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Less Drugs, More Pain Management


That’s the number of people who die every year from unintentional overdose of opioids, commonly known as painkillers— it’s higher than the number of overdose deaths from cocaine and heroin use combined and higher than the number of automobile deaths. That shocking fact was shared with me as I toured the Minneapolis VA Medical Center to learn more about pain management, and how our staff in Minneapolis is revolutionizing team-oriented care.

Our nation didn’t arrive at an opioid crisis overnight, so it’s important to understand how we got here. Professional associations in the 1990s besieged medical journals and health care providers with the idea of untreated pain as a medical crisis. Those charts you’ve probably seen at the doctor’s office—faces with pain numbers—went up across the country, and pharmaceutical companies pressed doctors to fill more opioid prescriptions.


From 1999 to 2010, prescriptions for opioids increased by 400 percent, according to the Center for Disease Control. As a result, overdose deaths also rose 400 percent. Patients sought opioids and gravitated to doctors willing to prescribe them despite side effects like sedation and decreased testosterone. Widespread addiction and an alarming rise of overdose deaths prompted the medical community to rethink its approach to opioids, such as OxyContin, as a silver bullet to pain management.

The pain management staff at the Minneapolis VA Medical Center, led by Dr. Peter Marshall, transformed mounting medical research into action. In 2011, the team established the Opioid Safety Initiative to bring down the use of OxyContin and high dose opioids among chronic pain sufferers—usually Veterans with issues like chronic back and neck pain and arthritis. Other formulary medications, along with a greater emphasis on behavioral chronic pain management like yoga and exercise, were deployed to help Vets deal with their ailments.

The results are drastic. As of May 2013, OxyContin use at the Minneapolis VA Medical Center has plummeted 94 percent, and high dose opioid use has fallen 55 percent since the implementation of the Opioid Safety Initiative. More behavioral pain management and generic medications have also been utilized.

The model of care itself has been transformed as well. Dr. Marshall’s staff took cues from team-centered treatments of issues such as diabetes and applied it to pain management in a system called stepped care management. A full spectrum of care brings medical professionals together to holistically target and treat chronic pain affected Veterans. It’s a model that shows promising signs for not only VA’s medical system, but the private health care system at large.

There are so many advances in medicine throughout VA’s 152 medical centers that it’d be impossible to track them all. This is just another example of great minds coming together to help solve pressing issues affecting not only Veterans, but society in general, getting them back to living their lives as easily—and as painless—as possible.

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