The National Health Interview report estimated that 126.1 million American adults (55.7%) experienced some level of pain within a 3-month period.1 Pain in general and severe pain in particular are more common in veterans than in nonveterans.2 According to the Institute of Medicine, more than 100 million American adults experience chronic pain. The prevalence of chronic pain conditions, depending on the size of the survey, is estimated between 11% and 47% in the general adult US population.1,2 These statistics are likely higher since it does not include children, nursing home residents, or those in active military.

CRISIS IN PAIN MANAGEMENT

In addition to the increased rate of morbidity and disability due to pain, the economic cost for treatment and lost productivity in America is estimated at $635 billion on an annual basis.2 This expenditure exceeds the annual combined cost for cancer, heart disease, and diabetes, the leading health conditions.3 The most common pain conditions in the United States and the leading cause of disability include low back and neck pain, headache, and osteoarthritis. The National Academy of Sciences report indicates that the incidence of chronic pain is expected to rise as the rate of chronic diseases increases.4 This is exemplified by the sharp increase in neuropathic pain that affects more than 6 million Americans and is expected to rise significantly due to the increasing prevalence of diabetes. Likewise, obesity has increased dramatically, affecting more than 48% of American adults, and is associated with risk of diabetes, neuropathy, and orthopedic problems.2

PAIN CRISIS, DRUG CRISIS

In 2020, North America experienced the greatest mortality rate of the opioid epidemic to date, with more than 100 000 drug overdoses recorded in the United States, of which 76 000 were attributed to opioids, an increase of approximately 30% compared with that incurred in 2019. Extenuating circumstances of the COVID-19 pandemic brought fear, pain, suffering and death, financial devastation, self-isolation, and quarantine that negatively impacted normal life activities, resulting in an increase in loneliness, anxiety, depression, and insomnia that precipitated excess alcohol consumption, drug abuse, and overdose deaths, exacerbating the already existing opioid crisis.

Although prescriptions for opioid medications have been decreasing, there has been a dramatic increase in the supply and availability of illicit synthetic opioids and fentanyl drugs in the United States. According to a recent report generated by the federal Commission on Combating Synthetic Opioid Trafficking, from June 2020 to May 2021, fentanyl and synthetic opioids accounted for two-thirds of the more than 100 000 deaths in the United States from overdoses.5 These fatalities were largely among Americans between the ages of 18 to 45 years. This detailed report provided evidence that the primary cause of the US opioid epidemic is fentanyl, a synthetic opioid, which is 50 times more potent than heroin.

Fentanyl is an illicit drug that is often laced in heroin; it is also manufactured into counterfeit tablets, including brand name drugs, in "minute" quantities. According to the report, 70% to 80% of fentanyl that was seized by federal authorities, between 2014 and 2019, had its origins in China that was trafficked principally by land across the US southern border with Mexico. The commission recommended improving oversight and federal law enforcement, noting "without intervention, the US will continue to experience a rise in the number of overdoses as markets for illicit drugs evolve, respond, and produce an even wider variety of synthetic opioids."5

There is an obvious fentanyl and synthetic opioid crisis in the United States, and it continues to grow unabated, with no apparent end in sight. Furthermore, the COVID-19 pandemic has created a wake of deleterious consequences that has driven increases in substance use, creating greater demand for both prescription opioids and illicit drugs.

PAIN SOLUTIONS: A NONPHARMACOLOGIC APPROACH

Marked by inadequate pain treatment, continued reliance on opioid drugs, an increased availability of illicit synthetic opioids, and an epidemic of addiction and overdose deaths that has permeated the American society, there is a rallying call for a shift toward comprehensive pain management that includes evidenced-based nonpharmacologic options.

In Integrative Pain Solutions, Parts 2 and 3, a detailed account of evidence-based, nonpharmacologic therapies effective for acute and chronic pain will be presented. These therapies include nutrition therapy, acupuncture, exercise, spinal manipulation, therapeutic massage, mindfulness meditation, movement therapy, electromedical therapeutics, and photobiomodulation.

REFERENCES