The NY Times on 4/9/2012 ran a story about the overuse and unintended negative consequences of strong (opioid) . They mentioned opposing views concerning the liberal use of opioids. I participated in a debate in 1995 about the inappropriate use of the diagnosis “Chronic Pain Syndrome”(CPS) in patients whose muscles had not been assessed as a cause of their persistent pain, which resulted in the justification to put some of these patients on opioids for the rest of their lives.   

Since then one of the largest growth industries in medicine is the evaluation and treatment of back and neck pain, currently accounting for ~$100 billion in direct medical costs. The pain juggernaut is fueled in part by ignoring muscles which are the most common reason for pain complaints. Addressing the incorrect causes of pain leads to inappropriate, expensive and potentially harmful treatments with poor outcomes, persisitent pain, and overuse of opioids. CPS is a license to prescribe life-long medication. Chronic use of opioids has not been studied for its overall impact on patients with CPS but neither have any of the other medications that we are now using. Does the marginal reduction in pain in many of the patients taking these medications justify their costs and side effects? As the Times reports, for some patients the treatment is actually making them worse.

Imagine if some of these patients had pain that could be eliminated. Many do; it’s from muscles that are not evaluated or treated in a systematic way.  My new book, End Back Pain Forever, to be released by Atria on June 5, 2012 is a wakeup call to change the way we are treating common pain problems.

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