Natural Pain Management to Fight Opioid Abuse
In 2015, nearly 100 Americans died each day due to prescription opioids, heroin and fentanyl addiction, and half of these came from prescription overdose.
In most cases, prescription addiction begins with the patient and physician’s quest to alleviate pain, either the acute form due to injury or surgery, or the chronic form due to a wide variety of causes stemming from injury, disease, trauma, aging and mental illness. The reality is that most people will experience pain at some point in their lives, so knowing what non-opioid options are available could save you from addiction, or even death due to overdose.
This article will walk you through what we know today about how to manage or eliminate pain more safely, effectively and consistently.
The Prescription Opioid Addiction Problem
I recently met with an addiction center where one of the senior executives I spoke to was a recovering addict. His story was the truest face of opioid addiction I’ve come across. For decades he’d had no addiction issues, was an active athlete and father, and had a good job. No sane person would have ever thought he could become an addict.
Ironically, it was his active lifestyle that started him down the path. After a baseball knee injury and subsequent surgery, within several days he became physically addicted to prescription opioids, and within several months he was a full-blown addict suffering from this devastating mental illness, and slowly tearing apart his life and family. Luckily he was able to escape, get help, and recover. Many can’t.
So, why does our medical system start so many people down the path to addiction in the first place?
It’s a complex problem, and one that defies any singular explanation. Much of it is driven by the remarkable pharmaceutical innovations in twentieth century bio-technology that have literally changed the world. Our expectations of what it means to be alive were altered radically when antibiotics and various vaccinations for mass killing diseases became broadly available, and some of the same positive hopes existed for helping billions of global pain sufferers when new opioids such as Vicadin, OxyContin, and Percoset were designed and produced in the late twentieth century.
These drugs were often advertised to reduce the euphoria (and thus addiction) experienced by other opiates such as morphine that had been used for centuries. These new longer-acting drugs also appeared to solve problems associated with older forms of morphine that were short-acting and encouraged addictive habit formation. For years, doctors, pharmaceutical companies and patients literally binged on opioids, and in some case even made (or accepted) false claims about addiction risk.
Companies, lawyers, governments and medical foundations then colluded to make the problem far worse in America.
Amazingly, patients who were denied opioids by their physicians began successfully suing doctors who wouldn’t prescribe pain medications. And companies, the US government’s HHS agency, and many private medical foundations worked together to support and promote a broader use of opioids, for example, expanding Medicare spending on opioids between 2006 and 2014 from $1.5 billion to $3.9 billion. Medicaid also saw a massive increase in prescription reimbursements for opioids, meaning that US taxpayers are literally paying for and supporting an expansion of opioid addiction, vis-à-vis their elected officials. Even the FDA, which is supposed to be safeguarding our public health, has routinely and continually approved new classes of powerful and addictive opioids, often over the loud objections of medical and public health groups.
So we now have 4% of the world’s population consuming 80% of the world’s opiate supply. It’s a statistic that is hard to comprehend.
Blatant Disregard for Scientific Evidence
What’s worse is that there is no evidence that opioids are effective for managing pain after several months of use, and in fact often increase pain sensitivity, a condition known as hyperalgesia.
Let’s repeat that: after several months opiates make pain worse. Wow. How many prescriptions did we provide Americans last year? A lot. In 2012, the latest data I’m aware of, we prescribed 259 million prescriptions, more than enough for every American adult. In 2016 it was certainly far higher, even though these products don’t work after a few months.
And, even worse, opioids cause physical addiction in a matter of days, or a week, depending on the dosage and person. So we’ve built a juggernaut of an industry, with distribution and medical support, for products that turn out to be make long-term pain worse, and are essentially guaranteed to create addiction! That’s why we have nearly 3 million opioid addicts in the US today.
We’re only now starting to talk about the truth, that opiates have no long-term effectiveness, often make pain worse, and are inherently addictive.
So, these miracles of modern science and industry were too good to be true, and today we’re left to clean up the mess – and do what we can to rebuild the many lives and communities destroyed by addiction. And though there are many positive things starting to happen—for example the free availability of the opioid withdrawal treatment drug Noloxone in many pharmacies across the U.S., movements by legislators in almost every state to limit opioid prescriptions, and a broad-based and growing awareness of the problem—it appears that opioid addiction continues to grow, not shrink. How can this be?
The Simple Truth: Non-Pharmacological Pain Management is More Effective—But it Requires Work
We believe it’s quite simple, and even obvious, but no one is willing to hear or act on the truth: most chronic pain is manageable via a variety of proven non-pharmaceutical approaches that require the patient, and their therapist or healthcare provider, to work at it.
