Chronic pain and opioid drugs combine a nasty condition with an equally nasty treatment. For many Americans, treating pain with narcotic pharmaceuticals has become a habit, one encouraged for years by the medical profession.

But now, as Paula Span writes in The New York Times, the nasty couple may be breaking up.

As media and medical professionals continue to track the growing “opioid crisis,” suddenly what was once a panacea for the suffering of many seniors is now being attacked as the enemy. Using opioids has been rebranded as a dangerous method that makes the elderly lazy, dependent and incapable of following safer treatment programs that don’t include opioids.

Span notes the irony of the chronic pain-opioid evolution. Prior to 1999, chronic pain was not officially considered to be a treatment priority for physicians, who tended not to prescribe painkillers to patients complaining of chronic pain.

In that year, the Veterans Administration (now the Department of Veterans Affairs) cited chronic pain as one of five key "vital signs" of patients, which increased the pressure on doctors to treat pain with opioids. Hospitals and clinics began to be evaluated on how well they managed patients' chronic pain, and opioid prescriptions increased dramatically.

Today, as the federal government reverses course on treating pain with opioids, many doctors and their patients are hooked on the treatment.

But the tide is turning. The Centers for Disease Control and Prevention came out with new, more-restrictive guidelines for opioid treatments. States are cranking out their own laws to limit opioid use, and a reclassification of some of the drugs makes them harder to come by.

Rather than prescribing painkillers, physicians are now being told to prescribe therapy and healthier habits, such as better diets and more exercise, to control pain. Good luck with that, Span says. “Some of their doctors are going to get an earful when they suggest different medications or nonpharmacological alternatives,” she writes.

Seniors may have cause for concern if their physicians turn on a dime to replace their current meds with any of the new drugs coming on the market designed to augment or replace opioid use. Span notes that the side effects of some of the new drugs are serious and could do more harm than good.

With the national focus on deaths related to opioid overdoses, seniors with chronic pain will be forced to change the way they treat the aches and pains of growing old. And, Span warns, that could be a frustrating and expensive shift until a new anti-pain paradigm emerges. For instance, cognitive behavioral therapy has shown positive results with some pain patients.

“But not enough practitioners offer alternatives like cognitive behavioral therapy, and insurers (including Medicare) generally won’t pay for them,” Span writes.

So, not only will new treatment methods need to be explored, but insurers will have to be convinced to help seniors pay for them. And that’s almost as nasty a combination as chronic pain and opioid drugs.

Instant Insights /

Seniors facing a painful retreat from opioid treatment

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