Opioids for Pelvic Pain - What Are the Alternatives?

Opioids, FDA

Mesh Medical Device News Desk, June 23, 2016 ~ Douglas Scott got an ultimatum from his wife - wean yourself off opioid medication, he began to treat pain after two car accidents, or expect changes at home. Today Mr. Scott is narcotics free. Instead he entered a program and spent five weeks, six hours a day training in alternative pain management techniques. They include relaxation exercises, behavior modification and physical therapy.

This story in the New York Times illustrates how difficult it is to reduce the widespread use of painkillers such as OxyContin and Percocet.

As part of a nationwide trend to reduce the abuse of pain drugs, doctors are being urged to first treat pain without using opioids. That has been the traditional course of treatment for women suffering pelvic pain after a transvaginal mesh implant when the doctor no longer understands how he can address her complications.

Other avenues include chiropractic and osteopathic manipulation, acupuncture, yoga, massage, meditation. Problem is most insurance has not kept up with the push to limit opioids and may not cover these alternative treatments. Medicaid may cover physical therapy under the Affordable Care Act but that varies by state. Historically when limits were placed on coverage, these alternatives to opioids were the first to go. Now Medicaid must grapple with adding them back.

There is a National Pain Strategy that was issued in March that outlines ways to improve pain care in America.

The Mayo Clinic in a 2008 study found that alternatives to opioid use led to a significant improvement in function and less pain.

In Mr. Scott's case, he now admits he was addicted to oxycodone and morphine. His treatment in alternatives led him to Brooks Rehabilitation in Jacksonville, Florida. Workers’ compensation and Aetna and United Healthcare cover the program’s costs. Blue Cross and Blue Shield of Florida does not. In a statement, Florida Blue said some alternative treatments are experimental and unproved. State Medicaid plans have not traditionally covered a range of alternative programs, but now with the national push to reduce opioid addiction, has prompted some states to consider passing legislation to develop pilot programs to incorporate acupuncture, chiropractic, cognitive behavioral therapy, massage, exercise, yoga and osteopathic manipulation. Oregon leads the nation in providing such treatments.

Mental health counselling is also being recognized as a necessary component to pain drug addiction. ##