Page 25 - CASA Bulletin of Anesthiology 2021, Vol 8, No. 6 (1)

Vol. 8, No. 6, 2021

For more than 20 years, opioid misuse, over-prescription, and unauthorized distribution
(diversion) have resulted in a significant increase in opioid use disorders and accidental overdose
death rate at alarming levels. Around 6% of the US population (15–64 years old) reported
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some type of opioid abuse, and an estimated death of 115 US citizens per day due to opioid
overdose was reported in 2015, and over 66% of all overdose episodes in 2016 were opioid-
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related.
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Current efforts to address the opioid crisis have been made to identify potential associations
between demographics (ethnicity, culture, gender, religion) and other factors with opioid
accessibility, abuse, and overdose. Furthermore, numerous regulations and enhanced prescription
drug monitoring programs have contributed to decreases in opioid prescriptions from 255 million
prescriptions in 2012 to 191 million prescriptions in 2017, a 25% decrease. Other measures
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would be valuable to manage the opioid crisis in the future, such as investigation of the nature of
opioid use disorders, patient education, rehabilitation program, prescription drug monitoring
program, as well as development of new opioid abuse-deterrent medications.

Non-opioid medications may be effective in reducing opioid dosages and minimizing opioid
toxicity. Such medications include acetaminophen, NSAIDs, antidepressants, anticonvulsants,
muscle relaxants, topical analgesics, and anxiolytics. However, these non-opioid medications are
associated with their own risks with different mechanisms of action. These medications could be
additive or synergistic when used in combination. However, a risk–benefit analysis must be
performed prior to engaging in combination therapy in each individual patient.

Multiple complementary and integrative health approaches have been applied in managing
chronic pain as well, including acupuncture, manipulative therapies, mind-body medicine,
cognitive behavior therapy, etc. However, more data are still needed through innovative clinical
research regarding the efficacy, side effects and other aspects of these treatment modalities.
Thus, it is essential to continue to support clinical research in this field and give evidence-based
recommendations to patients regarding each of these treatment modalities.
B. Interventional Procedures

Interventional pain procedures were initially introduced in the early 20th century and there
have been substantial developments in diagnostic and therapeutic interventional techniques since
then. Currently, interventional pain procedures are the second most commonly utilized
technique in managing chronic pain. Multiple interventional techniques are evidence-based as
well as cost-effective. They range from epidural steroid injection, facet joint injection and
radiofrequency ablation, peripheral nerve block, joint injection, sympathetic nerve block,
vertebral augmentation procedure, multiple neuromodulator techniques, intrathecal infusion
pump, and finally regenerative therapies with interspinous prosthesis spacer devices.
There was an increased utilization of interventional pain procedures by 173.6% from 2000 to
2009. However, this trend has been reversed with a 6.7% decline, specifically epidural steroid
injections, from 2009 to 2018. Therefore, utilization of multiple interventional techniques in
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conjunction with other modalities such as physical therapy, home exercise programs and medical
therapy may further improve chronic pain management.
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