After researching the relationship between pain and opioids for 12 years, Dr. David Thomas joined the National Institute of Drug Abuse (NIDA) in 1995 to oversee the organization’s pain and opioid research efforts. Today, Dr. Thomas serves as the chair of the NIDA Prescription Opioids and Pain work group, which focuses primarily on pain and opioid research, along with education.
The American Massage Therapy Association's Massage Therapy Journal asked Dr. Thomas a few questions about the current opioid crisis in America, as well as the role integrative therapies such as massage therapy can play in helping health care professionals treat pain without having to resort to using prescription opioid medication.
That we're in the midst of an opioid epidemic is clear to many people, but can you give us an idea of the scope of this crisis?
The scope is huge. It’s the largest epidemic in our country in 100 years and is rivaling the AIDS epidemic in both scope and impact. The number of people dying from opioid overdose in the United States exceeded 33,000 in 2015 and predictions for 2016 and beyond look dramatically worse.
What are some of the key strategies now in place to help fight the opioid epidemic?
The National Institutes of Health is taking an all hands on deck approach to helping to reduce this crisis. We are taking significant steps to develop new and better ways to treat opioid use disorder and working on developing better ways to reverse opioid overdoses. We are also studying how opioid addiction starts and developing strategies to prevent opioid use disorders. And importantly, we are launching major efforts to develop better ways to treat pain. These efforts include accelerating the development on non-addictive pain treatments, and the promotion of using multimodal approaches to the treatment of pain rather than relying on the “quick fix” of opioid prescribing.
In terms of pain management, what are some of the top alternatives to opioids?
That depends on whether the pain is acute or chronic, as well as severity, location of pain, a patient’s race, allergies, other medical conditions, genetics ... a whole host of variables. Pain is typically a very complex condition that impacts the individual on many levels, including the physical, psychological, social and spiritual levels. And pain often impacts function and quality of life, too. The best likely treatments for pain will include an integrative health approach, where any given individual in pain will get the best results from an array of pain treatments that may include pharmacological, behavioral, surgical, psychological and other approaches.
Recent research shows a variety of conditions for which massage therapy can be an effective pain treatment alternative. What role can massage therapy play in helping health care providers give patients alternatives to opioids for pain management?
Massage definitely can have a role in the treatment of pain. We know that massage can activate “touch fibers” that in turn can inhibit pain signaling of nerves in the skin and muscle. Plus, massage promotes blood flow and can reduce inflammation. And while all the ways massage may work to reduce pain and promote healing are not understood, it is clear that massage can be part of a more integrated treatment of various types of pain, especially pain originating in muscles.