Managing Pain Without Opioids
At the 2019 National Council of Self Insurers Annual Meeting a panel discussed managing chronic pain without medications. The speakers were:
- Mark Pew – Preferred Medical
- Geralyn Datz, PhD. – Southern Behavioral Medicine Associates
- Becky Curtis – Take Courage Coaching
Pain is your body’s reaction to a stimuli. One way to alter that reaction is with the use of medications that can mask the pain. However, these medications have a wide range of bad side effects and your body eventually develops a tolerance making them less effective.
Mental health plays a tremendous role in pain and unfortunately this is often ignored. In many ways the “opioid” crisis was caused both by an over-abundance of drugs and a lack of mental health treatment.
The Neuroscience of Pain
What we believe to be true often becomes our reality. This is especially true with pain. If we expect something to hurt, it does. When we focus on the pain which increases our perception of the pain. The more people worry about the pain, the more it becomes intertwined in their every-day existence.
To adequately address pain, we need to focus on the role that psychology plays in pain management. Focusing on the psychology of pain won’t make the pain go away, nothing does. But patients can be taught coping skills that assist them in managing their pain so that they can increase their functionality.
Patients are not often told there are alternative to medications when it comes to pain control. Education about this is needed with both physicians and patients.
Increasing functional activity is a big part of pain control. When a person is active and when they are working, it gives them purpose in life. They have a reason to get out of bed every day and get moving. People perform better when they have some structure and purpose in their lives.
Patients also need to understand that pain is part of life. There are no medications or surgical procedures that can completely eliminate pain. Aging causes pain. Life experiences cause pain. Pain is part of the normal human condition. When working with pain patients this is one of the first things they need to understand. Pain is normal.
Getting the patients engaged in their recovery is another important element to overcome chronic pain. This starts with listening. You need to understand what the patients’ concerns are. What motivates them, what are they angry about and what makes them happy. Sometimes to move forward a patient needs to first vent about what is frustrating them. The pain psychologist will work with the patient to move beyond those issues and toward focusing on improving their functionality.
Patient engagement also means that the patient needs to understand that someone else is not going to fix their problem. We live in a society where we expect other people to fix our problems. But with pain the fix lies within the patient themselves. Pain will not improve if the patient does not take steps to self-manage.
Role of Opioids
Opioids can still play a role in pain management, but that is limited. It needs to be short-term during the acute phase of the injury or immediately post surgery. Screening tools have been developed to identify patients that are prone to opioid dependency. This screening was not done in the past which is what led to many patients with significant risks of addiction being prescribed opioids.
Alternatives to Opioids
Functional Restoration Programs are intensive multi-disciplinary programs where the focus is on restoring the patient to function. These are usually inpatient programs lasting about a month. The earlier you can start on such programs the better the outcome will be. The programs combine active physical therapy, occupational therapy, psychological counseling and Cognitive Behavioral Therapy (CBD).
Cognitive Behavioral Therapy is a proven method to train a patient coping skills so that they are not focusing on the pain and they can increase functionality.
Acceptance and Commitment Therapy emphasizes observing thoughts and feelings as they are trying to change them. The goal is to behave in ways that are consistent with the valued goals and life directions.
Motivational Interviewing helps people become motivated to change their behaviors that are preventing them from making healthier choices. The four key principles of this are Partnership, Acceptance, Compassion and Evocation.
Mindfulness and meditation can reduce the sensations of pain severity. It can decrease negative thinking and improve coping skills. Mindfulness can enhance feelings of relaxation and well-being and reduce depressive symptoms, stress, and medical symptoms.
Finally there are many things that a person can do personally to decrease their pain. This includes stretching, exercise, better nutrition, hydration, adequate sleep, and deep diaphragmatic breathing.