High costs curb doctors’ ability to find opioid alternatives

High costs curb doctors’ ability to find opioid alternatives – June 2016 

Ken Manning’s head is held up by two metal rods, four plates, and 17 screws in his neck. Since falling off a frame at a carpentry job in the early 2000s, he has had four surgeries.

The pain is still so bad that he sometimes “sees stars” or passes out. To cope with it, he has been prescribed opioid pain medication for more than a decade.

for someone with his level of pain, there are few other options.  

Doctors are left in a predicament:

How do you shepherd someone like Ken Manning through a devastatingly painful injury, days of local pain after surgery, and then years of chronic pain without him becoming addicted to opioids and all while seeing him in the 15-minute intervals that most doctors are allowed with patients?

Some doctors are looking for alternatives to replace opioids, but there seem to be few viable options for acute pain, and chronic pain patients must often overcome significant financial barriers to access other treatments.

Acute pain — the severe but temporary kind you might feel if you broke a bone — can often be treated by over-the-counter drugs like Tylenol or Advil. But such drugs come with limits: take too large a dose over a period of time and you can end up with long-term problems like liver or kidney damage.

“The thing that makes opiates attractive is that they are infinitely titratable, meaning you can keep giving patients opiates until the pain is gone, within certain safety parameters,” MacDonald said.

Dr. Scott Sigman, the hospital’s chief of orthopedics, was an early adopter of Exparel, a non-narcotic anesthetic that can be injected during surgery and keep the affected area pain-free for two to three days. He also uses Ofirmev, an intravenous form of acetaminophen.

Exparel costs around $300 a dose while Ofirmev runs about $35 per dose, and most patients require four or more doses. Meanwhile, the average Vicodin prescription in the U.S. cost $5 in 2015, according to IMS Health data.

Since adopting Exparel, Lowell General Hospital has saved an average of $1,638 per knee-replacement patient, due in large part to shorter lengths of stay, a study of the hospital’s data found.

But for patients, especially those with chronic pain, innovative treatments are often either not covered by insurance companies or remain far more expensive than opioids.

Ken Manning has tried alternatives to opioids, from steroid injections that left lasted for months but left him anxious and nauseous, to a therapy called transcutaneous electrical nerve stimulation, or TENS.

His TENS machine required him to attach electrodes to his body and it worked, until he started sweating and the pads fell off. Now, he is working with a doctor at Boston Medical Center in the hopes of receiving TENS implants.

The hard truth for chronic pain patients is that there is usually no such thing as a cure, said Cindy Steinberg, national director of policy and advocacy for the U.S. Pain Foundation.

“To a person, the hundreds of people who have come to my groups over the years have had to see four or more physicians before they’ve been able to get help,” she said. It is often because insurance companies compensate doctors for 15-minute appointments, which is not enough time to build a comprehensive pain-management plan


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