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The Ongoing and Ever Difficult Dilemma of Interventional Pain Treatment, Opioids and Health Insurance Companies

In the United States alone, there are millions of individuals experiencing chronic pain.

Those suffering from chronic pain endure more of a burden due to coverage determination policy-making on behalf of major insurance companies.

In recent years, there has been an industry-wide shift by health insurance companies to consider alternative treatments for chronic pain (also known as interventional pain treatments) as unconventional or even ineffectual, even though such alternative treatments previously established high rates of success.

As a result, health insurance companies are limiting the coverage or refusing coverage completely for alternative treatments leaving patients suffering from chronic pain no other option but to treat with opioid pain medications.

Below are some examples of alternative treatments and opioids:

Alternative Treatments                                            Opioids

Steroid injections                                                     Oxycodone

Joint injections                                                         Hydrocodone

Fluid injections                                                         Fentanyl

Physical therapy                                                      Morphine

Nerve blocks                                                

Radio-frequency ablation     

As many physicians have recently noted, opioid pain medications invariably lead to long-term addiction and other equally serious health issues.

According to a report focusing on the global and national increase in abuse of opioid medications given by Nora D. Volkow, M.D. before a May 14, 2014 meeting of the Senate Caucus on International Narcotics Control, “Several factors are likely to have contributed to the severity of the current prescription drug abuse problem.  They include drastic increases in the number of prescriptions written and dispensed….”

As this trend continues, healthcare providers are met with a “take it or leave it” decision when dealing with patients who require long-term pain treatment, one which increasingly involves relying on the prescription of opioids solely.

Another trend running parallel is that of patients resorting to payment for non-medication based treatments with their own money, which is an option that many people simply will not be able to afford for an extended period of time. This particular trend essentially renders health insurance useless to enrollees, which is frustrating for all parties involved.

The profit margin for insurance companies is what governs these decisions. It is comparatively less expensive to keep patients on opioids, despite the very real possibility of someone experiencing the aforementioned potential health crises.

Until insurers are willing to acknowledge the risks associated with opioids, and the documented efficacy of interventional pain treatments, both patients and physicians are faced with a difficult dilemma.


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