The nation's opioid epidemic continues to make grim headlines as it devastates communities in Illinois and around the country. In Illinois, more people die each year of an opioid overdose, whether heroin or prescription painkillers, than of gun-related causes or car crashes, according to the Illinois Department of Public Health.
But there's reason for hope, courtesy of Chicago: a concentration of doctors and researchers who are the vanguard of a national push to treat pain without narcotics. Alternatives can't come quickly enough, as drug overdoses in the state increased 7.6 percent from 2014 to 2015—making Illinois one of 19 states with a "statistically significant" uptick in overdose deaths, according to the Centers for Disease Control & Prevention.
"There's no doubt that alternative forms of pain management are essential to reducing opioid abuse," says Juliet Sorensen, a professor of law at Northwestern University who organized a recent symposium in Chicago on the epidemic. "But they take more time, more effort and more resources than popping a pill, which is how we got ourselves into this problem in the first place."
Concern about opioids has created a push for both the advancement of safer clinical alternatives and a better understanding of pain in general. As a result, Timothy Lubenow, an anesthesiologist and pain medicine specialist at Rush University Medical Center, tells his young medical fellows that there's never been a better time to work in the field. His Rush Pain Center has been a national leader in studying opioid alternatives including spinal cord stimulation.
For three decades Lubenow has specialized in the procedure, in which a device similar to a pacemaker is implanted under the skin. It uses mild bursts of electrical current to disrupt the pain signals that originate in the spine's nerve fibers, preventing them from reaching the brain. The replaceable devices, which last up to eight years, are a long-term treatment for chronic pain that can prevent people from remaining on prescription painkillers indefinitely. Lubenow says that while spinal cord stimulation has been FDA-approved since 1967, improvements in the devices over the past 18 months mean the electricity is better targeted and can be varied in intensity, which helps patients who have built up a tolerance.
"Stimulation is gaining greater traction because there have been a number of randomized controlled studies that show it reduces pain more than surgery," he says—especially in patients with chronic back pain. "It's an effective way to get by with a lower dose of opiates or no opiates at all."
There's a catch. Lubenow says it's a huge hassle to get insurers to approve the stimulators, which cost about $105,000. A month of opioids, by contrast, runs about $80.
One of his patients recently saw a 50 percent improvement in her nerve pain during a trial of a new stimulator. Despite the results, her insurance refused to pay for the device after the trial ended. Lubenow had to send a letter to the Illinois Department of Insurance, asking them to investigate, before the insurance money came through.
"Opioids are more economical in the short term but are an incredibly expensive drain on our economy in the long term," says Sorensen, the Northwestern professor. "That's why it's critical we move away from this short-term perspective."