Endometriosis and the Opioid Epidemic
On Monday I had the wonderful opportunity to have lunch with Kim Lopdrup, former CEO of Red Lobster. The connection between a casual seafood restaurant and endometriosis isn’t obvious, but one of Kim’s passions is dismantling the stigma associated with opioid addictions and has done wonderful work within our community.
The cumulative effect of the pain associated with endometriosis is a substantial burden on sufferers; 70% of patients live with unresolved pain, with impacts to all aspects of their quality of life. So are patients with endometriosis pain susceptible to the opioid epidemic?
How pain works:
Women with endometriosis live with chronic pain. The persistence of this pain, and the presence of peripheral sensitization, lowers the body’s natural threshold for nociceptor activation. In other words, over time, things that are not normally “painful” can produce incredibly painful signals in sensitized patients.
If you think that endometriosis is making you more sensitive to pain, you might be right. Women with CPP (chronic pelvic pain) show lower pain tolerances than controls. This pain can interfere with daily activities, like sleep, relationships, and work.
Endometriosis and Opioid abuse:
Women with endometriosis may resort to opioids to manage their pain, despite the fact that opioids are not recommended for treating endo pain or any other chronic non-malignant pain condition. Long-term opioid use can be associated with significant harm.
A study by Dr. Georgine Lamvu compared opioid usage patterns among women with endometriosis and those without
Women with endometriosis were:
3 times more likely to fill an opioid prescription
4 times more likely to fill a prescription with at least 50 morphine mg equivalents
3.5 times more likely to fill a prescription with at least 100 morphine mg equivalents
The over prescription and accessibility of opioids among endo patients is astonishing. Although Lamvu reported that three out of four women will fill an opioid prescription prior to endo-related surgery, non-preoperative data sets, as provided by Dr. Sawsan As-Sani, are just as concerning.
Two out of three women fill an opioid prescription within one year of being diagnosed with endometriosis
After excluding prescriptions in the perioperative period, one in two of women with endometriosis filled at least one opioid prescription
Both of these studies focus only on prescribed opioids; the reality of illicit and abused prescriptions remains a reality for many women.
What needs to be done:
There is a perfect storm of factors that need to change- and that includes the methods by which we detect and determine endometriosis. In 2017, ACOG reported that over half of general practitioners feel uncomfortable diagnosing and treating patients with endometriosis, and many are unfamiliar with the three main symptoms of the disease. Because doctors don’t know how to deal with endometriosis, it becomes an easy way out to prescribe painkillers- including opioids- and reassess when a patient returns for a follow up. But this can lead to patients innocently getting trapped into opioid dependency. When as many as 19 percent of those who are prescribed long-term opiates abuse the drug or become addicted, it's no surprise that many chronic pain patients are wrapped up in the opioid crisis.
FlowIntell’s Mission:
Chronic pain management for endometriosis, like chronic pain management for any other disease, requires more research, more vigilance on the part of the medical community. We need to support all the research we can to find the most effective and valuable treatments for endometriosis and chronic pain. This includes early detection and screening of endometriosis. Because so many doctors are uncomfortable with diagnosing, our non-invasive screening tool would benefit the doctor-patient relationship. With FlowIntell’s definitive results regarding endometriosis biomarkers, patients and doctors could have educated conversations about endometriosis treatment, management, and care.
