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Dynamic Chiropractic – December 16, 2012, Vol. 30, Issue 26
Dynamic Chiropractic
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Dynamic Chiropractic

The Problem With Masking Pain

By Kent Greenawalt

Imagine this scenario: You're hurting and you just want to make it through the day with as little pain as possible so you can keep your job and maintain a normal life. Unfortunately, many people do not have to imagine this because it is their way of life.

Whether it's an injury, chronic pain or degenerative condition that leaves a person in pain, the goal of any patient is to feel better. However, you know as doctors of chiropractic that feeling better doesn't necessarily mean getting better.

You understand that masking the pain with certain drugs and treatments does not fix the underlying issue; it only puts a Band-Aid on a bigger problem. Due to the overuse of some pain medications, we must also be aware that this model of care can create new – and sometimes deadly – problems. See the table below for evidence of this growing problem of medication overuse. For example, from 1997-2005, oxycodone purchases in the United States rose 588 percent!1 By now, these numbers are likely even higher.

When Masking Pain Becomes Deadly: From Steroids to Spinal Meningitis

Recently, medications that were used to help patients have turned into a major health scare for thousands of Americans. An unknown number of patients were given potentially contaminated steroid injections, with a rising number of those injected now showing symptoms of fungal meningitis. Hundreds of cases of fungal meningitis and dozens of deaths have been reported by the Centers for Disease Control and Prevention (CDC).2 While no original source of the outbreak has been found, the CDC has determined that "all infected patients identified thus far have received preservative-free (PF) methylprednisolone acetate (80mg/ml) from among the three lots voluntarily recalled by the New England Compounding Center in Framingham, Massachusetts, on September 26, 2012."3

This outbreak is particularly alarming because it takes 1-4 weeks after the contaminated injection for the onset of symptoms; while 19 states have reported cases, 23 states are known to have received medication from the New England Compounding Center; and fungal meningitis can be difficult to diagnose and treat. It requires the use of powerful antifungal drugs that cause severe side effects, such as kidney damage.4 Additionally, diagnosis of fungal meningitis is problematic because "the symptoms can be vague and mild initially, including fever, headache, nausea and stiffness of the neck, according to the CDC. People with fungal meningitis can also experience dizziness and confusion. Several of the patients in the current outbreak have had strokes."5

This outbreak is bringing attention to compounding pharmacies, which the FDA has tried unsuccessfully to gain greater authority over in the past decade. Government officials say the FDA is concerned about large compounding pharmacies that send out large amounts of drugs across the country, as opposed to small pharmacies that may compound a medication three or four times a year.5

Increase in U.S. Retail Drug Purchases, 1997-2005 (Amount Sold in Grams)
Drug 1997 1999 2001 2003 2005 Change*
Oxycodone 4,449,559 9,717,597 19,947,287 26,655,149 30,628,971 588%
Methadone 518,736 965,389 1,893,322 3,683,878 5,362,813 934%
Fentanyl base 74,085 107,158 186,082 317,197 387,926 423%
Morphine 5,922,870 6,804,933 8,810,755 12,303,954 15,054,842 154%
Hydrocodone 8,699,309 12,102,623 15,597,209 21,106,646 25,803,541 197%
Hydromorphone 241,806 292,585 400,639 579,370 781,284 224%
Source: Drug Enforcement Agency (DEA) Automated Reports and Consolidated Orders System. Revised Aug. 1, 2007.
* Percentage change in amounts sold from 1997 to 2005.

Time to Address the Elephant in the Room

Regardless of regulations and tighter control over how medications are manufactured, there is an elephant in the room that needs addressing: overmedication. While there is a definite need for medication for many illnesses, injuries, etc., there are also times when medication could be used, but isn't the best solution to the underlying problem.

If you have a flat tire in your car, you could stop at every gas station and fill it with more air so you could keep driving. But until you patch the hole in your tire, you'll never fix the real issue of why your tire is losing air. The same can be said about many conditions doctors treat with pain medication or steroid injections. There is a definite need for them at times, but there is also a need for medical professionals (doctors and pharmacists) to determine if the patient could benefit from less medication and instead use alternative therapies. These could include chiropractic care, rehabilitative exercise, acupuncture and massage therapy, among others.

A pharmacist can't tell if a patient needs medication, but the pharmacist certainly has the right and responsibility to raise a red flag if the patient is filling prescriptions for multiple pain / anxiety medications from several different doctors. There need to be more safety nets in place for patients who need help to get it, while health care professionals keep a close eye on those abusing the system. Also, tougher regulations should be put in place to make it harder for that abuse to continue – from both those who write and fill the prescriptions, and patients who abuse the system by obtaining fraudulent prescriptions.

From Patients to Players

The average patient isn't the only one susceptible to the dangers of overmedication. Professional athletes often deal with the choice to sit out due to injury or take more drastic measures to finish the game and/or the season. A recent article in USA Today highlighted the overuse of cortisone injections for injured athletes. Washington Nationals third baseman Ryan Zimmerman understands many times they just treat the symptom, instead of the problem: "[The cortisone injection] it's masking pain. If something's hurt and you're masking pain," Zimmerman said. "Sooner or later you're going to have to do something a little more than a cortisone shot."6

Unfortunately, even with the knowledge that the cortisone shot will not make their problem go away – and could even cause further damage if done too frequently – many players do what they feel must be done to finish the season.

Promote Chiropractic

While professional athletes and the everyday patient are part of this growing trend of overmedication, there is something you can do to help. Chiropractic care does not mask the problem or just treat the symptom; it treats the underlying issue. It also doesn't have the potentially harmful side effects of so many of the medications discussed in this article. That's why the Foundation for Chiropractic Progress (F4CP) is working hard to generate a positive buzz about chiropractic.

As the foundation gains more support, the general public and media will advance both their acceptance and knowledge of chiropractic. Help spread awareness by supporting the foundation. Visit www.f4cp.com or call 866-901-F4CP (3427) to join today.

References

  1. "U.S. Opioid Risk Management Initiatives." International Association for the Study of Pain (IASP), Pain: Clinical Updates, November 2009.
  2. Multistate Fungal Meningitis Outbreak Investigation: At-a-Glance. Centers for Disease Control and Prevention, Nov. 10, 2012.
  3. Frequently Asked Questions for Clinicians: Multistate Fungal Meningitis Outbreak Investigation. Centers for Disease Control and Prevention, Oct. 23, 2012.
  4. Fox, M. "More than 200 Diagnosed in Fungal Meningitis Outbreak." NBC News.com, Oct. 14, 2012.
  5. Martin T, Burton T, McKay B, Levitz J. "Meningitis Cases Rise Amid Hunt for Victims." The Wall Street Journal, Oct. 8, 2012.
  6. White P. "Cortisone: Is It Worth the Shot?" USA Today, Oct. 9, 2012.

Click here for more information about Kent Greenawalt.

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