Opioids have a centuries-long history in medicine, but doctors say treating pain is a cutting-edge medical problem that researchers and clinicians are just beginning to unpack.
The problem begins with diagnosis. Unlike health indicators such as cholesterol or blood sugar, pain isn't something doctors are able to easily measure.
"It is a very problematic thing," says Dr. Erika Petersen, a University of Arkansas for Medical Sciences neurosurgeon. "You can't see what you're treating. You have to rely on a person to tell you that they're getting better."
To dig into the issue, researchers have tried using functional-brain scans to take a look at what's happening when a person feels pain.
They've also used animal studies. Some individual rats, for example, are more sensitive to pain, while others are more tolerant.
It may be similar for people, Petersen says. She uses the example of three different people, each of whom gets a paper cut.
"One screams bloody murder. One says 'darn' and moves on, and somebody else is kind of like, upset for a minute, and is OK," she says.
These gaps in understanding have led to delays in developing new treatments for people who are experiencing pain, particularly chronic pain.
As a tool in that effort, the use of opioids may have been exacerbated by the fact that doctors often only get a couple of minutes with a patient, providers say.
"Doctors have been kind of in this Catch-22 situation, especially in hospital settings," says Dr. Nick Camp of Camp Interventional Pain Associates in Bentonville.
"We're looking at these subjective, numerical pain scores that patients are giving us and trying to get those under a certain number.
"And if we're not doing that, it's like we're doing something wrong."
Historically, doctors have asked patients to rate their pain on a numerical scale -- 1 to 10 for instance -- but providers are beginning to lean away from that approach.
As clinicians better understand pain and long-term opioid use, a shift away from using the medications as therapy has been supported by ongoing scientific research.
In his practice, Dr. Navdeep Dogra at Jefferson Regional Medical Center in Pine Bluff says he's now more conscious of opioid-induced hyperalgesia, in which long-term opioid use worsens pain.
Ultimately pain is a "biopsychosocial" condition exacerbated by mood disorders and unhealthy habits, he says. In his perspective, doctors have a duty to be straightforward with the populations they work with about those factors.
"We need to do our part as physicians to educate our patients, to say, "you know what, there is no one magic pill, there is no one magic procedure,'" he says.
Petersen, who this year won a national award for her work on pain treatment from the American Society of Pain and Neuroscience, says she typically uses a combination of therapies to treat pain -- nerve blocks, injections and surgical procedures such as spinal cord stimulation.
She also tries to trace the specific source of someone's pain to understand how to attack it. In her experience, chronic pain often connects to nerve damage or neuropathy, conditions that are less responsive to narcotics.
Providers say it helps to gain the fullest possible understanding of a patient's personal story, especially for pain, which is intimately linked to psychological wellness.
That's doubly true when prescribing opioids, says Dr. Michael Mancino, director of the Center for Addiction Research at the UAMS Psychiatric Research Institute.
"Are you really treating chronic pain, or are you treating an addiction, or are you treating psychic pain?" he says. "What are you really treating?"
SundayMonday on 12/01/2019