Opioids vs... what?

Author: Mary Lynn McPherson

Mary Lynn: I think this is a fine kettle of fish we find ourselves in with this opioid controversy. It’s easy to decry the use of opioids if you don’t have Plan B. So I think we’re seeing this in practice all the time, aren’t we?

Alexandra: I think the pendulum has swung too far in the other direction. In the early 2000s, there was this increase in opioid prescribing and use that has led us to the predicament we’re in now with the opioid abuse and misuse epidemic, as they’re calling it. And now no one wants to prescribe them. For our patients with truly legitimate pain, what are we doing for them. We’re really leaving them in a pickle because prescribers aren’t comfortable prescribing opioids anymore. So really we’re turning to alternative therapy which is what we should be doing at baseline, truly assessing our patient’s pain and determining whether or not their pain is opioid responsive in the first place. Can we use a nonsteroidal. Can we use acetaminophen or an SNRI, gabapentin, something along those lines, and then utilizing things like nerve blocks, integrative medicine, nonpharmacologic therapy in addition to opioids if appropriate.

Mary Lynn: When we talk about the multimodal therapy, the important thing is I think we need more data on the efficacy. Like I know I often read that massage has better data than drugs for low back pain which is great, but then the next part of that puzzle is will third party payers reimburse for these alternate therapies. I do think we have to ask people first and foremost—what a concept—and use some common sense. Do a thorough assessment and use a multimodal approach, but let’s not throw the baby out with the bathwater just yet.

Alexandra: I agree.

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