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John Casey MISCP MScSportsMed.

February 2021.

Pain is not pleasant. People in severe pain will do almost anything to ease it and the quicker the better! The first thing most people will want to do is get medication but is this the correct means of managing pain?  Well in certain circumstances yes but you need to be very careful about how you do it. Society has become very unaccepting of discomfort and searches a quick, easy, doctor-provided pain relief without realising that medication cannot resolve injuries nor correct the cause of any chronic musculoskeletal condition.

Opioids are a class of drug naturally found in the opium poppy plant that work in the brain to produce a variety of effects, including pain relief. The forms of opioid based drugs range from prescription codeine-based medication to heroin. Codeine can be found in many prescription medications in Ireland. In addition to controlling pain, opioids make some people feel relaxed, happy or ‘high’, and can be addictive.

The prevalence of codeine use in Ireland is high and has not been sufficiently researched to fully understand the problem it might be in terms of abuse.

Film (2020) published a paper in relation to the opioid epidemic that currently grips the US and some of the facts stated are startling.

  • Today approximately 2.3 million Americans have an Opioid Use Disorder (OUD) of whom 74% abuse prescription opioids.
  • Physician-prescribed narcotics are the gateway that opens to the world of illicit narcotics for 80% of all Americans who die from opioid overdose.
  • Over 500,000 Americans have dies from opioid overdose since 1999.
  • Paradoxically, opioids increasingly cause pain hypersensitivity over time, making dependence more likely.
  • Prescribing opioids for patients with chronic pain leads to misuse in 1 in 4.

To avid going down the same road we need to consider alternatives to pharmacological management of chronic pain. We need to advocate interventions such as self-care, lifestyle management, guided physical rehabilitation, and independent exercise as alternatives to medication in chronic musculoskeletal conditions. We need to make these interventions affordable and accessible to people and educate the general public in order take back control from Pharma for the long-term good. We need a culture change in terms of pain-relief medication.

Maybe the tables are beginning to turn. Reuters recently published an article on a $600 million fine imposed on McKinsey and Co, a consulting firm in the US, who helped drug manufacturers market and boost sales of painkillers. Their role in destroying lives and families was alluded to in court. Another firm Purdue filed for bankruptcy in 2019 as part of a proposed settlement it valued at $10 billion to resolve lawsuits alleging its painkiller marketing helped fuel the epidemic.

More local measures are also being taken. In 2019 a group of us organised Parkrun in our local Knockanacree Woods in an effort to promote exercise in a social setting in our community. Parkrun is a free 5km event which participants from 4 years old are encouraged to walk, jog or run and it staged in numerous settings around the world every Saturday morning at 9am. It was a great success and will be again once the COVID pandemic passes.

The Irish College of General Practitioners and Parkrun Ireland launched a ground-breaking initiative where GPs prescribe outdoor, community-based physical activity rather than medication for people who may benefit. This is an amazing step forwards and one which should be embraced by GPs and physiotherapists alike. We certainly will be doing this at SportsPlus Physiotherapy!

If you have any queries regarding the management of chronic pain, please feel free to contact us and we will give you more information.

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