Better Ways to Treat Pain Other Than With Opioids

In one key respect Baltimore is the epicenter of the nation’s opioid epidemic, but not in the way you think. Most of us picture illicit drugs sold on city streets not prescription medications promoted from a downtown office building on Charles Street. Here in Baltimore is where a major part of the national movement to treat pain with addictive drugs began.

For over 10 years, Baltimore was home to the American Pain Foundation, an organization that billed itself as a patient advocacy group, but in practice was little more than a marketing front for the pharmaceutical industry. It received corporate funding from among others Purdue Pharma, the makers of OxyContin. OxyContin and other “pain killer” medications unleashed what the Centers for Disease Control describes as the first wave of the epidemic: the over-prescribing of opioid drugs.

American Pain Foundation founder and former board chairman Dr. James Campbell, a neurosurgeon once affiliated with Johns Hopkins University, wears glasses and a bowtie, like a slightly older version of Bill Nye the Science Guy. He spoke at one of the White House opioid task force meetings last year as a subject matter expert. When it comes to pain management, Campbell’s career can be characterized as pre-opioid epidemic and post-opioid epidemic.

Campbell is credited with making pain the fifth vital sign in 1996, equating its importance with blood pressure and breathing, a medically controversial protocol still being debated today. In 1999, he suggested doctors were afraid to prescribe opioids because they were clinging to outdated beliefs that the drugs caused addiction. He defended Purdue Pharma to the U.S. Senate during hearings after company executives pleaded guilty to fraudulently marketing OxyContin as non-addictive in 2007.

In 2012, the foundation he started abruptly ceased operations in the wake of media scrutiny which examined conflicts of interest between pharmaceutical companies and his pain advocacy organization.

My intention here is for doctors and patients to learn from Campbell. You see, he has adopted a remarkably different position today.
In 2016, he told a medical journal that doctors are now writing too many opioid prescriptions. Last year, he told The New York Times that people can live with pain in many circumstances without drugs.

He is president and co-founder of Boston-based pharmaceutical company Centrexion which is developing non-opioid pain medications. The company’s mission statement warns against “abuse and addiction issues, as well as deaths, that have arisen from the high use of opioids.”

The company announced plans for an IPO in October then postponed it apparently due to subsequent market volatility. Nevertheless, I wish him success in this latest endeavor as a potential way to sever the relationship between treating pain and causing addiction.

Equally important, I would like every American to learn from Dr. Campbell’s evolving career. Anyone suffering from knee surgeries, toothaches, hip replacements and the like should know the consequences of walking out of the doctor’s office with a prescription for opioid pain medications. A recurring theme of this epidemic has been turning patients into addicts as they seek illegal heroin and fentanyl. The pattern has become familiar: as prescriptions become more difficult to fill, addicts find cheaper illegal opioids on the street.

I believe we can do better than over-reliance on medical experts whose advice might be deemed consensus one decade only to fall out of favor the next. Medical scholars describe passive acceptance of advice from presumed health care experts as “eminence-based medicine.” That would be opposed to “evidence-based” medicine where data should be used to measure health care outcomes.

Dr. Amar Setty

The phrase “ask your doctor” should mean exactly that, where patients and consumers should not be afraid to raise questions about what they are being prescribed and why.

As a practicing physician and anesthesiologist working to develop alternatives to treating pain or at least managing opioids for patients where these drugs are the only viable option, I have seen first-hand the consequences of addiction. These days, news reports compare rates of annual drug overdose deaths to fatal car crashes and gun homicides as the public has grown weary of mere numbers.

More doctors and patients are getting the memo about the dangers of opioids. The challenge now is educating more Marylanders and the entire population that there are better ways to treat pain. Most people don’t realize the number of options that patients have from exercise and wellness to non-opioid pain medications and interventional pain procedures that reduce pain and improve function.

Mobile applications track and monitor pain activity level and emotional state to guide treatment decisions and educate patients. None of this was discussed when new and powerful prescription drugs hit the market in the 1990s. Today, one need not be a health care expert to explore alternatives that work best for them.

If Dr. Campbell can change his mind about opioids so can everyone else.

— DR. AMAR SETTY

The writer is past president of the Maryland Society of Anesthesiologists and serves on the board of the state’s prescription drug monitoring program.

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