Friday, July 28, 2017

Life with Chronic Disease: Alternatives to Opioids

Recently headlines have been announcing that even though prescriptions for opioids are down, they are still way over prescribed. According to Anne Schuchat, the Centers for Disease Control (CDC) acting director, the prescription rate is still triple the level it was in 1999 and four times what it is in some European countries. Even at the reduced prescribing rate, enough opioids were ordered in 2015 to keep every American medicated round-the-clock for three weeks.

There is much discussion about cutting back on how many pills can be obtained for an acute episode as well as the CDC saying that people with chronic pain should seek alternatives.

Keep in mind that Americans don’t like to be in pain and have gotten use to being prescribed a pill for whatever ails them. Opioids do have their place, particular for acute painful episodes, or when someone is dealing with end stage cancer pain.  However , there are a variety of modalities that can be used to replace them.

There is no one measure that works for everyone all of the time. Some of the treatments listed below may not be covered by insurance since the practice can be an “off label” use-such as hyperbaric medicine for the treatment of fibromyalgia.  There are many options to consider and it’s worth exploring them in order to avoid addiction.

Acetaminophen: The generic version of Tylenol. Combining acetaminophen with ibuprofen can provide better pain relief for dental pain than opioids and in Europe there are pills that combine the two. However, they can have side effects, so be sure to talk to your provider before taking them. Do not exceed 1,000 mg to 2,000 of acetaminophen in a 24-hour period and  use as low a dose of ibuprofen as possible.

Acupuncture: Research shows it can benefit those with back and neck pain, osteoarthritis, chronic headache and shoulder pain.

Anticonvulsants: Effective in treating neuropathic pain conditions

Antidepressants: Tricyclic antidepressants, such as Amitriptyline, Imipramine and Clomipramine, are particularly effective in treating neuropathic pain.

Breathing: This is now a common practice for women to use in childbirth and many emergency room and first aid staff are trained in coaching patients with acute pain. This is a good relaxation technique that can help with various types of pain management. Just concentrating on taking deep breaths helps to distract the mind from pain.

Chiropractic Care: This is a field that is expanding. Check out Chiropractic Care for Pain Relief from Harvard Health

Cognitive Behavioral Therapy: A form of talk therapy that helps people identify and develop skills to change negative thoughts and behaviors. CBT is often combined with other pain management including medications, physical therapy, massage or even surgery.

Exercise: Doctors recommend exercise to all patients, but research has shown that it is especially important for those with chronic pain. Low-impact exercise helps improve mobility and functionality. Studies have shown that chronic back pain, joint pain, arthritis, and fibromyalgia can all be improved with yoga and tai chi.

Gait retraining: A person's normal pattern of standing, walking, or running may invite joint problems. A physical therapist can analyze your gait and help you learn to move more efficiently.

Hypnosis: Research shows that medical hypnosis can help with both sudden (acute) and long-term (chronic) pain from cancer, burns, and rheumatoid arthritis. Researchers at Mount Sinai School of Medicine in New York analyzed 18 studies and found moderate to large pain-relieving effects from hypnosis, supporting its use for pain management. Note that patients with post traumatic stress disorder or who are vulnerable to false memories can experience a worsening of their conditions due to hypnosis

Hyperbaric Medicine: Hyperbaric oxygen treatment has been effectively used to reduce chronic pain, especially fibromyalgia syndrome, complex regional pain syndrome, myofascial pain syndrome, migraine, and cluster headaches. Hyperbaric Oxygen Therapy A New Treatment for Chronic Pain? 

Ice & Heat (cryotherapy and thermotherapy): Both have a role for acute and chronic pain. Check out The Great Ice vs. Heat Confusion Debacle  to learn which one to use and for how long.

LumiWave/Infrared Energy: Developed in 2005 by the Colorado-based company BioCare Systems Inc., the device is a chain of four black discs, each of which contains 50 infrared LEDs. When placed on painful areas, such as a strained bicep or an inflamed lower back, the device sends pulses of light that induce the release of nitric oxide in the body, which promotes healing on a cellular level. The device supposedly outperforms ice or heat to eliminate sourness. The device was cleared by the FDA as a Class II medical device “for temporary relief of minor muscle pain and spasms and minor joint pain and stiffness.” There is research  that does support applying infrared energy to reduce chronic low back, which also found no adverse effects.

Kinesiology Tape: Used by physical therapists and sports trainers, this treatment benefits those who have a variety of musculoskeletal ailments and pain by providing support and stability to muscles and joints without restricting the body’s range of motion. There isn’t a lot of research on the use of this tape, let alone its effectiveness, but it does appear that taping is helpful for certain injuries, such as patella tendonitis. See a licensed therapist who can show you the proper way to tape if you want to try it.

Massage: There are various reasons why massage is helpful in reducing pain-it aids in sleep, reduces stress and releases serotonin in the brain-a natural production of anti pain chemicals. Be sure to check with your medical provider about any possible adverse effects from massage and inform your therapist accordingly. 

Meditation: See Mindfulness Based Stress Reduction

Mindfulness Based Stress Reduction: There is a great deal of research now that supports the use MBSR for chronic pain.  Learn more about it at the UMass Medical School’s Center for Mindfulness website and check with your provider about local programs. If there isn’t a program near you or finances are an issue, there is a free option online.  However, part of what helps is the group interaction, so it’s best if you can be part of an MBSR group.

Neurostimulators: This treatment uses implanted electrodes to interrupt nerve signals. This does not cure what is causing the pain, but stops the pain signals before they reach the brain. It can be used for back, neck, arm, or leg pain.

NSAIDs (Non-Steroidal anti-inflammatory drugs): This includes aspirin, ibuprofen. See information for acetaminophen above about combing the two for pain relief.

Tens Units: Transcutaneous electrical nerve stimulation has been a physical therapy and chronic pain clinic staple for decades. There are many consumer TENS units available and many swear by them. Effectiveness is based more on an individual experience than scientific evidence. Check out Zapped! Does TENS Work for Pain?

Therapeutic Ultrasound: Relaxes muscle spasms and aids healing

Therapeutic exercise: Can strengthened muscles and reduce stress on joints, knees and hips.

For more ideas about what might work, check out PainScience: Sensible Advice for aches, pains & injuries


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