Opioid medications do not work for managing chronic pain. The Center for Disease Control (CDC) released guidelines in March of 2016 based on a review of published academic literature on different strategies for managing chronic pain. To sum up the CDC’s findings, it found no evidence that opioids were effective for managing chronic pain. The CDC did find, however, that the use of alternative strategies -- such as cognitive behavioral therapy, acupuncture, medical massage, physical therapy, among others -- were useful in providing relief.
As a reminder, chronic pain is pain that lasts six months or longer, and research has shown that the brain experiences chronic physical pain as a type of emotional pain. The CDC found that most of the studies on the use of opioids for chronic pain management were less than six weeks in duration, meaning that the studies weren’t measuring the impact of opioids on chronic pain at all.
So why don’t all healthcare insurance companies pay for treatments proven to work?
Insurance companies are perhaps hesitant to pay for the alternative methods of managing chronic pain because they are expensive and they take time and patience to implement properly. In the short term, it is more cost effective to provide a pill. I suppose also that relying on pharmaceutical therapies fits the accepted paradigm on how modern medical treatment should work. No one would question giving a pill, but using acupuncture sounds outlandish. It’s interesting that this is the accepted notion, when research shows there is no evidence that opioids are effective in treating chronic pain, while acupuncture and other therapies do work.
As for whether opioid treatments for chronic pain truly are the cheaper option, I would challenge insurance companies to take a look at the ten-year cost of treating chronic pain patients with opioids. Many of these patients are not really going to have adequate pain relief, as the body adjusts to the long-term use of opioids. Even worse, patients can become prone to misusing or abusing their prescribed medication, requiring outpatient or residential treatment for substance use disorder, which is an expensive proposition. They may also over-utilize emergency services and other healthcare services, as people with substance problems frequently do.
After a decade of using opioids, the ability of these patients to function in everyday life is likely to deteriorate. They are less likely to be employed. They might develop psychiatric illness -- particularly mood disorder -- that goes hand in hand with both long-term pain and long-term substance use.
Compare that to the long-term cost of treating somebody with chronic pain aggressively with multi-modality therapy such as physical therapy, regular acupuncture, medical massage, and a personal wellness plan -- such as covering a local gym membership, where they can go and exercise on a regular basis.
My guess is that insurance companies would find that the overall long-term cost for opioid based pain management is going to be much more expensive than using these multi-modality therapies. The initial outlay for these therapies will be more expensive, but, in the long run, it will be cheaper for insurance companies and more effective for patients, who will see improvement in both pain and function.
Insurance companies are welcome to prove me wrong, but the CDC has made it clear that opioids don’t work for chronic pain. So why are insurance companies still paying for it? Why aren’t they paying for the therapies that work?
I used to be hesitant to talk about this, because I felt it was important to be in alignment with the standard thinking on pain management. The problem is, the longer I do this, the more I believe the standard thinking about chronic pain management is just wrong. Things are going to change dramatically over the next ten years, as research identifies additional non-pharmacological modalities of treating chronic pain. Insurance companies need to adjust from short-term thinking and look at the long-term benefits, both in terms of medical costs and better patient quality of life, of using alternatives to using opioids for chronic pain.