The year in pain: Healio’s top 2023 stories on opioids, chronic pain myths and management
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The state of pain management in rheumatology has always been in flux.
However, after the explosion of the opioid era in the 1990s, and the subsequent implosion and backlash against opioids in the past decade, never before have there been so many competing ideas — and myths — regarding pain relief.
Rheumatologists, meanwhile, continue to rely on physical activity and analgesics — including opioids — to help their patients feel better.
Here is a collection of 2023 Healio features, covers, meeting news and other stories dealing with pain and how rheumatologists manage it in daily practice.
Despite a robust armamentarium of over-the-counter and prescription drugs, the main strategy for pain management in osteoarthritis remains physical activity. According to experts, rheumatologists need to explain to their patients with OA that some pain from their condition is normal. However, understanding the threshold of when “some pain” becomes “too much pain” can be challenging.
In a March cover story, Healio raised a number of questions surrounding pain. Is a pain-free life possible for anyone, much less a patient with a chronic rheumatic and autoimmune condition? Is a pain-free life even desirable? What, exactly, does a pain-free life mean?
A growing body of data show that acceptance of some pain — physical, mental, emotional, or other — is essential to minimizing the stress and despair that can accompany any chronic condition.
Leonard Calabrese, DO, of the Cleveland Clinic, and chief medical editor for Healio Rheumatology, tackled a similar topic in a March editorial. Calabrese zeroed in on fibromyalgia, a condition that has been at the center of much debate and controversy within the rheumatology and pain management community for decades.
“Unfortunately, and not infrequently, the pain of fibromyalgia is too often viewed by practitioners, and many in the lay public, as ‘nonorganic’ or merely residing in the mind,” he wrote. “In some minds, it reflects some sort of weakness or inability to put up with the viscosities of daily life that we all experience. With this background, I will begin by casting my opinion that this later belief is both reductionist and pejorative to those who suffer with such pain.”
Pain management also took center stage at many conferences in 2023.
Popular myths continue to influence the way physicians and patients alike think about and engage with chronic pain and the use of opioids, according to a speaker at the 2023 Biologic Therapies Summit.
Haider Warraich, MD, of Brigham and Women’s Hospital, debunked several myths surrounding opioid use, covering topics ranging from efficacy and safety to addiction and race.
Looking at specific sites of pain, a paper published by Manuela L. Ferreira, PhD, of the Sydney School of Health Sciences, and colleagues, noted that approximately 500 million people worldwide were impacted by lower back pain in 2020. That number may balloon to as much as 800 million by 2050.
Factors including smoking and workplace accommodations may be involved. Ferreira and colleagues dug into the numbers to paint a broad portrait of this pervasive and perhaps even unavoidable human condition.
In the 2022 Ruan v. United States decision, the U.S. Supreme Court ruled unanimously that it must be proven beyond a reasonable doubt that a defendant charged with writing an unauthorized prescription knew, at the time of writing, that the prescription would be classified as unauthorized according to federal guidelines.
In the decision, the court overturned and vacated the convictions of three physicians who had previously been found guilty of overprescribing opioids in violation of the Controlled Substances Act.
In a presentation at the Congress of Clinical Rheumatology West, Stephen J. Ziegler, PhD, JD, professor emeritus at Purdue University, suggested that thoroughly documenting all patient interactions may help address physicians’ trepidation regarding opioid prescriptions.
Over-the-counter medications like ibuprofen and naproxen can be life-changing for patients with lupus or rheumatoid arthritis who experience chronic pain. However, many patients are unaware of the risks of ongoing use of these medications. In an October feature, Healio offered some hardboiled advice for navigating the risks and benefits of OTC medications in the chronic pain setting.