When opioids aren’t the best option

Published October 23, 2018

More than one in 10 Americans say they live with chronic pain, a devastating statistic. Until recently, opioids have been the one of the first solutions. But there’s little evidence that opioids are effective in the long-term for chronic pain. Often, the risks may outweigh the benefits, including the risk of addiction. But attitudes toward managing chronic pain are changing. And the range of opioid alternatives is growing.

“Sometimes patients believe pain management automatically means a prescription for an opioid,” says Dr. Anuradha Rao-Patel, lead medical director for Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and pain management specialist. “But patients may not understand there are better or safer alternatives.” She shares her perspectives about those alternatives—and how BCBS North Carolina is making them more accessible.

Q: As a clinician who specialized in physical medicine and rehabilitation, how have you approached pain management differently?

Patel: I try to look at pain from a holistic approach, treating the underlying causes as well as the immediate experience. We housed physical therapists right in our practice, for example. Most importantly, I’ve tried to focus more on improvement of a patient’s function rather than elimination of pain entirely, which is often not possible. What does the patient hope to be able to do that he or she cannot do now because of pain? Play with grandchildren, go grocery shopping? And then we can develop a plan to achieve that goal. 

Q: What are some of the alternatives to opioids?

Patel: Besides opioids, we have a range of non-opioid medications for treating pain. We can prescribe muscle relaxers and anti-depressants, which have proven effective in treating some kinds of chronic pain, and drugs that treat neuropathic pain, such as for a pinched nerve or diabetic foot pain. Physical therapy, aquatic therapy and chiropractic care are also tools that we can prescribe to help manage pain. 

Q: Are there opportunities to support primary care doctors and specialists who want to offer alternatives to more patients, or even equip doctors who may have little experience with these therapies?

Patel: Primary care physicians are often the first person a patient sees for a pain complaint. For that reason, alternative therapies are increasingly important tools in their toolbox. Another tool is better education about the benefits and limitations of opioids for pain. Part of the reason for the opioid epidemic is that training about opioids was generally lacking. Now the tide has turned. Opioids and opioid addiction are becoming part of the curriculum in more medical schools and residency training programs.
We’ve actually developed a website as a resource for providers, members and the public. It includes links to resources for providers about not only alternative pain management therapies but opioid use disorder treatment information.

Alternative Pain Management
Q: What role should health insurers play in making alternative pain management therapies more accessible? Patel: We have a vital role to play. When it comes to accessibility, many complementary therapies like physical therapy and chiropractic care require no pre-authorization from Blue Cross NC, which means doctors can prescribe them without seeking our permission first.

Q: How do you increase patient awareness about alternatives to opioids? 

Patel: Patients should absolutely be partners in their own care. They can learn more about opioids on our website. If they’re planning to see a doctor, we have a downloadable checklist they can bring along to help ask important questions before being prescribed an opioid. 

We understand patients may not know what alternatives are covered, or how to get help if they or a loved one is facing opioid or substance use disorder. Our new website is designed to connect members to some of those answers, and make seeking help a little easier. 

This interview has been edited and condensed. 

Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.