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Opioids, Opiates and Other Options

Bottle of opioids.

August 03, 2022

When the Sumerians of southwest Asia wrote about the "joy plant" in 3400 B.C., they weren't just happy to gaze upon the striking red flowers. This is the earliest known reference to the opium poppy, and the Sumerians discovered that the milky fluid dripping from the plant's broken seed pods had narcotic effects when dried and consumed.

Opium and its naturally derived pharmaceutical cousins, morphine and codeine, are collectively known as "opiates." As scientists discovered how to produce synthetic opiates, which include the drugs hydrocodone, oxycodone and fentanyl, the class of drugs known as opioids developed.

Opioids vs. opiates

"Opioids work on the same pain receptors as opiates," says Dawood Sayed, MD, who specializes in pain management at The University of Kansas Health System. Meanwhile, he adds, "narcotics" typically refer to illegal substances.

"When a physician prescribes an opioid, it's not referred to as a narcotic," he notes. "Methamphetamine is a narcotic; synthetic fentanyl sold on the streets is a narcotic; but a drug prescribed by a doctor for pain control is not a narcotic."

Dr. Sayed and his colleagues only prescribe opiates under strict conditions, including pain related to cancer, an acute injury or surgical recovery.

"We do not use opiates unnecessarily," he said. "But many people suffer from poorly treated pain and many are being weaned off opioids and need to have their pain properly managed. Their first step should be to see a board-certified pain management specialist. We maximize pain management strategies, usually without using opioids or opiates."

People who have chronic pain have options other than opioids. A pain management specialist can offer new treatments that can improve your quality of life without drug dependence. – Dawood Sayed, MD

Pain management

Targeted drug delivery

For example, a patient with chronic back pain may benefit from targeted drug delivery. Physicians implant a medication pump in the abdomen or back. The pump infuses medication through a very thin tube directly into the patient's spinal fluid. This medication may or may not include an opioid, depending on the individual's specific condition. However, if physicians deploy an opioid through this method, it binds directly to the pain receptors at the site instead of being delivered through the bloodstream.

"These targeted systems allow us to choose the best drug for the pain without the side effects and dependence that occur when someone takes the drug orally or by injection," Dr. Sayed said. "And by hitting the pain receptors directly, we need only a tiny fraction of the amount we would need to give by mouth to see the same level of pain relief. There's no risk of abuse when the physician is measuring these very specific doses."

Targeted drug delivery is an option for an increasing number of patients, including those who have cancer-related pain, have failed to experience relief with other treatments, and want or need a nonsurgical option.

Options in pain relief

Another treatment available to manage chronic low back pain is the Intracept® procedure. The University of Kansas Health System was among the first hospitals in the world to offer this treatment, which was commercially launched in April 2018. "The chief indication for this procedure is degenerative disc disease or pain that emanates from the lumbar discs between the vertebrae. This is a very common source of pain and has historically been one of the most challenging types to treat," Dr. Sayed says.

Intracept targets a nerve within the vertebrae that creates sensation in the discs. Under X-ray guidance, the physician accesses the nerve and cauterizes it. With the nerve destroyed, the pain is eradicated without the use of drugs.

"People who have chronic pain have options other than opioids," Dr. Sayed says. "Technologies in interventional pain management are quickly developing. A pain management specialist can offer new treatments that can improve your quality of life without drug dependence.

Jessica: 32 million Americans are living with back pain right now. That's according to the Chronic Back Pain Organization. And one of those people was NBC host Carson Daly, who recently underwent a procedure. Joining us now to talk about that is Dr. Dawood Sayed, Division Chief Pain Medicine and Vice Chair of the board at the American Society of Pain and Neuroscience. A big title, so we're glad you're with us today to talk all about this. Dr. Sayed, you've been performing this procedure here at the health system for the last 2 years. Tell us, what is it called? What does it entail?

Dr. Dawood Sayed: Yeah, thanks for having me on, Jessica. What Carson Daly had was a procedure called the Intracept procedure. Technically, it's called basivertebral nerve ablation. That's a lot of words to say, but it comes from about 30 years of research. For a long time people have been (diagnosed with) degenerative disc disease. And a lot of the treatments, procedures and surgeries for targeting the degenerative disc have had failure rates as high as 50%. This is a new and innovative way of targeting these types of patients with chronic low back pain from that where we target, actually, not the disc itself but actually the interface between the disc and the vertebrae.

It's a disease entity called vertebrogenic pain and a lot of people are suffering from this. Really, we find it on MRI. We can find these degenerative changes in the vertebrae on any type of MRI, even on a CT scan. And if patients have back pain that they've had for more than 6 months that has failed conservative measures, they could be potentially a candidate for this new procedure.

Jessica: This is when celebrity news can be helpful because when somebody like Carson Daly has some type of ailment or then gets some type of procedure it becomes a headline and then people get to learn more about it and find out they're not the only ones. You actually know the doctor who did Carson's procedure. How do you know that guy?

