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shawsome12 t1_j1m54k1 wrote

Why can’t we find better pain management than opioids?

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carlitospig t1_j1m7ovx wrote

Usually because the folks who are doing pain management research aren’t actually pain management sufferers. I work adjacently to healthcare in which I review educational protocols for health higher ed. I was shocked to learn that a ‘new’ pain management teaching module did absolutely everything but discuss opiates. Which, fine - for the times it makes a sad kind of sense. But, there was literally nothing new in their protocols. And it didn’t even address part of the issues which is that some of the more holistic approaches (yoga, those fancy sea salt soak pods, acupuncture) are terribly expensive and many aren’t covered by insurance. So they build up protocols that nobody but the rich can use, and wonder why the poor are relying on opiates to be able to make it through a work day.

TLDR: we are avoiding the money problem in healthcare.

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ohhelloperson t1_j1meozs wrote

Massages and acupuncture are the only real alternatives that have helped with my pain (lupus related). But neither are covered by insurance while prescriptions are. It’s super frustrating to have to regularly explain to my various doctors that I can’t afford to pay for monthly massages and acupunctures on a nannying-salary. Like obviously I would love to get those treatments as often as necessary. But I’d also like to pay my rent and eat too.

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Baud_Olofsson t1_j1me8p3 wrote

> And it didn’t even address part of the issues which is that some of the more holistic approaches (yoga, those fancy sea salt soak pods, acupuncture) are terribly expensive and many aren’t covered by insurance.

... because they're placebos.

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SleekExorcist t1_j1n90iy wrote

Ehhh acupuncture has some clinical support. So does physical therapy, which can and does include massage. But seriously no one wants to cover appropriate PT.

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Baud_Olofsson t1_j1nj40v wrote

Acupuncture is pure placebo.
One of my favorite studies compared actual acupuncture (needles inserted at extremely specific woo-woo energy sites) to a sham treatment of poking the subjects at random with toothpicks. The real acupuncture and the toothpicks were equally as effective at relieving pain.
(And note that unlike poking people with toothpicks, inserting actual needles carries actual risks (mostly infection))

Pain is very, very subjective. It can be greatly relieved by things like simple distraction and personal attention (hell, even swearing has an analgesic effect). Acupuncture provides both personal attention and distraction. So it "works", but it doesn't work better than sham treatment. Meaning it only works as well as a placebo. Meaning it is a placebo.

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neuro__atypical t1_j1ne3oa wrote

There are novel and highly effective ways to treat pain being developed, like capsaicin injections, but development is moving at a snails' pace. Not enough money being put into it, probably.

There are also less novel treatments for pain like ketamine/esketamine, the latter being a nasal spray. But this isn't allowed to be used (regulatory red tape) even though it's safer than opioids. They won't let you take esketamine nasal spray home, it has to be administered at a clinic, and prescribing for pain is considered off-label use.

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argv_minus_one t1_j1ozjv9 wrote

Why is there so little money going into it? Chronic pain isn't exactly an uncommon problem; that's why Purdue made so much money selling a drug for it.

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