Why do some people on opioid pain relief also seek CAM?
Tom Shillock, M2 Consulting
18 May 2007
The paper backgrounder states: “Complementary and alternative medicine (CAM) is an increasingly common therapy used to treat chronic pain syndromes. However; there is limited information on the utilization and efficacy of CAM therapy in primary care patients receiving long-term opioid therapy.” Yet the authors provide neither statistical evidence for the use of CAM to treat chronic pain nor for its efficacy in relieving pain in people on long-term opioid therapy.
One can easily imagine several reasons people would resort to CAM which has little to do with its pain relieving efficacy. The pressure the DEA puts on physicians and medical boards is readily communicated to patients. Simply acquiring and filling prescriptions is difficult. Moreover, pain contracts make people feel guilty for using opioids, they make them feel like criminals for seeking pain relief with opioids. Inadequate opioid therapy may have motivated an interest in CAM. The fact that 78.6% of CAM users were women suggests that acquiescence in the face of physician pressure to cut back on opioids may have motivated greater interest in CAMs. Perhaps people using CAMs receive a more caring relationship with their alternative therapist than from their PCP? Did people seek CAM because of adverse effects of opioid therapy, the most prevalent of which, constipation, the authors do not mention in their list of adverse effects while including ones that seldom happen but are more the concern of the DEA. These are in addition to a desire for more personal control and philosophical congruence (Astin JA: Why patients use alternative medicine: Results of a national study. JAMA 1998, 279:1548-1553).
Why do some people on opioid pain relief also seek CAM?
18 May 2007
The paper backgrounder states: “Complementary and alternative medicine (CAM) is an increasingly common therapy used to treat chronic pain syndromes. However; there is limited information on the utilization and efficacy of CAM therapy in primary care patients receiving long-term opioid therapy.” Yet the authors provide neither statistical evidence for the use of CAM to treat chronic pain nor for its efficacy in relieving pain in people on long-term opioid therapy.
One can easily imagine several reasons people would resort to CAM which has little to do with its pain relieving efficacy. The pressure the DEA puts on physicians and medical boards is readily communicated to patients. Simply acquiring and filling prescriptions is difficult. Moreover, pain contracts make people feel guilty for using opioids, they make them feel like criminals for seeking pain relief with opioids. Inadequate opioid therapy may have motivated an interest in CAM. The fact that 78.6% of CAM users were women suggests that acquiescence in the face of physician pressure to cut back on opioids may have motivated greater interest in CAMs. Perhaps people using CAMs receive a more caring relationship with their alternative therapist than from their PCP? Did people seek CAM because of adverse effects of opioid therapy, the most prevalent of which, constipation, the authors do not mention in their list of adverse effects while including ones that seldom happen but are more the concern of the DEA. These are in addition to a desire for more personal control and philosophical congruence (Astin JA: Why patients use alternative medicine: Results of a national study. JAMA 1998, 279:1548-1553).
Competing interests
none