These data demonstrate that “exercise, multidisciplinary rehabilitation, acupuncture, CBT, and mind-body practices were most consistently associated with durable slight to moderate improvements in function and pain for specific chronic pain conditions” (Agency for Healthcare Research and Quality, 2018, p. 284). Another aspect of being discussed is emotional health: “noninvasive devices designed for patient self-use for pain control reduced pain and improved depression and anxiety” (Morrow et al., 2019, p. 181). Thus, studies evidentially prove that nonpharmacological therapies are indeed useful for chronic pain reduction and contribute to a patient’s emotional wellbeing.
Furthermore, there are various options of nonopioid alternatives for pain relief: physical therapy, exercise, and nutritional counseling – but their influence does not seem obvious for many. For instance, Kim studied the influence of yoga practice on chronic neck pain (2016). As the scholar concludes, “neck pain intensity and functional disability were significantly lower in the yoga groups than in the control groups” (Kim, 2016, p. 2171). Hence, breathing practices, meditation, and physical effort can contribute to the pain relief problem. Another example to be discussed is nutrition: some foods may not only grow pain levels, but also increase inflammation, and their exclusion from one’s diet may contribute to pain reduction. Moreover, even sleep can be considered as another nonopioid alternative practice: sleep patterns establishment is essential for patients going through pain. Therefore, there are different forms of nonopioid alternatives that contribute to pain relief.
Last but not least type of nonopioid alternative is psychotherapy. Various psychotherapy forms are proved to be effective: mindfulness-based stress reduction, cognitive behavioral therapy, or, for instance, acceptance and commitment therapy (Wong, 2016). As experts notice, “even though the main objective of these forms of psychotherapy is not to reduce the intensity of pain but to improve quality-of-life, coping, and in general to contribute to a more meaningful life, pain intensity may also improve” (Wong, 2016, p. 11). What is more, chronic pain could be prevented by psychotherapy: studies are being developed that examine the condition of postsurgical patients at risk of chronic pain. Finally, psychotherapeutic practices help individuals fight against depression and anxiety (Wong, 2016). In a word, psychotherapy becomes a vital contribution to pain relief and patients’ emotional wellbeing.
Nonopioid Alternatives Policy Application for Coordinated and Comprehensive Care
As demonstrated in the analysis above, the policy focused on nonopioid alternatives promotion appears to be an issue of outstanding importance. However, one may pose a question of how the authorities should build their policy to popularize access to nonopioid pain management means. National Governors Association articulated several strategies for governors and various agencies to implement in their work to promote the policy under discussion (Williamson et al., 2020). Among those measures, there is an examination of “current evidence and access for nonopioid” alternatives and consideration of the “state of Medicaid strategies for expanding access to chronic pain management services” (Williamson et al., 2020, p. 2). Moreover, experts recommend that the authorities explore “coordinated and interdisciplinary care delivery models” and seek new strategies to expand access to pain management (Williamson et al., 2020, p. 2). Such models could be various: coordination of patients’ care plans, provision of pharmacological options and exercises, teaching self-management, or, for instance, access to professional help (Williamson et al., 2020). Hence, there are logical steps towards the governmental success in nonopioid alternatives policy.
Meanwhile, it is essential to point out the challenges of expanding access of the public to nonopioid alternatives. According to the National Governors Association report (2020), there are three critical issues: firstly, it is a lack of skilled workers as the staff is not frequently trained to deal with chronic pain. Secondly, this shortage of employees is caused by the low level of education in the realm, as primary care providers do not receive such training (Williamson et al., 2020). Thus, professionals are unable to conceptualize the complexity of chronic pain cases. Thirdly, another challenge has a lot to do with geographical inequality: “access to behavioral health providers, acupuncturists and chiropractic services differs significantly based on locality” (Williamson et al., 2020, p. 6). What is required is “a substantial investment in surveillance and research on many fronts and a coordinated policy response by federal and state agencies and stakeholder organizations” (Bonnie et al., 2019, p. 31). Therefore, the existing challenges seem to pose risks to the popularization of nonopioid alternatives.
Conclusion
To conclude, the problem of pain relief is still urgent, even in the United States. It is not just the feeling reductions issue, but the opioid epidemic: physicians do not limit themselves in providing prescriptions that tend to be misused by patients. Hence, the statistics demonstrate the unfortunate numbers of fatal cases caused by overdosing. That is why the question of nonopioid alternatives popularization becomes hugely urgent. Their application could be extremely useful for relieving the pain and controlling patients’ emotional wellbeing. In other words, nonopioids have the chance to increase individuals’ level of life. In case this policy succeeds, patients will see more coordinated and comprehensive medical help. However, there are still some obstacles present in American society that have a lot to do with the lack of well-educated staff and geographical inequality. Nevertheless, the idea of the need to switch from the opioid-centered approach to pain management planning.
References
Bonnie, R., Schumacher, M., Clark, J., & Kesselheim, A. (2019). Pain management and opioid regulation: Continuing public health challenges. Promoting Public Health Research, Policy, Practice and Education, 109(1), 31 – 34.
Center for Disease Control and Prevention. (2020). U.S. opioid prescribing rate map. Web.
Healthcare Research and Quality. (2018). Noninvasive nonpharmacological treatment for chronic pain: A systematic review. Comparative Effectiveness Review, 209.
Kim, S.-D. (2016). Effects of yoga on chronic neck pain: a systematic review of randomized controlled trials. Journal of Physical Therapy Science, 28(7), 2171 – 2174.
McCance-Katz, E. (2018). The national survey on drug use and health: 2017. Substance Abuse and Mental Health Services Administration. Web.
Morrow, D., Fischer, E., Walder, A., & Jurban, N. (2019). Nonopioid alternatives to addressing pain intensity: A retrospective look at 2 noninvasive pain treatment devices. Federal Practitioner, 36(4), 181 – 187.
Williamson, K., Alikhan, S., Greene, K., Becker, M., & Tewarson, H. (2020). Expanding access to non-opioid management of chronic pain: Considerations for governors. National Governors Association Center for Best Practices.
Wong, C. (2016). Non-opioid alternatives for the management of chronic pain. Clinical Pain Advisor. Web.