Treating Pain Blog

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An Ounce of Prevention is Worth a Pound of Cure

Our very own Dr. Peter Staats, CMO, is leading efforts to promote interventional pain procedures as another way to address our nation’s ongoing opioid crisis.

The opioid epidemic has killed more people than the Vietnam War. From 2016 to 2017, opioids were the cause of the largest death rate increase in males aged 25 to 44.[1]

Given the magnitude of the problem, a great deal of attention has been placed on finding solutions to the crisis by developing better treatments for addiction. And while this is truly important, this is only part of the solution. Staats believes patients’ pain should be treated with alternatives to opiates, before problems occur. But he also recognizes that some patients can do well with opiates and should not uniformly be denied care if needed.

“The solution to this problem is nuanced,” says Dr. Staats, who serves on the National Pain Task Force commissioned by the U.S. Department of Health and Human Services (HHS). Through his work with these groups, as well as research being performed at NSPC, he is looking for ways to apply the results of their cutting-edge findings to patients treated at National Spine & Pain Centers.

Dr. Staats has been particularly interested in the results of a recent Department of Defense/Veterans Affairs study on opioids.[2] “This was a comprehensive study that looked at many aspects of chronic pain management, including opioid dosage as well as alternatives to opioid therapy,” he said, noting that the study also examined—and debunked—a popular misconception about opiate-related deaths.

A careful review of the VA study data, as well as other data, reveals that only a small percentage of opiate deaths are the direct result of physician-prescribed opiates. “There are many other factors that impact opioid-related deaths, including the patient’s initial psychological state as well as co-prescribing of other medications that create dangerous complications,” he said. “And there has also been a spike in the illicit use of drugs like heroin or fentanyl.”

The VA study also challenged traditional thinking regarding appropriate opiate dosage. “At one point, the Centers for Disease Control had suggested that opiate doses of 100 mg/day were tied to a higher risk of death, but this study concluded that even doses smaller than previously thought carry a risk of death,” Staats said.

As a result, the VA study recommends that there is really no “safe” dose of opioids, especially given the narcotics’ dangers related to increased tolerance—and dependence—in a very short period of time. “That means that even a small dose can represent a risk,” Staats said.

Given the findings of this exhaustive work, Dr. Staats is working with National Spine & Pain Centers physicians to replicate its recommendations in their treatment plans. “As experts in the field of pain medicine and interventional treatments, we have the opportunity—some might say the obligation—to be leaders in changing the paradigm on how we treat pain.”

[1] https://www.cdc.gov/media/releases/2018/p1221-complexity-drug-overdose.html

[2] https://www.healthquality.va.gov/guidelines/Pain/cot/VADoDOTCPGProviderSummary022817.pdf