Options for Treating Pain Ethically Without Opioids

In spite of the statistics on addiction and efficacy for opioids they are still a “go to” alternative

for acute pain. This can have a profound, and too often deadly impact on teens.

Most of us know at least one bright, energetic, passionate young person lost to addiction even though we now know it can occur in teens and adolescents as soon as 48 hours after starting their prescription. Higher addiction rates are due to the immaturity of the brain’s reward center, the prefrontal cortex, making it vulnerable to developing changes.

The prefrontal cortex fully matures more than a decade after we are old enough to vote. Teens are developmentally wired to pursue a neurological reward, a trait that is recognizable in risk-taking behavior. Thus, leading them to look for the next “good feeling”.

The statistics are alarming.

• Opioid overdoses in adolescents (age 14-18) increased by 94% between 2019 and 2020, rising an additional 20% the following year.

• Adolescents who misused prescribed opioids were 1.5x more likely to have ideas/plans of suicide.

• The rate of attempted suicide is 1.58x greater compared to those who did not misuse their prescriptions.

• High school students who legitimately use prescription opioids are 33% more likely to misuse opioids after high school.

• Opioids are a factor in 7 out of every 10 overdose deaths.

Now, let's dive into the efficacy issue.

It has been believed that opioids are the strongest pain medications and should be used for more severe pain, however scientific literature does not support that belief. In fact, studies have shown NSAIDs are just as strong as opioids.

The NNT, numbers needed to treat, is the number of people who must be treated by a specific intervention for one person to receive a certain effect. In this case, pain relief. Only a 50% relief of pain is considered effective treatment, allowing increased functional ability and improved quality of life.

So, how many people must be treated with a certain dose of medication for one person to receive 50 percent pain relief (effective relief)?

A lower NNT means the medicine is more effective. A NNT of 1 means that the medicine is 100 percent effective at reducing pain by 50 percent - everyone who takes the medicine has effective pain relief. Medicine with an NNT of 2 means two people must be treated for one person to receive effective relief. Or, alternatively, one out of two, or 50 percent, of people who take the medicine get effective pain relief.

Medication with the lowest NNT will be the most effective. For oral pain medications, an NNT of 1.5 is very good and an NNT of 2.5 would be considered good.

Take a look at the graph below from the Cochrane Collaboration ranking the various pain medications:

The Cochrane Collaboration is highly respected globally for its scientifically rigid, independent reviews.

• Oxycodone 15 mg: The NNT is 4.6. Since it is hard to conceptualize 4.6 people, consider that you would have to treat 46 people for 10 to get 50 percent relief of their pain. Thirty-six of those 46 people would not get adequate pain relief. (Gaskell, Derry, Moore, & McQuay, 2009)

• Oxycodone 10 mg + acetaminophen 650 mg: The NNT for this combination treatment (Equivalent to two 5 mg Percocet pills) is 2.7. Clearly this is better than oxycodone alone. Acetaminophen adds significant benefit. (Gaskell et al., 2009)

• Naproxen 500 mg (or naproxen sodium 550 mg): The NNT for this is also 2.7. Naproxen is not an opioid. It is an NSAID medication. Naproxen sodium is known to many as the brand name over-the-counter (OTC) medicine Aleve®. (C Derry & Derry, 2009)

• Ibuprofen 200 mg + acetaminophen 500 mg: The combination of these two OTC medicines provided the best pain relief of all, with an NNT of 1.6. (CJ Derry, Derry, & Moore, 2013)

Another study by Bandolier is below:

Bandolier an independent organization in Europe that produces reports on evidence-based medicine.

Prescription and OTC pain meds rank the best at effective relief with far less interactions.

Click on the link below for the complete study with resources:

evidence-efficacy-pain-medications.pdf (nsc.org)

Treating pain ethically while providing more than “effective relief”.

Pat is a hockey player who was sidelined by a fall. Resulting in a rotator cuff tear that had major implications and kept him off of the ice.

The biggest initial challenge was sleep. Pat had travel to China scheduled before his surgery. He used BioE + CryoT during the trip, which allowed him to sleep. It also started the prehab process, ensuring that he presented for surgery with lower tissue temperature and reduced inflammation and edema.

After surgery Pat proved to himself that he was ill-suited for pain management via narcotics. Within 48-hrs this adult hockey player wept openly because there was no canned cranberry at Thanksgiving, it was pitiful. In spite of some evidence that opiates may have an anti-psychotic effect, there is also evidence of depression associated with long-term use (and apparently people like Pat). He was instructed to stop taking the meds, despite the pain.

Result: No issues after stopping pain meds two days after surgery.

Click on the link below to read the full story:

Rotator Cuff Rebuild Recipient Goes Cold Turkey With Postop Pain Meds (bioe-cryot.com)

More testimonials ...

"My post rehab bioelectronic and cryotherapy routine is literally easier than making my protein shake. And I can go back to work while I do it."

Jack N - UX/UI Developer

"Had a 75-year-old total knee that just hit the eight-week ROM (Range Of Motion) goal in four weeks. Over 90° 24-hours after surgery."

Chris R, MD - Orthopedic Surgeon

Brief Overview of Treatments/Protocols:

Combining layered therapeutics of bioelectronics, cryotherapy and NSAIDs, BioE & CyroT provides a faster, safe and non-addictive, ethical approach to healing and pain management with reduced infection risk and better outcomes.

Prehab treatments: prepares muscles tissue, post-op with more ATP and less inflammation and pain, improved healing in less time, faster to reach rehab goals.

Post Surgery: When the surgical site is closed, electrode pads and leads are applied under wound dressing, and 8-hour intermittent Microcurrent cycles are started immediately.

During Sleep: Use ReviStim in sleep mode with Cold Therapy. The Nocturnal mode takes advantage of the body's regenerative phases during deep sleep accelerating healing.

This is an exciting treatment that simply delivers!

Want to learn more?

Learn how BioE + CryoT is changing the recovery/rehab DME value proposition for orthopedic surgical practices.

Explore the financial impact for your practice, see our DME business model that is incredibly easy to deploy and measure the impact from.

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References:

Youth and the Opioid Epidemic | Pediatrics | American Academy of Pediatrics (aap.org)

NFLIS-Drug 2020 Annual Report (usdoj.gov)

Law enforcement seizures of pills containing fentanyl increased dramatically between 2018-2021 |National Institutes of Health (NIH)

The American Opioid Epidemic in Special Populations: Five Examples – National Academy of Medicine

Teenagers and the Opioid Epidemic || CIRP (Chop.edu)

Examining the association between prescription opioid misuse and suicide behavior among adolescent high school students in the United States – PubMed (nih.gov)