The shift from opioids to antiinflammatory drugs for pain has much to do with patient expectations, the medical community’s rush to prescribe and the drug industry’s push to fix problems with a pill, according to experts.

Dr. Robert Goldberg, chief medical officer and senior vice president of Healthesystems L.L.C., a Tampa, Florida-based national workers compensation pharmacy and ancillary benefits management provider, calls the pick between opioids and non-steroidal antiinflammatory drugs a “false choice.”

“Right now, the conversation has been dominated by pharma,” he said. “Pill for every ill – we have been hearing that for 30 years.”

Another issue is that most patients seeing a doctor expect a prescription, said Nikki Wilson, Omaha, Nebraskabased pharmacy product director for Coventry Workers Comp Services.

“The psychology of why we prescribe is patients’ expectation and demand,” she said. “The mentality has been give them a prescription and get them out the door.”

The U.S. Food and Drug Administration found in a 2004 study that 42% of those seeking a doctor’s care expect a prescription; 63% of those individuals are seeking a refill.

Workers compensation is trying to change that, said Dr. Brigette Nelson, Scottsdale, Arizona-based senior vice president of workers compensation clinical management at Express Scripts Holding Co. “All of the treatment guidelines for managing pain are emphasizing nonpharmacological therapies,” she said.

“Pain control should always start with nonpharmacological forms of treatment,” said Dr. Goldberg, who puts self-care, ice, heat, exercise and other alternative, physical therapies at the top of the list.

“The onus is on the patients — they have to participate in their own care,” said Sylvia Sacalis, Tampa-based pharmacist and vice president of clinical services for Healthesystems. “They need to take part in some of these modalities. A pill is easier, but there are other modalities they have to be willing to try. It’s a mind shift — they have to get their mind there.”