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insurance companies, the government, and employers help perpetuate the opioid crisis


Opioid Epidemic Government Insurance

Unless you’ve been living under a rock you’ve heard about the OPIOID CRISIS — probably more than you care to.  You would expect that with all the bad publicity surrounding those most responsible, things would be getting better.  Unfortunately, that’s not what the current research and statistics say.  With tens of thousands of Americans dying each year and the annual financial cost approaching 3% of GDP (over half a trillion dollars), shouldn’t something drastic be done? 

New studies are proving what you’ve suspected for quite some time —- that the 3rd party entities responsible for taking care of the biggest majority of our nation’s medical bills (the government, health insurance companies, and workman’s compensation programs) are essentially forcing chronic pain patients — particularly LOW BACK PAIN PATIENTS — down ‘Opioid Road’.  Why? 

Because their cost is much lower for providing drugs than it is for providing services such as chiropractic or therapy.  The problem is, drugs — NO MATTER WHICH ONES WE ARE TALKING ABOUT IN THIS CONTEXT — have virtually no benefit other than masking pain.  For proof, look no further than the June 2018 issue of the Journal of the American Medical Association (Opioid Prescribing for Low Back Pain: What Is the Role of Payers?)

“Low back pain is one of the leading causes of disability and chronic pain among adults and one of the most common reasons for which patients are treated with opioids.  Recent data from the first randomized clinical trial with long-term outcomes demonstrated that opioid treatment did not confer benefit with respect to pain-related function and that adverse medication-related events were more common among patients receiving opioid therapy.

Although opioids provide effective analgesia for acute pain, their initiation for the management of chronic pain remains problematic. For chronic pain, long-term opioid therapy is associated with poorer patient-reported pain, function, and quality-of-life outcomes and may be less effective among individuals with mood disorders, centralized pain syndromes, neuropathic pain, and psychiatric disorders.

Opioid therapy is also associated with numerous dose-related adverse effects, such as respiratory depression and overdose, as well as dependence, tolerance, worsened pain, depression, constipation, and confusion. Approximately 20% of individuals receiving long-term opioid therapy develop an opioid use disorder.”

If low back pain were rare, this might not be such a big deal.  But it’s not, and it is.   Cleveland Clinic says on their website (Back Pain Basics) that 85-90% of the population will deal with back pain in their lifetimes.  Furthermore, “On any given day, almost 2% of the entire US work force is disabled by back pain. In people under 40 years of age, back pain is the most common reason for the inability to perform daily tasks. It also is the direct cause of enormous healthcare expenses, with estimates as high as $60 billion annually.” 

While that’s certainly staggering,  a November 2017 warning published on Whitehouse.gov (The Underestimated Cost of the Opioid Crisis) revealed stats from 2015 showing the cost for opioid addiction at over 500 billion dollars annually.  That means that the total cost of back pain is a bit over 10% of the total cost of the opioid epidemic.

What’s interesting but certainly not surprising is that in our present age of EVIDENCE-BASED MEDICINE, the manner in which most people are being treated by their doctors for back pain is anything but evidence-based — particularly when it comes to the opioid crisis. 

A year ago this week, Lancet published a study titled Prevention and Treatment of Low back Pain: Evidence, Challenges, and Promising Directions in which they concluded, “Non-evidence-based practice is apparent across all income settings; common problems are presentations to emergency departments and liberal use of imaging, opioids, spinal injections, and surgery.”  I call it “THE BIG FIVE” plus SPINAL SURGERY

And while no one would argue that these are not needed in certain cases, the current system is indefensible.  Unless, of course, you are the payer.

I well remember our 2005 RUN-IN WITH A DRUNK.  My wife broke her arm, and among other things was prescribed a bottle of 100 hydrocodones.  Although she only took one or two of them, the price of the prescription was what most amazed me.  Without using any sort of insurance to pay for them, my out-of-pocket cost was about 15 bucks. 

I asked MY BROTHER what the street value of 100 hydros was, and he said they would go for about that much a pill on the open market.  Cheap on the front end, costly on the back.  Dave Chase summed up this up in yesterday’s article for STAT in their ‘First Opinion’ column……

“To this day, health plans pay for non-evidence-based interventions like opioids and make it difficult and expensive for patients to access evidence-based interventions such as physical therapy. That doesn’t make sense until you look at the reason: For the carriers that administer health insurance plans, there is far more profit in pills than physical therapy. (This also explains why the three largest pharmacy benefits managers have recently merged with insurance carriers.) Our entire health care system is built on a vast web of incentives that push patients down the wrong paths.

And in most cases it’s the entities that manage the money — insurance carriers — that benefit from doing so. They negotiate prices with health systems and pharmaceutical companies, all of which share the objective of increasing revenues, to craft and sell health plans that offer trumped up ‘discounts.’ As long as carriers negotiate a high price with a provider or a rebate scheme with a drug maker, they can still make a sizable profit even after a 50 percent discount.”

There you have it folks.  And it’s not like any of this is new information.   I’ve shown you how our government was busy creating the opioid crisis over three decades ago (HERE).   Which all begs the question of alternatives —- what are alternatives to back and NECK PAIN’S status quo; especially in light of what we now know about diagnostic imaging (X-RAYS, CT SCANS, and MRI)?  My biggest piece of advice would be to grab hold of the fact that low back pain, whether disc-related or not, is not simply a mechanical issue — it’s a chemical issue, meaning it’s another of the myriad of health problems driven by the immune system chemicals we collectively refer to as inflammation (HERE).  

While some of the Big Five class of drugs are geared at diminishing inflammation, it’s not happening at the source.  Instead, these drugs act as ‘mops,’ trying and clean up water that’s pouring out of the clogged sink, when the reality is, the faucet needs to be turned off and the drain unplugged (HERE). 

There’s not a day that goes by that I am not using my ONLINE HANDOUT to teach people how to start this process on their own.  Simply read these two articles (HERE and HERE) if your desire is to actually address the underlying causes of your pain instead of perpetually masking symptoms.  And while this isn’t going to completely solve situations like CENTRAL SENSITIZATION or failed back surgery syndrome, reducing systemic inflammation along with gentle specific function-restoring strategies, at the very least, will provide a shot at actually addressing your pain at it’s source.  

Otherwise, the downhill spiral continues, at a cost that’s becoming INCREASINGLY UNSUSTAINABLE WITH EVERY PASSING DAY —- no matter WHICH POLITICAL PARTY you believe has the best solutions to our national healthcare woes.  If you appreciate our site and feel it’s worthy of sharing, by all means share it.  A great way to reach the people you love and value most is still FACEBOOK.


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