EMS providers are on the frontline in managing the devastating effects of opioid addiction in the United States. In states like New Hampshire, Kentucky and Ohio, local agencies are overrun with opioid overdoses. Naloxone has become part of the first responder lexicon, just as CPR and AEDs did decades ago. And there’s no sign that it’s about to let up any time soon.
Part of the issue is the wide availability of prescription opioids. In the well-meaning attempt by the medical community to make pain the “fifth vital sign,” physicians have been prescribing opioid medications at a rate unmatched by any other country. Unfortunately, these medications have powerful addictive properties that are very difficult to resist. The combination of these facts has resulted in a genuine epidemic that kills over 70 people every day.
Alternate forms of pain management
In response, there is a significant amount of attention being paid toward alternative forms of pain management. A recent article describes the use of topical, non-opioid based analgesia in helping reduce patient dependency on narcotic medication for chronic pain. These results are promising for patients who require long-term pain management avoid addiction.
Another treatment option is to layer several non-opioid medications to achieve a synergistic effect. Studies show that Naprosyn alone achieves the same level of pain control when compared to combinations of Naprosyn with oxycodone or flexeril. A 400mg dose is thought to be ideal, as the analgesic ceiling is reached at that range. If that doesn’t achieve the desired response, consider adding acetaminophen. The combination of the two have been shown to achieve better control of post-operative and dental pain, than either one alone.
Osteopathic manipulative therapy (OMT) stretches and realigns muscles and tendons, and takes advantage of the body’s natural ability to heal. In one study, OMT was shown to achieve similar results in pain control when compared to IM ketorolac.
Acupuncture has been used in Eastern medicine for centuries. Endorphins are hormones that, when released, can block the sensation of pain in a manner similar to opioids. Acupuncture is thought to work by increasing the level of endorphins in the body. Chiropractic treatment and massage have also been shown to help reduce back, neck and other musculoskeletal discomfort.
Marijuana has also been demonstrated to have a modest effect on pain caused by multiple sclerosis and HIV. Certain dietary supplements, such as fish oil, appear to have pain-reducing properties as well.
Cognitive therapy has also been implicated in managing chronic pain. There is evidence that managing depression can reduce the level of chronic pain.
While few of these therapies would be suitable for the EMS environment, providing patient education about them during transport could be quite helpful and possibly reduce the effects of opioid overuse.
