(Reuters
Health) - Veterans of the Iraq and Afghanistan wars who are treated for pain
are more likely to get very strong painkillers if they also have mental health
problems, including post-traumatic stress disorder, according to a new study.
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"There's
really been a culture of, 'Let's get rid of pain,' and I think unfortunately
that pendulum may have swung too far," said Dr. Karen Seal, from the
University of California, San Francisco and the San Francisco Veterans Affairs
Medical Center, the study's lead author.
"What
we need to do now is really individually assess patients and talk to patients
about what we know of the risks of opiates, especially in those with mental
health problems," she told Reuters Health.
Prescriptions
for the powerful painkillers have been on the rise not just among veterans, but
in civilians as well, with more deaths and hospitalizations attributed to the
drugs as a result.
According
to the Centers for Disease Control and Prevention, the number of Americans who
die of a prescription drug overdose has tripled in the past 20 years, with
14,800 people killed by an overdose in 2008 -- more than from heroin and
cocaine combined.
Seal said
that instead of taking opioids, some patients with pain and mental health
problems may do just as well, or even better, with talk therapy, physical
therapy and anti-inflammatory medications such as ibuprofen.
She and her
colleagues analyzed data from about 141,000 war veterans who were treated for
pain at a VA medical center between 2005 and 2010, some of whom also had been
diagnosed with a mental health disorder. Out of all patients, close to 16,000
were prescribed at least a three-week course of opioids.
The
researchers found that while less than seven percent of veterans without any
mental health problems were prescribed the powerful painkillers, close to 12
percent with a diagnosis such as depression or anxiety were given opioids, and
almost 18 percent with PTSD got a prescription.
More than
one-third of veterans with both PTSD and a drug use disorder who had pain were
prescribed opioids.
Veterans
with PTSD were also more likely than others to be prescribed multiple opioid
drugs at a time, to get higher doses of the drugs and to receive early refills,
Seal and her colleagues reported Tuesday in the Journal of the American Medical
Association.
And those
treated with opioids were more than twice as likely as veterans not prescribed
the painkillers to suffer an injury, overdose on drugs or alcohol or
intentionally hurt themselves.
Seal said
she thinks too many veterans are being prescribed opioids, instead of going to
talk therapy and getting other types of pain treatment, for example.
"One
of the things that we're trying to do is, if it appears that there may be a
risk for unsafe use of opioids, to really bring that up honestly with the
patients, and suggest that there may be other alternatives," she said.
"It's important to be open to alternative ways of treating pain."
The study
"further draws attention to the challenges of meeting the pain care needs
of veterans with chronic pain and mental health conditions, particularly
post-traumatic stress disorder," said Robert Kerns, the National Program
Director for Pain Management at the Veterans Health Administration and a
psychologist at Yale University in New Haven.
Kerns, who
was not involved in the new study, agreed that it's important to develop other
approaches for managing pain.
"At
the same time I think it's still widely accepted that opioids may have a role
in the management of chronic non-cancer pain, even in persons with mental
health conditions," he told Reuters Health. But, "they need to be
used responsibly and safely."
Seal said
that veterans and their families should be open to the idea of talk therapy and
other help for mental health problems.
"It's
okay to accept mental health help," she said, "and that might
actually help both their pain and their PTSD or other mental health
problems."
SOURCE:
bit.ly/hwxtTL Journal of the American Medical Association, online March 6,
2012.
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