Flipping the script on pain could help stem the opioid crisis
As an orthopedic surgeon, my days are often filled with seeing patients who are in pain. The pain generators can be broken bones, dislocated joints, or cuts in the skin. Often, the discomfort cannot be defined, and the cause can be difficult to pinpoint.
My patients have different ways of describing the debilitating chronic pain that is limiting their ability to go about their daily lives. Some say it feels like tingling, scalding, electric shocks, and even lightning bolts. Others say the pain feels like “green chiles under the skin.” My Spanish-speaking patients often use the word “comezón” to describe a burning, itching pain. Each day, I have frank conversations with patients about treatment plans for their pain. Opioids are often seen as the easy answer by clinicians and patients alike. But these powerful painkillers are, of course, highly addictive. This default to medication has only added fuel to the opioid crisis.
Pain isn’t just a problem for the more than 100 million Americans who find themselves no longer able to do their jobs, enjoy their hobbies or even just get a good night of sleep—it’s a problem for our society. One in 10 suicides nationally is linked to chronic pain.
Countless measures have aimed to decrease the number of opioid prescriptions physicians are writing and the duration for which prescriptions are issued. These steps are essential to stemming the opioid crisis because the majority of opioid addictions start with a legal prescription. Despite these measures, two-thirds of New Mexico drug overdose deaths involve an opioid.
In many cases, all the words that patients use to describe their pain—burning, itching, electric shocks—are clues to the cause of the injury. These descriptors are actually symptoms of a nerve injury; the pain generated by nerve injuries feels different from other types of pain.
Nerves run throughout the body and send signals to the brain that allow us to feel and move. However, they can also be the source of debilitating pain when injured. Many nerves, like those in the hands and feet, are only a few millimeters below the skin and can be damaged in seemingly superficial injuries. Nerve damage can also stem from surgical incisions, amputations or traumatic injuries (e.g., crush injuries). Injured nerves, left unaddressed, can lead to painful neuromas that disrupt normal nerve function and cause chronic pain. A neuroma results from the injured nerve and is a tangled mass of nerve endings and scar tissue—a common, but often overlooked cause of chronic pain.
Patients with pain caused by injured nerves are more likely to take opioids and multiple pain medications yet report less pain relief. What if instead of just masking chronic pain, it could be addressed at its source? Advances in microsurgery make it possible for surgeons to repair, reconnect or properly manage damaged nerves, fixing the source of the pain and potentially alleviating chronic pain for good.
I have had many patients over the years with symptomatic, painful neuromas. One that stands out to me was a gentleman in his 70s who lived with chronic ankle pain for 20 years. He is a classic New Mexico cowboy: tall, thin and has worked hard his entire life—and he continues to work. His ankle was so bothersome that he would cut holes in his boots so they wouldn’t rub on the outside of his ankle. I was seeing him for an entirely different problem, and I noticed his modified boot. He told me his symptoms, and after I examined his ankle, the issue was obviously a neuroma. He had lived like this for more than 20 years because he didn’t understand the problem, nor did he know a solution existed. After a short surgery to remove the neuroma and repair his nerve, the pain completely resolved, and he was able to put those modified boots in the back of his closet.
Neuromas are common, and there is a potential solution for chronic neuroma pain. Addressing the pain at its source by removing the neuroma can be life-changing—and this can potentially eliminate one’s need for opioids. If you’re living with chronic pain, you shouldn’t have to “cowboy up,” abandon your passions to cope, or live a life ruled by opioids. The cause may be nerve damage, and treatment options may be available. Talk with others; local chronic pain support groups are available in New Mexico through the U.S. Pain Foundation. I encourage you to learn more about nerve damage, and if the symptoms are familiar to you, ask your doctor for a referral to a surgeon who specializes in peripheral nerve injuries.
If you have suicidal thoughts or feelings, contact the National Suicide Prevention Lifeline at 800-273-8255.
Dr. Deana Mercer is an orthopedic hand, upper extremity and peripheral nerve surgeon in Albuquerque.
This article originally appeared on Las Cruces Sun-News: Flipping the script on pain could help stem the opioid crisis
