Alternatives to opioids in musculoskeletal medicine

Huaiyu Tan, M.D., PH.D.
Physical Medicine and Rehabilitation / Interventional Pain Medicine Specialist
Andrews Institute for Orthopaedics & Sports Medicine
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 Q: Talk about the prevalence of opioids in MSK medicine and how new legislation looks to curb their use?
Huaiyu Tan, M.D., Ph.D.: Opioids are heavily over-utilized and musculoskeletal medicine. The United States only represents 4.6% of the world's population yet are responsible for 80% of the world's opioid prescriptions. What we know about opioids is that with a 10-day prescription of opioid medications, 20% of people will still be taking them at the one-year mark. They are extremely habit-forming, and we really do not have any scientific evidence that they actually are helpful in chronic pain.
 Q: How do you determine if a patient needs opioids?
Huaiyu Tan, M.D., Ph.D.: The use of opioids should be a very thoughtful and deliberate process. In the prescription of opioids, careful consideration must be given to weigh the potential short-term benefit versus long-term risk. I believe that educating the patient and informing them that these medications are not perfect with regard to controlling pain. So giving the patient realistic expectations is key. Also letting the patient that opioids indeed do carry a high risk with regard to their prescription.
 Q: What are alternatives to opioids in MSK medicine and why are they important?
Huaiyu Tan, M.D., Ph.D.: I think it's important to understand that pain is your body's way of letting you know that something is wrong. That's there is a problem. I think that not having pain can potentially make somebody injure something worse. I think letting the patient know that it's normal to have pain in certain instances, certainly setting realistic expectations and goals will help the patient understand this. Alternatives to opioid medications include other classes of medications, including anti-inflammatories, neuropathic pain medications such as Gabapentin and Lyrica, muscle relaxants, etc., but those medications are not perfect as well. Physical therapy is an important piece of any type of treatment for spine or musculoskeletal.


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