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

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

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As media and medical professionals continue to track the growing“opioid crisis,” suddenly whatwas once a panacea for the suffering of many seniors is now beingattacked as the enemy. Using opioids has been rebranded as adangerous method that makes the elderly lazy, dependent andincapable of following safer treatment programs that don’t includeopioids.

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Span notes the irony of the chronic pain-opioid evolution. Priorto 1999, chronic pain was not officially considered to be atreatment priority for physicians, who tended not to prescribe painkillers topatients complaining of chronic pain.

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In that year, the Veterans Administration (now the Department ofVeterans Affairs) cited chronic pain as one of five key "vitalsigns" of patients, which increased the pressure on doctors totreat pain with opioids. Hospitals and clinics began to beevaluated on how well they managed patients' chronic pain, andopioid prescriptions increased dramatically.

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

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

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Rather than prescribing painkillers, physicians are now beingtold to prescribe therapy and healthier habits, such as betterdiets and more exercise, to control pain. Good luck with that, Spansays. “Some of their doctors are going to get an earful when theysuggest different medications or nonpharmacological alternatives,”she writes.

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Seniors may have cause for concern if their physicians turn on adime to replace their current meds with any of the new drugs comingon the market designed to augment or replace opioid use. Span notesthat the side effects of some of the new drugs are serious andcould do more harm than good.

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

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

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

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Dan Cook

Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.