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Published in: Current Pain and Headache Reports 3/2018

01-03-2018 | Other Pain (A Kaye and N Vadivelu, Section Editors)

Pain States, the Opioid Epidemic, and the Role of Radiologists

Authors: Mark R. Jones, Alan D. Kaye, Laxmaiah Manchikanti, Joshua A. Hirsch

Published in: Current Pain and Headache Reports | Issue 3/2018

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Abstract

Purpose of Review

The prevalence of chronic pain and prescription opioid abuse has resulted in epidemic problems for patients and clinicians. The consequences are taking a heavy toll on patients, physicians, and society. Specific to radiology, a significant need exists for best practice assessment and treatment approaches for pain management, as patients with chronic pain often undergo radiological tests of unclear clinical relevance.

Recent Findings

The USA is amid an opioid-prescribing epidemic and resultant overdose public health emergency. A variety of reasons, which are examined in this manuscript, have contributed to the dramatic increase in the use of chronic opioid therapy for chronic non-cancer pain. This increase of opioid prescriptions and related deaths is based on many factors including the perception that there was systemic undertreatment of pain, the philosophical approach of advocacy groups for pain relief, promotion by the pharmaceutical industry, Joint Commission’s Fifth Vital Sign, and permissive regulations by boards of medical licensures promoting excessive use of opioids. Overall, opioid treatment has been based on subjective pain relief and radiographic findings, which may not correlate with the source of pain generation.

