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November – December 2018
A message from Dr. Duane DiFranco
Battling the opioid crisis and treating patients experiencing chronic pain: A delicate balance
 One of the key challenges in battling the opioid epidemic is balancing the needs of individuals who are experiencing chronic pain — and whose conditions are best treated with an opioid prescription — against those who are misusing or abusing opioids.
We know that people experiencing extreme pain aren’t causing the opioid crisis, and we want to assure health care providers, our members and the community that those who need the medication can still acquire it. Our goal is to keep the medication out of the wrong hands and reduce the chances of addiction.
It’s been about a year since Blue Cross Blue Shield of Michigan launched its opioid task force to tackle the growing crisis. We’ve made tremendous progress on several fronts, from launching our Opioid 101 website to helping providers better identify patients with opioid use disorders and treat them more effectively. A flyer developed earlier this year outlines our strategy and efforts to fight the opioid epidemic.
Our team has continued to work diligently to help reduce opioid abuse and support patients who experience chronic pain, as well as care providers. For example, we work closely with the Michigan Quality Improvement Consortium,* which has drafted guidelines* for the proper use of opioids and the treatment of pain in primary care.
We also understand that many people would prefer not to rely on opioids to manage their pain. Here are some non-opioid alternatives you may want to consider when treating patients with pain:
Comprehensive evaluations: Primary care providers can work in tandem with psychologists who have special training to provide comprehensive evaluations of a patient’s pain. It’s one of the best, most effective ways to determine a safe, long-term way to treat chronic pain.
Physical therapy and functional rehabilitation: In certain cases, physical therapy can be a great way of relieving pain over time through the natural strengthening of the body. Functional rehabilitation also has a psychological care component beneficial to all patients.
Other drug combinations: Ibuprofen and Tylenol taken together may be as effective as opioids, but with fewer side effects and a lower risk of addiction. Also, some conditions, such as fibromyalgia, may actually get worse with opioid use.
Injections: Where appropriate, you may want to prescribe injections of non-opioid drug combinations that are less addictive than opioids.
Lifestyle modifications: Weight loss, exercise, proper sleeping habits, a healthy diet and a number of other factors can all play into chronic pain. Helping patients manage these aspects of their life can result in less pain and a healthier path going forward.
More research is needed for us to determine whether some alternative forms of pain treatment, such as massage therapy and acupuncture, can effectively treat pain. However, the options listed above are both comprehensive and effective. Blue Cross will continue to explore and evaluate the efficacy of alternative treatments for chronic pain going forward as part of our multi-pronged effort to help people struggling with pain.
Duane DiFranco, M.D., is senior medical director of Health Care Value for Blue Cross and BCN.
*Blue Cross Blue Shield of Michigan doesn’t own or control this website. |