Dr. Dawood Sayed: Actually, it's a her ...

Jessica: A her.

Dr. Dawood Sayed: It's Dr. Karen Patel. Yeah, she's a fantastic physician. We trained together back in New York City over 10 years ago, and we've done a lot of research together and worked together on a lot of these new and novel therapies. She's a wonderful physician. Really, one of the leading physicians not just only in New York City but around the country. And having a high profile patient like Carson Daly whose from ... What I saw from the story and talking to Dr. Patel, he's just been a really good advocate for patients suffering from chronic pain.

One thing with this procedure, as with a lot of new procedures, access and coverage through insurance can be a struggle, so Mr. Daly has been a really big advocate for his struggle. I think it took him almost 4 months to get his insurance to authorize this. He was eventually able to get it authorized and he's doing wonderful from the story that I saw. I think there are some challenges when we talk about these new therapies but having celebrities with a big mic that can get some of the word out really do help because a lot of people are just suffering unnecessarily. Think about something like chronic low back pain. Either we suffer from it ourselves, or we definitely know someone that does, and a lot of these new treatments are out there so there's answers for that.

Jessica: Couple quick questions. We know Carson was a good candidate. Who else would make a good candidate for this procedure? If somebody is at home and they're having pain, they've been living with pain, how do they know that maybe they might want to reach out and find out more information about this?

Dr. Dawood Sayed: Yeah. There's a couple of things that would potentially make you a candidate for this. One of them is you have to have back pain. We typically want patients that we think are good candidates for this. Most of their pain is localized to the low back. Not a lot of pain shooting down into their legs, things like sciatica radiculopathy. Is this really more for patients that have pain that's localized to that belt line in the lower part of the back.

The other thing is, typically patients should have had an MRI, and on that MRI what we like to see to see if candidates are candidates for this are degenerative changes in the spine. And specifically what we look for is something called modic changes, M O D I C. It's some sort of a word that people probably look on their MRI and they see and they have no idea what it means. But what it means is that there's been a long-standing degenerative process in someone's lumbar disc that's actually starting to affect the vertebrae. And that's why we target the nerve that goes right into that vertebrae. It's a new way of targeting the pain signals.

We've done things into the disc, into the joints. We fused the discs together. And again, as I mentioned previously, failure rates can be as high as 50%. With this therapy, you know, now we have almost 10 years of data for. We were involved in the clinical trial almost 5 or 6 years ago. And we see that patients at 5 years out, 85% of them would say if they had the chance to do the procedure again, they would. On top of that, the safety profile of it is very good. We have, in the published literature and with the experience with over the last 2 years, 0.3% complication rate. Any complication that does happen has been very limited and mild, so very safe procedure, as well.

Jessica: That's good to hear because I would imagine going down the road of trying to decide if you're going to have back surgery would be very concerning. So, that is good to hear. But I do have to find out, what is the recovery time for something like this, maybe compared to another type of procedure?

Dr. Dawood Sayed: Yeah. I think if people have had things like lumbar injections, it's very similar to that. It's a little bit more. It's not as involved as having back surgery. It's probably somewhere in the middle. It's an outpatient procedure typically done through a 1 inch or a half-inch incision. We access that vertebral level. The procedure takes about 30 minutes and patients go home the next day. Recovery is usually some soreness from the procedure, itself. There's really no limitations as far as activity. People are fully walking and ambulatory that night. Usually, people notice some sort of response or improvement of their symptoms at around 5 to 7 days, peak results usually around a month. And then usually what we've seen so far is the results are sustained.

A lot of these injection or ablation-type procedures we've done in the past, one of the big downfalls of them is you will do really well for a short period of time and then the pain comes back. We've followed these patients out to 5 years and, really, there hasn't been any change in the pain relief. We think this is most likely a permanent procedure.

Jessica: All right. Lastly, if folks are in pain, how do they find you? How do they find out more information?

Dr. Dawood Sayed: Yeah, I think there's a lot of good resources on the internet. I think if you go to our health system’s website and put in the word “spine” you can find myself and you can find our Spine Center physicians. There's myself performing the procedure and a couple others. I think there's a lot of resources out there. I think, also, for patients if you want to get on to just find some information generally about this procedure called basivertebral nerve ablation or the Intracept procedure, how it's branded, you can go to Relievant.com. R E L I E V A N T. Or you could just Google the Intracept procedure and you'll find it. It's pretty easy.

Jessica: Always great to have you on. Thank you so much.

For comprehensive pain management care, call 913-588-1227.

Choosing the right treatment requires a comprehensive evaluation. For some people, a combination of approaches might be recommended for longer-lasting pain relief. If you are enrolled in a managed care plan, your treatment at The University of Kansas Health System may be covered by insurance. Before scheduling an initial appointment, call your health plan/insurance company and ask if you have access to our services.

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