Chronic pain is a common problem affecting many Americans. In the United States, roughly 100 million individuals suffer from chronic pain. Opiates are the most common medications prescribed to treat chronic pain, more than anti-inflammatory medications, making them the most commonly prescribed type of medication in the country. Approximately 259 million prescriptions of opiates are prescribed each year.
With the opioid epidemic at an all-time high in the United States, physicians are using alternative methods to treat chronic pain. Dr. Michael Gaume, pain management specialist, is walking us through the options available at The University of Kansas Health System St. Francis Campus.
“The opioid problem really started in the physician’s office,” said Dr. Gaume. “Pharmaceutical companies came in and told physicians that these were safe medications, had very low risk for addiction and complications, and could be used for treating chronic pain. It took off from there. Pharmaceutical companies were very successful in their marketing and getting healthcare providers to prescribe these medications. As we now know, these medications are very addictive and have a lot of adverse effects.”
There was little to no research done on the treatment of chronic paim with opiates. “There’s no evidence that these medications even help with chronic pain,” said Dr. Gaume. “The duration of the studies that were performed only lasted for around six weeks. Patients felt like it was helping them during that time frame, but that wasn’t enough time to prove anything when controlling non-malignant pain. What studies did reveal was that the medications put patients at great risk for adverse side effects.”
Opiate overdoses have led to many deaths in recent years. “In 2016, nearly 20,000 people died due to overdose of prescription opiates, killing more people than motor vehicle accidents that year,” said Dr. Gaume. “Approximately 50 Americans die every day from overdose of prescription pain medication. What’s interesting is that the United States makes up about five percent of the world’s population, but we consume over 80 percent of the world’s opiate production.”
Knowing that these medications have significant inherent risks associated with them, people are interested in alternative treatment methods. “Patients suffering from chronic pain are now trying to avoid using these medications,” said Dr. Gaume. “So what treatment methods does that leave them with? With pain medicine, the pendulum has swung in the opposite direction. We’re trying to do more interventional type things like epidural steroid injections, non-narcotic medications and pain relievers, physical therapy and pain psychology. We try to get to the pain pathway at multiple levels along that pathway while minimizing or avoiding the use of opiates altogether.”
Becoming addicted to opiates doesn’t take long. “When patients start taking these medications, they build up a tolerance to the opiate very quickly, which is a normal human physiologic response,” said Dr. Gaume. “Our central nervous system is dynamic and undergoes change very quickly. The medications ease pain during the four to six week beginning period, but over a short period of time the medications stop working. When this happens, the typical response would be to increase the dosage to get that same desired level of pain relief. The cycle continues with that working for a few weeks, and then the pain returns. In the long-term, patients are at a very high level of opiate use and consumption just to control their pain.”
Opiates can also induce pain. “This paradoxical effect occurs when the central nervous system is exposed to the opiate analgesic and the medications start to amplify pain,” said Dr. Gaume. “This is referred to as opiate induced hypersensitivity. The pain gets wildly out of control and patients are often left wondering how they can get relief.”
Chronic pain cannot safely be treated with opiates. “Opiates have been found to be useful in treating cancer pain, post-operative pain and trauma pain,” said Dr. Gaume. “For the treatment of chronic pain, where you are taking these medications month after month and even year after year, the risk outweighs any benefit the opiates might have. This is why we are trying to find alternative therapies to control chronic pain.”
There are many alternatives that can be used to treat chronic pain. “As interventional pain physicians, we offer traditional therapies like epidural steroid therapy,” said Dr. Gaume. “This can be helpful for lower back pain and neck pan. Peripheral nerve blocks can also be done, where we identify a particular sensory nerve and insert a local anesthetic and steroid on that nerve, under ultrasound guidance, to diminish or dampen down that pain pathway. I’m also a big believer in physical and aquatic therapies. Getting patients in those type of therapies can help to improve their functional status and well-being.”
An exciting new form of therapy was recently introduced at The University of Kansas Health System St. Francis Campus. “Coolief Cooled Radiofrequency Therapy is a radio-frequency ablation treatment,” said Dr. Gaume. “This therapy is useful in treating patients with arthritic joint pain of the knees, hips, lower back, sacroiliac joint, lumbar spine, thoracic spine and cervical spine. With this, we are targeting sensory nerves to the joint. We apply thermal energy to that sensory nerve that causes it to stop working. It’s not a permanent cure, but it helps relieve pain for patients with arthritic joint pain for many months. After the nerve slowly regenerates and the pain returns, the procedure is repeated. We are the first hospital in the region to offer this therapy.”
A specific type of patient can benefit from the Coolief Cooled Radiofrequency Therapy. “Patients who have arthritic joint pain but might not be a candidate for joint replacement are great candidates for this therapy,” said Dr. Gaume. “Maybe they have an underlying comorbidity such as obesity, heart disease or age, or the patient simply does not want to undergo a total joint replacement, then they could benefit from Coolief Cooled Radiofrequency Therapy. I have also used this with patients who have already had a joint replacement but continue to have chronic pain. Approximately 30 percent of patients who have had a total joint replacement will continue to have chronic pain.”
Neuromodulation is also offered at The University of Kansas Health System St. Francis Campus. “Neuromodulation, also known as spinal cord stimulation, is like a pacemaker for the spinal cord,” said Dr. Gaume. “We deliver electric currents to the spinal cord that inhibits the pain transmissions from the lower extremities or lower back up to the brain for interpretation. We are able to block the sensation and down damper the patient’s pain. This type of therapy has really advanced over the past 35 years. The little generators are very sophisticated and highly programmable. We compare them to cell phones, as new models are made every few years.”
Neuromodulation is one of the more profound methods of pain medicine. “When I identify a patient who I think can benefit from this therapy and they haven’t had any success with epidural steroids, physical therapies and medications and surgery is not an option, we will offer them the spinal cord stimulation,” said Dr. Gaume.
Neuromodulation is a two-step process. “We start with a trial where we do an epidural similar to that of labor or steroid injection,” said Dr. Gaume. “Instead of injecting medicine, we thread a tiny little lead that has electrodes and contacts on it. This is threaded up into the epidural space and comes out of the skin. It’s attached to a small generator that patients wear for about a week. During this time, we, along with the company representative, make adjustments to see if we can cover the patient’s pain. After that week, we take the trial lead out and talk to the patient about their pain control and if they were able to do things they hadn’t previously been able to do. We look for at least a 50 percent reduction in their pain before we proceed with the out-patient implant procedure.”
These therapies are beneficial in making strides towards ending the opioid crisis. “There’s a lot of pressure from government agencies to limit the number of opiates prescribed,” said Dr. Gaume. “We are evolving and trying to find new treatment therapies for chronic pain which effects so many individuals.”
Dr. Gaume joins fellow pain specialist Dr. Guy Giroux in leading the experienced Pain Management Clinic at The University of Kansas Health System St. Francis Campus. For more information or to schedule an appointment, call 785-295-8385.