The reason we aren’t getting a grip on our addiction problem is that we’re unwilling to put in the effort, or unwilling to tell patients that their answer to chronic pain is going to be more intrusive on their lifestyle and time-consuming than simply taking a pill. We’re unwilling to tell people the truth about managing chronic pain without opioids: it takes some work but will be more effective.
It’s not easy to tell a patient ‘no’ to an opioid prescription, and physicians worry they’ll just drive that patient to use heroin or fentanyl. But it’s far harder when non-pharmaceutical pain management tools are unavailable, or not integrated into patient treatment models. If there are good non-opioid alternatives to managing chronic pain, many people will give them a try.
Common Approaches to Non-Opioid Pain Management: NSAIDs and other Drugs
Today doctors and pharmacists can provide or prescribe a variety of (mostly) safer options such as NSAIDs (e.g. aspirin, acetaminophen), skeletal muscle relaxants, tricyclic anti-depressants, steroids and other non-opioid pharmaceuticals. It’s worth noting that even NSAIDS and other non-opioid drug alternatives can have their own health risks, especially from long-term use, and should be taken in consultation with a physician. And in some studies NSAIDs and tricyclic antidepressants, which are also used for pain, show little clinical benefit. But compared with the dangers of opioid addiction, if they’re working for you, they’re much more appealing.
A Multi-Modal Approach to Eliminating Pain
Of course, these drugs are unlikely to solve chronic pain issues on their own, and what’s really needed today is greater awareness, education and access to the broad array of effective, evidence-based treatments that require no drugs at all. Superficial heat and massage, TENS (electrical nerve stimulation), physical therapy, mind-body work and exercise all offer pain reduction benefits. Physicians who treat acute, subacute or chronic pain face legislative, pharmacological, quality-of-care and patient compliance challenges that require new approaches, new knowledge, new tools – and new mindsets.
Overall, the evidence points clearly to one idea above all others: individuals who suffer from pain will usually best manage, reduce and eliminate that pain through a combination of physical and mental exercise, training and therapies, sometimes combined with low-risk pain medications—often called a multi-modal approach.
The multi-modal approach is all about personal self-care, and taking the time to learn, practice and integrate mind-body care regiments into life.
Effective pain management often comes down to consistent, multi-modal self-care. The core techniques are summarized in the section below. None are meant to be seen as silver-bullet solutions to chronic pain. Rather, they should be used together, or at different times in recovery, to create a diverse set of self-care tools in the patient that enable pain management across a wide range of situations, lifestyles, and ages.
Exercise to Reduce Pain
Exercise, and physical therapies in general, are essential to recovery from most forms of chronic pain.
It may be the last thing you want to do, but if you don't exercise, muscles lose conditioning, the risk of obesity grows, bones get weaker, joints don’t move as well, and your body’s entire fascial structure gets stiff, inflexible and injury-prone. Your pain will usually increase simply because your body isn't functioning as well as it could.
Some chronic pain patients also struggle with depression, anxiety, or other mental health issues. It's difficult when injury or pain changes what you can or can’t do, so staying active is important to feel that you own your life experience. Exercise releases positive chemicals in the brain, and reduces stress. It’s also fun to exercise and socialize with others!
So, as hard as it may sound, exercise is likely part of a balanced, realistic and healthy treatment plan for chronic pain. Rest will be effective up to a point, but your recovery depends on moving, strengthening, and stretching.
Consistent Movement Reduces Chronic Pain
The benefits of training yourself to move around, stretch and adjust your body continuously and habitually throughout the day include greater mobility, reduced wear and tear on muscles and joints, reduced pain, improved mental and cardiovascular health, and just feeling good!
For those suffering from chronic pain, consistent movement is particularly important. Over time, many become conditioned to stop moving, stop stretching, and stop maintaining range of motion. Unfortunately, this typically makes pain worse, and can lead to a whole host of other health problems – which can in turn further compound the pain experienced.
The answer is to move, move, and move more, as much as you reasonably can. Movement doesn’t have to be intense or extreme, it can in fact be light and easy, comfortable even. Just keep your body in motion. Even if you work at a desk, try and spend 5 – 10 minutes most hours moving around, and remain aware of your body.
Breathing for Chronic Pain Management
Breathing is connected to everything we do, we do it fifteen thousand times each day, and it directly influences our physiology and mental health. In fact, conscious breathing is one of the most effective pain management techniques.
Yet in many cultures breathing techniques are relegated to specialized pursuits such as eastern martial arts and yoga, weight lifting, soldiering, trauma – or giving birth. Given its remarkable ability to make us feel better, reduce pain and stress, adjust mood and focus our mind, why don’t we teach more breathing throughout childhood?
