Health experts inside and outside the military are attempting to change how chronic, long-term, pain is treated in military personnel and veterans, The New York Times
Tens of millions of Americans suffer from chronic pain, and the use of opioids — drugs like hydrocodone, methadone, and oxycodone (the active ingredient in painkillers like OxyContin) — to treat such conditions has soared over the last decade.
Pharmaceutical companies, pain experts, and others have argued that the drugs could defeat pain with little risk of addiction. Insurers embraced opioids as a seemingly effective and relatively inexpensive solution to a complex problem that often involves psychological and emotional issues.
But in recent years, sales of opioids have flattened because of their role in 16,000 overdose deaths annually in the United States, cases that often involve abuse of the drugs. A growing number of specialists have sharply reduced or stopped their prescription of opioids for another reason: their belief that the drugs have led doctors to focus on the wrong goal in treating chronic pain.
Opioids blunt a patient's discomfort for a time. But the drugs can become a barrier to improving how well a patient functions physically and socially. As a result, specialists are returning to strategies that were popular before the opioid era, like physical therapy
, behavior modification, and psychological counseling. Others are exploring alternative treatments like acupuncture and yoga.
"We have to change the paradigm and the culture," said Dr. Karen H. Seal, who specializes in pain treatment at the Veterans Affairs Medical Center in San Francisco.
Big changes are taking place inside the military and the Department of Veterans Affairs, organizations that have drawn criticism from lawmakers and others for overprescribing opioids and other powerful medications.
Five years ago, approximately 80 percent of the injured soldiers treated at Walter Reed Army Medical Center in Washington were prescribed opioids. That figure has since plummeted to 10 percent, and many patients are benefiting from the change, said Dr. Christopher Spevak, a pain specialist there.
"As we decrease the amount of opioids, their healing and recovery has gotten much quicker," Dr. Spevak said.