How to Address Opioid Abuse with Patients

It’s estimated that 63% of regular opioid users are suffering from arthritis, despite the lack of long-term studies showing the efficacy of opioids for chronic pain.^1,2 The Centers for Disease Control and Prevention guideline asserts the unknown benefits of long-term opioid use are far outweighed by the well-identified risk of opioid addiction and overdose.³

“Although prescription medications, like opioids, are effective for treating pain, when it comes to chronic pain, it’s important to provide access to additional, complementary treatments patients can use for the long term,” says Maggie Wimmer, coordinator of programs and outcomes for Public & Patient Education at the Hospital for Special Surgery (HSS) Education Institute in New York.

She notes rheumatologists have the perfect opportunity to discuss with their patients alternative and complementary options for managing chronic pain. “As simple as it sounds, many patients do not know what options are out there besides medication for treating their pain,” she says.

Alternatives to Opioids
Ms. Wimmer leads the Pain and Stress Management Program at HSS, which was launched in 2017 as a pilot in an orthopedic clinic at HSS. The program focuses primarily on mind-body techniques, such as mindful breathing, guided meditation and yoga.

Early research on the efficacy of the pilot found it was highly rated by 98% of participants and 95% of patients showed the ability to apply the techniques learned to manage their pain and stress. Through debriefing sessions, patients reported reduced pain and stress, and that they were less reliant on pain medication to manage their conditions.⁴

“Our programs are designed so they can be modified to meet patient needs. For example, when we were implementing meditation programs in the rheumatology clinic, we recognized that patients were struggling with pain from their stiff muscles and joints. To address this [factor], we adapted the program to focus not only on the breath, but on movement as well. The movement aspect assists in lubricating the joints to help ease their pain,” she says.

With this in mind, Ms. Wimmer and colleagues incorporated seated restorative yoga poses and a deep relaxation session that ties together the movements with breathing.

She says participants have noted that these mind-body and meditation workshops have helped them manage their pain and restore a sense of clarity and calmness. The breathing has helped reduce their stress and anxiety, which often lead to pain.

“It’s also important to consider program accessibility for patients. Some patients may live farther away and not have the means to frequently attend programs on site at the hospital,” Ms. Wimmer says. They have incorporated a weekly mindful breathing group phone call, led by a certified yoga instructor, for patients to join in [remotely] to practice their skills and better manage their pain.”

A variety of on-demand health videos featuring a guided meditation and other educational videos are also available to help make pain and stress management accessible to patients.

How to Start the Opioid Conversation
Ms. Wimmer shares the following tips for rheumatologists to talk openly with patients about alternatives to opioids for managing their chronic pain.

1. Share the evidence: “Studies show that non-opioid treatments or complementary alternative treatments, like exercise and meditation, may be as effective for patients suffering from chronic pain, by providing relief or lessening the severity of their pain,” she says. “Making patients aware of all treatment options is essential to their comprehensive care.”⁵

2. Give patients concrete alternative strategies: Rheumatologists can actively promote alternative pain management options in their practice, Ms. Wimmer suggests.

Example: One social worker in her program shared a story in which one of her patients went to an appointment and came out with a prescription to go swimming and the number of the local YMCA. Rather than simply suggesting they should try yoga or swimming, rheumatologists can provide a list of nearby yoga studios or local community centers that offer these programs, Ms. Wimmer advises.

3. Collaborate with an interdisciplinary team: The HSS Pain & Stress Management Program is a collaboration between health education coordinators, certified yoga instructors and licensed clinical social workers. Often, patients are referred to the program by clinicians and physicians after the patient finishes physical therapy or if the patient is looking for additional opportunities to educate themselves about their condition.

“Having professionals from a variety of areas working together helps to thoroughly assess and address all aspects of the patient’s care,” says Ms. Wimmer.

Carina Stanton is a freelance science journalist based in Denver.

References

1. Hudson TJ, Edlund MJ, Steffick DE, et al. Epidemiology of regular prescribed opioid use: Results from a national, population-based survey. J Pain Symptom Manage. 2008 Sep;36(3):280–288. Epub 2008 Jul 10.2.
2. Chou R, Turner JA, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: A systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015 Feb 17;162(4):276–286.
3. Frieden TR, Houry D. Reducing the risks of relief—the CDC opioid-prescribing guideline. N Engl J Med. 2016 Apr 21;374(16):1501–1504.
4. Wimmer M, Wiesel R, Adams B, et al. Complementary practices as alternatives to pain: Effectiveness of a pain management program for patients in an orthopedic clinic [abstract]. Arthritis Rheumatol. 2018 Oct;70(suppl 10).
5. National Academies of Sciences, Engineering, and Medicine, et al. Pain management and the opioid epidemic: Balancing societal and individual benefits and risks of prescription opioid use. Washington, D.C.: The National Academies Press. 2017 Jul.