There are certain breathing skills every person on earth should know from a young age: abdominal breathing, balanced and long exhalation patterned breathing, nasal breathing, and fast or bellows breathing. These techniques can be used for relaxation, oxygenation before athletics, pain reduction, focus and energy building, and as an essential accompaniment to mindfulness, imagery and meditation practices.
In many exercises, it’s the parasympathetic nervous system that is being stimulated – an action that produces a hard-wired and involuntary relaxation of our central nervous system, releasing chemicals that help to naturally reduce pain in our bodies
Learn More about Breathing exercises to Manage Chronic Pain
There are also a few breathing subject areas that everyone should have a basic understanding of: extended breathing patterns for focus and control development, breathing physiology and posture basics, how to train for slow, quiet, deep and even qualities.
It’s also useful to use breathing patterns for effect in different practical situations, like before or during an exam or meeting, as a means of getting energized or warm, or even to calm nerves before social situations. It’s hard to understate the importance of using breathing for health, and especially pain reduction.
Mindfulness: One of the Most Effective Opioid Alternatives
Mindfulness is paying attention to something in the present moment (e.g., your breathing) and learning how to separate what you experience or sense from how you judge, react or respond to it. It is learning how to observe yourself (interoception) and the world around you (exteroception) with awareness, so you fully observe and feel your experiences, but maintain the presence of mind to remain calm, focused, thoughtful and intentional in your reactions.
The benefits of cultivating mindfulness for pain are broad. Mindfulness practice literally changes your brain to better handle stress through what is called neuroplasticity. In simple terms, when you practice choosing not to respond to stress, you train your brain to automatically respond this way more of the time! This works similarly for pain, so by working to isolate pain in your mind, you can over time make it less intense and less present in your consciousness.
Over the long-term, this form of pain reduction is one of the most profound and impactful of all the approaches we know.
Cognitive Therapy for Pain Reduction
Some conditions and our responses to them can be affected by our thought processes. For example, some people with pain react in ways that actually make the pain more frequent and intense, or last longer. And some people experience what’s known as secondary pain, the experience of pain due to memories of past pain in the brain. This can be as a result of thought patterns that have developed over-the-years and, though normal, can impact pain by causing stress or affecting the emotions.
Fortunately, these patterns often can be neutralized and even reversed through cognitive training, one form of which is mindfulness practice. For many, this is a relatively easy, consistently successful and low-risk process.
Body Alignment: Another Non-Opioid Technique for Managing Pain
Body alignment impacts how you feel, how well your body works, how much pain you experience, and how you physically hold up over time. Most of us have experienced first-hand the discomfort of misalignment and injuries from repetitive activities, whether in sports, or simply sitting at a desk, typing, hunching over a phone or driving, to name a few. If you look around today, you’ll see many people with unhealthy (and in time, painful) forward-head posture due to constantly looking down at their phone or tablet.
The specifics of preventing injury, pain and inflammation vary, but one thing is always true: learning to be aware of your body from moment-to-moment and making little adjustments throughout the day improves overall health and reduces chronic stress, injury and fatigue.
Guided imagery is another medically validated tool for pain. It primarily works indirectly, by creating and reinforcing pleasant, positive feelings and emotions to relax mind and body. It turns out that maintaining a positive view of life has a significant effect on how we feel (or don’t feel) pain.
Imagery can also directly dissipate pain with advanced techniques that imagine moving pain around the body. Science shows these approaches grow more effective with practice.
Group therapy for chronic pain management using cognitive-behavioral therapy (CBT) has become common. Controlled studies have established benefits for patients with a variety of chronic problems, including low back pain, facial pain, arthritis and headache. Some have even concluded that group therapy is as effective as one-on-one therapy. And for many, group time hastens mood improvement and feelings of community.
Pain is highly related to our attitudes: patterns of thinking, feeling and reacting, and overall health literacy.
In recent studies, anatomical causes for pain account for a relatively small number of cases, yet positive attitudes about one's ability to recover, and about the effectiveness of various treatments, are highly correlated to successful recovery.
In other words, working on your attitude and knowledge are among the most important aspects of recovering from or managing pain. Cognitive training and mindfulness are the primary tools we can use.
So Many Ways to Reduce Pain Without Risky Drugs
Let me be clear about one thing: pharmaceuticals have revolutionized health and the experience of life for billions of people, and they may be right for you. And your physicians are the best people to advise you.
But it’s also true that taking opioids for more than a short period are risky for most of us. Now you know there are other non-pharmacological pain management options that carry little risk and are more effective than opioids over the long-run. It’s your choice.