Opioid Crisis Newsweek Editorial: Peter Staats, MD

[drusso]

Is Dr. Staats justified saying this??

There’s one sure way to fix the opioid crisis

"The only way to solve the nation's opioid crisis is to treat chronic pain effectively. By embracing interventional therapies, doctors can do just that."

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[Aether2000]

No, the statistics on interventional pain do not bear this out. If even half of all patients being treated with interventional procedures had more than 50% relief continuously, then perhaps.... but that is not the reality of interventional pain for the chronic pain population. Of course if we start implanting peripheral nerve and field stimulators all over the body in addition to spinal cord stimulation at costs of $100,000 per person, then perhaps.....

Interventional pain medicine is a tool, not an endpoint, and interventional pain will not help the acute post surgical patient who becomes hooked on pills. Nor will it help the heroin addict or the chronic pain patient on moderate to high dose opioids.

 

[Malayil]

If we all changed the treatment ladder and kept writing opioids for chronic pain last then yes this plus time can eventually overcome the opiate issue.

Conservative care, Interventional techniques, Neuromodulation which includes HF 10, BurstDR, DRG and IT pumps can all stage off chronic opiate need.

It is not an overutilization like most people on in the medical community may think. If used appropriately it can help a lot of patients.

 

[Aether2000]

While it is delightfully self serving to make such proclamations, they must be backed up with proof. We have proof that ESI provides short term incomplete pain relief for the majority of patients with radiculopathy. We have proof other steroid injections provide some degree of short term relief. We have proof that highly selected patients with facet arthropathy may derive more than 50% relief long term with RF, but the selection process used by many physicians is flawed, thereby promoting overuse of facet injections and poor outcomes in general. We have proof SCS may provide significant relief long term but many patients continue to use opioids despite their claimed relief. So no, I don't think we do have proof that opioid use would be curtailed using interventional techniques, since continuous relief with steroid injections is only possible if the injections are repeated many times a year, and many having these injections are prescribed opioids by their physicians (in many cases, the same pain physician doing the injections). Clearly pain physicians prescribing opioids do not believe their interventional techniques can eliminate opioids.

 

[BobBarker]

But we can all agree that interventions work better in the opioid naive...
Something to ponder

 

[Malayil]

Mwe all have seen it work but the chemical dependence makes them continue the opiate.

Stop prescribing opiates for non-cancer pain and you will see interventions probably work much better.

 

[nvrsumr]

Risk benefit for interventions is very favorable. Most studies have multifactorial back pain treated with a single interenvetion.

Show me the esi study done after SI injection and negative facet blocks with two epidurals a week apart in opioid naive patients with a concomitant excersize program then we can talk

 

[lobelsteve]

Risk benefit for interventions is very favorable. Most studies have multifactorial back pain treated with a single interenvetion.

Show me the esi study done after SI injection and negative facet blocks with two epidurals a week apart in opioid naive patients with a concomitant excersize program then we can talk

If a doc needs SIJ, MBB, and 2 ESI, im pretty sure treatment is not geared towards the patient. I blame Donzi.

 

[DrCommonSense]

While it is delightfully self serving to make such proclamations, they must be backed up with proof. We have proof that ESI provides short term incomplete pain relief for the majority of patients with radiculopathy. We have proof other steroid injections provide some degree of short term relief. We have proof that highly selected patients with facet arthropathy may derive more than 50% relief long term with RF, but the selection process used by many physicians is flawed, thereby promoting overuse of facet injections and poor outcomes in general. We have proof SCS may provide significant relief long term but many patients continue to use opioids despite their claimed relief. So no, I don't think we do have proof that opioid use would be curtailed using interventional techniques, since continuous relief with steroid injections is only possible if the injections are repeated many times a year, and many having these injections are prescribed opioids by their physicians (in many cases, the same pain physician doing the injections). Clearly pain physicians prescribing opioids do not believe their interventional techniques can eliminate opioids.

Dont remember him saying that it would eliminate all opioid prescribing. Argument was it should be used as a first line treatment option BEFORE considering opioids rather than putting them on opioids first.

His argument was that some insurances rather pay for opioids as the first line treatment rather than last.

 

[hyperalgesia]

Is Dr. Staats justified saying this??

There’s one sure way to fix the opioid crisis

"The only way to solve the nation's opioid crisis is to treat chronic pain effectively. By embracing interventional therapies, doctors can do just that."

I think his commentary should be viewed in the context of an existential war with the health insurance industry. They mislead people with garbage studies; they place road blocks in front of non-opioid treatment pathways; they place patients second to profits.

I agree that his conclusion is misleading but I am prepared to give him some leeway.

 

[Aether2000]

"Solve the opioid crisis", a quotation by Peter, means eliminating the escalated levels of prescription opioids and the now exploding heroin usage and overdose death rates. Initially, the opioid crisis was primarily precipitated by acute pain that then either became chronic pain or chemical dependency (or both). Those now trapped in opioid addiction and chemical dependency are well beyond "chronic pain" being their major problem. They take the opioids to avoid withdrawal syndrome and withdrawal related escalation of pain, but these opioids have little beneficial effect in the treatment of chronic pain. Interventional pain therapies have no effect on addiction, on avoiding withdrawal syndrome, nor on psychologically based chronic pain, therefore it is a mystery to me how the current mess we are in with opioids, many of which are still being prescribed by pain physicians, can possibly be remedied by more injections/RF/neuromodulation. The future may find a potential reduction in opioid abuse if interventional methods are provided in a consistent methodology, pain docs stop continuing feeding the monster by continuing opioid prescribing, and other doctors stop their prescribing in excess of 3 days for acute pain and only prescribe for chronic pain when there is measurement and documentation of improvement of functionality.

 

[nvrsumr]

I wish I got the Dx right first time every time.

My chief complaint is listed only as low back pain in about 1/100 patients. I treat a lot of multiple pain generators in addition to the original presenting complaint of back pain. It all bleeds together and plays off each other. A lot of chicken and egg.

I enjoy treating varied msk pathology and accept poor patients in my high end private practice. Kinda like tornadoes finding trailer parks msk pain finds the working poor. If they are willing to get the shot in my zero narcotic practice and come back for more with that huge smile I am so used to seeing everyday then something must be working.

At the end of the day it comes down to your comfort with a type one or two error considering the risk benefit.