Alan Kaye, MD, PhD: Alternate Therapies for Rheumatologic Pain

Alternate therapies can be as effective, if not more effective, than traditional opioids for the treatment of pain related to rheumatic diseases.

Opiates suppress the body’s own production of opiate, known as endogenous opiate production, so the patient is only breaking even. The patient’s body is making opiates and taking a painkiller suppresses the body’s own natural opiates—endorphins, dynorphins, and natural substances made around the clock just shut down—and the patient becomes dependent on what they are being prescribed.

“A lot of doctors think they’re great doctors because they have a whole clinic of patients waiting to see them,” Alan Kaye, MD, PhD, said in a recent interview with HCPLive®. “It’s because the prescriptions are only for 4 weeks, and if you don’t keep taking the opiate, you’re going to get central nervous system hyperarousal and withdrawal.”

There is a better understanding in 2020 of therapies that are very exciting and can be very helpful, Kaye said. In fact, along with spinal cord stimulation, peripheral nerve stimulation has risen in its use over the last several years. Such treatment can be used for chronic knee pain, shoulder pain, or a specific area involving a specific nerve, the patient can now block it.

“The data are very impressive with it,” Kaye said. “This is a perfect fit for the practicing rheumatologist who may have felt limited in only being able to give opiate for patients’ pain.”