Summary

Radiologists, along with interventionalists, frequently interact with patients on chronic opioid therapy and at times take responsibility for patients with chronic pain. Beyond reading studies, diagnostic radiologists provide care to larger percentages of patients taking narcotics than ever before. This manuscript focuses on chronic pain, escalating opioid therapy, and adverse consequences, including the epidemic of overdoses and deaths. Radiologists’ expertise can potentially reduce unnecessary radiological tests and inappropriate prescribing of medications.
Literature
1.
go back to reference Manchikanti L, Kaye AM, Knezevic NN, et al. Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Phys. 2017;20(2S):S3–S92. Manchikanti L, Kaye AM, Knezevic NN, et al. Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Phys. 2017;20(2S):S3–S92.
2.
go back to reference •• Manchikanti L, Kaye AM, Kaye AD. Current state of opioid therapy and abuse. Curr Pain Headache Rep. 2016;20(5):34. Excellent review on the current state of opioid therapy and opioid abuse CrossRefPubMed •• Manchikanti L, Kaye AM, Kaye AD. Current state of opioid therapy and abuse. Curr Pain Headache Rep. 2016;20(5):34. Excellent review on the current state of opioid therapy and opioid abuse CrossRefPubMed
6.
go back to reference Schuchat A, Houry D, Guy GP Jr. New data on opioid use and prescribing in the United States. JAMA. 2017; Schuchat A, Houry D, Guy GP Jr. New data on opioid use and prescribing in the United States. JAMA. 2017;
7.
go back to reference U.S. Burden of Disease Collaborators. The state of US health, 1990 – 2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310(6):591–608.CrossRef U.S. Burden of Disease Collaborators. The state of US health, 1990 – 2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310(6):591–608.CrossRef
12.
go back to reference Boswell MV, Manchikanti L, Kaye AD, et al. A best-evidence systematic appraisal of the diagnostic accuracy and utility of facet (zygapophysial) joint injections in chronic spinal pain. Pain Physician. 2015;18(4):E497–533.PubMed Boswell MV, Manchikanti L, Kaye AD, et al. A best-evidence systematic appraisal of the diagnostic accuracy and utility of facet (zygapophysial) joint injections in chronic spinal pain. Pain Physician. 2015;18(4):E497–533.PubMed
13.
go back to reference Manchikanti L, Kaye AD, Boswell MV, et al. A systematic review and best evidence synthesis of the effectiveness of therapeutic facet joint interventions in managing chronic spinal pain. Pain Phys. 2015;18(4):E535–82. Manchikanti L, Kaye AD, Boswell MV, et al. A systematic review and best evidence synthesis of the effectiveness of therapeutic facet joint interventions in managing chronic spinal pain. Pain Phys. 2015;18(4):E535–82.
14.
go back to reference •• Kaye AD, Manchikanti L, Abdi S, et al. Efficacy of epidural injections in managing chronic spinal pain: a best evidence synthesis. Pain Physician. 2015;18(6):E939–E1004. Excellent review on efficacy of epidural injections PubMed •• Kaye AD, Manchikanti L, Abdi S, et al. Efficacy of epidural injections in managing chronic spinal pain: a best evidence synthesis. Pain Physician. 2015;18(6):E939–E1004. Excellent review on efficacy of epidural injections PubMed
15.
go back to reference Simopoulos TT, Manchikanti L, Gupta S, et al. Systematic review of the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions. Pain Phys. 2015;18(5):E713–56. Simopoulos TT, Manchikanti L, Gupta S, et al. Systematic review of the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions. Pain Phys. 2015;18(5):E713–56.
16.
go back to reference •• Grider JS, Manchikanti L, Carayannopoulos A, et al. Effectiveness of spinal cord stimulation in chronic spinal pain: a systematic review. Pain Phys. 2016;19(1):E33–54. Excellent review on efficacy of spinal cord stimulation •• Grider JS, Manchikanti L, Carayannopoulos A, et al. Effectiveness of spinal cord stimulation in chronic spinal pain: a systematic review. Pain Phys. 2016;19(1):E33–54. Excellent review on efficacy of spinal cord stimulation
18.
go back to reference Manchikanti L, Nampiaparampil DE, Candido KD, Bakshi S, Grider JS, FJE F, et al. Do cervical epidural injections provide long-term relief in neck and upper extremity pain? A systematic review. Pain Phys. 2015;18(1):39–60. Manchikanti L, Nampiaparampil DE, Candido KD, Bakshi S, Grider JS, FJE F, et al. Do cervical epidural injections provide long-term relief in neck and upper extremity pain? A systematic review. Pain Phys. 2015;18(1):39–60.
19.
go back to reference Helm S II, Racz GB, Gerdesmeyer L, et al. Percutaneous and endoscopic adhesiolysis in managing low back and lower extremity pain: a systematic review and meta-analysis. Pain Phys. 2016;19(2):E245–82. Helm S II, Racz GB, Gerdesmeyer L, et al. Percutaneous and endoscopic adhesiolysis in managing low back and lower extremity pain: a systematic review and meta-analysis. Pain Phys. 2016;19(2):E245–82.
20.
go back to reference Manchikanti L, Datta S, Gupta S, et al. A critical review of the American Pain Society clinical practice guidelines for interventional techniques: part 2. Therapeutic interventions. Pain Phys. 2010;13(4):E215–64. Manchikanti L, Datta S, Gupta S, et al. A critical review of the American Pain Society clinical practice guidelines for interventional techniques: part 2. Therapeutic interventions. Pain Phys. 2010;13(4):E215–64.
23.
go back to reference Manchikanti L, Pampati V, Hirsch JA. Utilization of interventional techniques in managing chronic pain in Medicare population from 2000 to 2014: an analysis of patterns of utilization. Pain Phys. 2016;19(4):E531–46. Manchikanti L, Pampati V, Hirsch JA. Utilization of interventional techniques in managing chronic pain in Medicare population from 2000 to 2014: an analysis of patterns of utilization. Pain Phys. 2016;19(4):E531–46.
24.
go back to reference Hirsch JA, Chandra RV, Pampati V, et al. Analysis of vertebral augmentation practice patterns: a 2016 update. J Neurointer Surg. 2016;31 Hirsch JA, Chandra RV, Pampati V, et al. Analysis of vertebral augmentation practice patterns: a 2016 update. J Neurointer Surg. 2016;31
25.
go back to reference Enthoven WT, Roelofs PD, Deyo RA, van Tulder MW, Koes BW. Non-steroidal anti-inflammatory drugs for chronic low back pain. Cochrane Database Syst Rev. 2016;2:CD012087.PubMed Enthoven WT, Roelofs PD, Deyo RA, van Tulder MW, Koes BW. Non-steroidal anti-inflammatory drugs for chronic low back pain. Cochrane Database Syst Rev. 2016;2:CD012087.PubMed
31.
go back to reference Vu T, Al-Grain H, Liu A, Grim R. The clinical efficacy of repeat magnetic resonance imaging in patients with chronic spine pain, presented at: the American Pain Society 36th Annual Scientific Meeting; May 17-20, 2017; Pittsburgh PA. Vu T, Al-Grain H, Liu A, Grim R. The clinical efficacy of repeat magnetic resonance imaging in patients with chronic spine pain, presented at: the American Pain Society 36th Annual Scientific Meeting; May 17-20, 2017; Pittsburgh PA.
33.
go back to reference Manchikanti L, Atluri S, Hansen H, et al. Opioids in chronic noncancer pain: have we reached a boiling point yet? Pain Phys. 2014;17(1):E1–E10. Manchikanti L, Atluri S, Hansen H, et al. Opioids in chronic noncancer pain: have we reached a boiling point yet? Pain Phys. 2014;17(1):E1–E10.
34.
go back to reference Rosenkrantz AB, Hirsch JA, Allen B Jr, et al. Identifying radiology’s place in the expanding landscape of episode payment models. J Am Coll Radiol. 2017; Rosenkrantz AB, Hirsch JA, Allen B Jr, et al. Identifying radiology’s place in the expanding landscape of episode payment models. J Am Coll Radiol. 2017;
35.
go back to reference Rosenkrantz AB, Nicola GN, Allen B Jr, et al. MACRA, alternative payment models, and the physician-focused payment model: implications for radiology. J Am Coll Radiol. 2017; Rosenkrantz AB, Nicola GN, Allen B Jr, et al. MACRA, alternative payment models, and the physician-focused payment model: implications for radiology. J Am Coll Radiol. 2017;
Metadata
Title
Pain States, the Opioid Epidemic, and the Role of Radiologists
Authors
Mark R. Jones
Alan D. Kaye
Laxmaiah Manchikanti
Joshua A. Hirsch
Publication date
01-03-2018
Publisher
Springer US
Published in
Current Pain and Headache Reports / Issue 3/2018
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-018-0672-x

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