The following is a guest article by Vijay Yanamadala, MD, Chief Medical Officer at Sword Health and System Medical Director of Spine Quality at Hartford Healthcare.
In 2017, after years of over prescribing opioids to treat pain, leading to opioid addiction for millions of Americans, opioid dependency was declared a public health emergency.
Since then, the opioid epidemic has only worsened. The COVID-19 pandemic, and its impact on people’s mental and physical health, has greatly contributed to a rise in opioid-related deaths.
When I was a medical student in the early 2000s, pain was viewed as a vital sign, like heart rate or blood pressure. In the United States, the attitude among medical practitioners – and largely influenced by drug companies – was that pain was unacceptable and must be treated. Prescribing physicians turned to opioids, so effective they could eliminate most pain, or at least that was their promise.
As a spine surgeon, I had the opportunity to gain valuable insights outside the U.S. healthcare system. I served in surgical mission trips to Kenya, Sri Lanka, India and Mongolia. In Kenya, for example, we did large spinal fusions for patients, never once prescribing opioids for post-operative care. The attitude and approach in Kenya was completely different. Pain was an unavoidable symptom of surgery and would be treated with a combination of Tylenol and physical therapy. Instant relief for patients was not on offer, nor was the promise of complete avoidance of pain. This meant that patients would have to struggle a bit, but long-term, they would be better for it.
In order to address the opioid epidemic in this country, we must start by reimagining pain. And we must be open to longer-term care and less “quick fixes.”
As a neurosurgeon, I know well the allure of a quick fix. Many patients have come to me with serious pain, pain in their back, their joints, very hopeful that surgery is the answer and the only solution for long-term quality of life. Unfortunately, surgery is too often NOT the answer. More than 50 percent of spine surgeries performed in the United States are unnecessary and avoidable. Often, a surgery that is unnecessary leads to additional surgeries. The problems continue.
This can be difficult for patients to hear. At the Walmart Centers of Excellence for Joint and Spine Surgery, patients are referred for second opinions after receiving recommendations for surgery in their local market. More than half of patients who visit the Walmart Center of Excellence are given a second opinion that surgery is unnecessary. Extensive published research supports the same conclusion.
Unfortunately, it is hard for patients to hear that surgery is no magic bullet. We had patients crying in our office when they were told surgery was not an option. And at the time, we did not have the right solutions for them as an alternative. These patients were at the greatest risk of opioid addiction.
However, there is good news. With the rise of new digital musculoskeletal care solutions, and their growing adoption by employers, health systems and health plans, alternative solutions to opioids are becoming more available to providers and patients alike. And these solutions really work.
Physical therapy (PT) has always outperformed surgeries and opioids for pain care. The problem, historically, has been keeping patients engaged with a PT program that is as clinically rigorous as it is convenient and accessible.
With the advent of digital musculoskeletal (MSK) care programs – like the ones offered by Sword Health – we’re seeing high levels of patient engagement and program completion that improve clinical outcomes, reduce or eliminate pain, and even improve patients’ overall mental health scores.
For example: 83% of patients complete our programs, compared to 30% of those who attend in-person PT. More than 70% of our patients report a minimum of 30% improvement in their pain scores; a well-established threshold for clinically meaningful improvements. For comparison, published data on surgery for back pain showed that less than 50% of patients had a minimum of 30% improvement in pain.
Additionally, mental health conditions, such as depression and anxiety, which we know play a role in chronic pain and vice versa, were also reduced by more than 50%.
And maybe most relevant to the discussion of opioid abuse is the impact digital MSK programs can have on medication use. Patients using Sword Health reported a 50% reduction in use of pain medicines, including opioids and non-opioids.
Chronic pain is the real epidemic. It’s estimated that 1 in 5 Americans suffer from chronic pain at any given time. It can be hard to give these patients effective solutions that resolve their suffering quickly.
But to combat the opioid crisis, and challenge decades-old thinking on treating pain, we must reimagine pain and teach our patients how to reimagine it, too. Pain can be managed and resolved – without serious consequence – by leveraging safe, effective solutions such as physical therapy and enabling technologies like digital MSK care.
