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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ReplyDeleteThis is really very helpful blog post to understand the benefit of oxygen treatment for fibromyalgia. Thanks for sharing
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