Chronic pain treatment is usually carried out with the use of opioids, which in turn causes addiction. According to the definition of the opioid use disorder (OUD), it is associated with physical dependence and withdrawal symptoms in case of drug abandonment (Volkow, Jones, Einstein, & Wargo, 2019). Numerous researchers, physicians, and other healthcare professionals have raised the issue of using complementary alternative medicine (CAM) to treat chronic pain and addiction.
CAM consists of treatment forms that are not part of the conventional medicine used in hospitals and include mindfulness, acupuncture, massage, yoga, and the like. This paper examines the present situation of opioid use with the focus on epidemiology, clinical presentation, and possible complications, and considers the possibility of using CAM for specific diagnoses.
Opioid Use Epidemiology and Clinical Presentation
At the current time, the use of opioids is typical for a vast number of patients suffering from severe chronic pain. Researchers state that “in 2016, a total of 392 000 individuals aged 18 to 25 years had OUD compared with 153 000 of adolescents and 1 599 000 of adults” (Volkow et al., 2019, p. 210). It should also be noted that the therapeutic use of opioids and the number of fatal overdose cases are increasing (Volkow et al., 2019).
As for the clinical presentation, the OUD is characterized by severe physical dependence due to the analgesic properties of opioids and their intense impact on the dopaminergic neural system (Volkow et al., 2019). Also, many patients are concerned about giving up opioids because of the withdrawal syndromes that are associated with this kind of drug. Thus, the problem of chronic pain is exacerbated by the problem of opioid addiction, which may indicate a specific opioid crisis in medicine.
It should be pointed out that other complications often accompany chronic pain and opioid addiction. Researchers report that they may be followed by disturbances in sleep, severe mood disorders, malaise, distortions in concentration, and work, which also lead to social problems and poor quantity of life (Hart, 2016). Moreover, it has been demonstrated that opioid-dependent patients are more likely to engage in addictive use of other substances and drugs, including heroin, alcohol, and cocaine (Hart, 2016; Volkow et al., 2019). Obviously, the most dangerous complication is an addiction to opioid drugs, which is no longer related to treatment, and the possibility of overdose.
Diagnosis for CAM
CAM is primarily regarded as a substitute for opioid drugs in the treatment of chronic pain. According to Hart (2016), the CAM has “been linked to pain relief” and has “also been shown to help with addiction prevention, treatment, and recovery” (p. 117). Researchers note that the use of CAM is effective in a significant number of diagnoses, which are associated with both neuropathic and nociceptive pain (Plunkett et al., 2017).
For instance, in a study of the acupuncture effect on pain reduction, “42.3% of the patients analyzed had successful treatment outcomes and 57.7% had nonsuccessful treatment outcomes” (Plunkett et al., 2017, p. 942). Therewith, this study involved patients diagnosed with neuropathic, nociceptive, and mixed pain, both of traumatic or nontraumatic origin. Thus, the CAM can be used in a wide range of cases involving chronic pain and opioid addiction.
It has been indicated that the increasing use of opioid drugs for chronic pain has the potential to cause a number of complications and adverse outcomes for patients. Research studies are proving that different types of CAM, such as acupuncture, help people cope with chronic pain and addiction. In this regard, it is reasonable to form a clinical research question within the PICOT framework:
- In adult patients in the primary care setting (P), how does complementary alternative medicine like acupuncture (I), compare with opioid use (C), reduce chronic pain, and prevent addiction (O) over one year (T)?
Hart, J. (2016). Chronic pain, addiction and complementary therapies. Alternative and Complementary Therapies, 22(3), 117-119.
Plunkett, A., Beltran, T., Haley, C., Kurihara, C., McCoart, A., Chen, L.,… & Cohen, S. P. (2017). Acupuncture for the treatment of chronic pain in the military population. The Clinical Journal of Pain, 33(10), 939-943.
Volkow, N. D., Jones, E. B., Einstein, E. B., & Wargo, E. M. (2019). Prevention and treatment of opioid misuse and addiction: a review. JAMA Psychiatry, 76(2), 208-216.