Biophysical Agent Alternatives to Opioids for Pain Management
Approximately 25 – 50% of community dwelling older adults have pain. Opioids are commonly prescribed for acute and chronic pain, including after surgeries such as THR, TKR, and ORIF. Opioids have numerous side effects and a high potential for misuse. Over-reliance on opioids for acute and chronic pain management has led to alarming trends across the United States, including record numbers of people developing opioid use disorders, overdosing on opioids, and dying from overdoses. Death from overdose has replaced motor vehicle crashes as the leading cause of injury death. In 2015 opioids killed more than 33,000 people, the highest number ever.¹
Many Medicare and Medicaid beneficiaries and their families have experienced opioid use disorder, commonly referred to as addiction. Given the growing body of evidence on the risks of misuse, highlighted by the recently published guidance from the Centers for Disease Control (CDC), and the Administration's commitment to combatting the opioid epidemic, CMS has recently outlined their strategy with four priority areas. The fourth priority is:
Increase the use of evidence-based practices for acute and chronic pain management
Physical Agent Modalities offer evidence-based treatment alternatives to decrease acute and chronic pain and can be used to replace and wean an individual from narcotics. When a patient is taking opioid analgesics:
• Treat the patient as medication is wearing off.
• Use IR, US, SWD, and Sensory or Nerve Block electrical stimulation when the patient is on narcotics. Motor stimulation may not give any added pain relief due to the pain medication filling the same receptor site (Mu).
• Use Motor sequential stimulation to replace narcotics and restart the endorphin system.
• Narcotics should be PRN and titrated as physical agent modalities manage the pain.
• Attempt to reduce analgesics to a single type if possible.2,3
For more information about using biophysical agents to address pain management, please see the quick reference guide or reach out to your ACP Clinical Program Consultant.
2. Sluka KA: Systemic morphine in combination with TENS produces an increased antihyperalgesia in rats with acute inflammation. J Pain 1(3): 204-211, 2000
3. Jauregui JJ: A Meta-Analysis of Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain. Surg Technol Int. Apr;28:296-302, 2016