Blog – President Trump’s recent declaration that the opioid epidemic is a national public health emergency is a great start to tackling the crisis, but it also further brings to light the lack of chronic pain management available for pain sufferers.
Currently, the main solution for treating chronic pain is to put out the fire with prescription painkillers. This suppression works for people who don’t become addicted, but not so much for those who already struggle with addiction of prescription meds, alcohol and tobacco, or have a family history of addiction and a history of mood disorders.
A partial proof is in the statistics. The number of deaths from drug overdoses has quadrupled since 1999. Half a million Americans died of drug overdoses — mainly from opioids — from 2000 to 2015. The CDC also found that 64,000 people died from drug overdoses in 2016.
The connection between opioid addiction and chronic pain is complex and includes psychological, epidemiological and neurobiological factors. Let’s look at some of the issues beyond just treating physical pain with pills.
What about emotional and mental pain?
Because of the opioid crisis and much to the dismay of people who truly need painkillers, doctors are curbing their distribution of certain prescription medication, including hydrocodone and oxycodone, to curtail the growing epidemic, but regardless the mental and emotional impacts of chronic pain aren’t being addressed.
People are struggling with depression, diagnosed or not because there’s no end to the pain in sight. Pain sufferers never get a break from their pain, and they feel like family and friends can’t relate, which is very isolating and frustrating. Addiction is just as miserable, though.
Compounded by hurried doctor’s appointments and lack of recommended resources for health coaches and behavioral specialists, it’s tough for doctors to adequately address underlying solutions for their patients. Trust is not fostered between patient and doctor. There are no rules that say doctors have to suggest integrative approaches to their patients.
It’s no wonder depression and even suicide rates are prevalent among those with chronic pain. The cause of the pain could be anything — from injury to lifestyle, to life-threatening disease — all that matters is that a patient’s pain is addressed rather than swept under the rug. Under-managed pain may lead to psychological distress, sleeplessness, exhaustion, anxiety, plus relationship and work problems.
If pain is inevitable, is suffering really optional?
According to psychologists, true pain relief can be achieved by distinguishing the difference between actual pain and the suffering it causes. Basically, that pain is unavoidable, but suffering is not.
An article in Psychology Today explains:
“Physical pain has distinct biological and psychological components that effectively represent stimulus and response. The biology of pain is the signal transmitted through the central nervous system that ‘something is wrong.’ The psychology of pain is the interpretation or meaning we give to that pain signal—the internal self-talk and beliefs about it which then drive our emotional reactions.”
What if we can control how we view pain? Here’s a real example: A woman who lost her two sons to opioid overdoses certainly feels an inordinate amount of pain, thinking, “it’s not fair … this is awful … I can’t go on … what did I do to deserve this.” If she chooses to let her emotional pain lead to anger, depression, muscle tension, hopelessness, etc., her negative thoughts lead to endless suffering.
Acceptance strategies and mindfulness-based practices can start the process of de-escalation. Detachment and mindfulness mean being consciously aware that negative thinking sets off a chain of events and fuels suffering, according to the article.
The woman who lost her sons wrote this on her Facebook page today and tagged her boys:
“Good morning lovelies — have a wonderful day in heaven: I love you. I saw visions of both of you yesterday: It knew it was you both saying “hi momma we love you.” Thanks for being with me always. One love.”
Her thought for the day shows love, compassion, and acceptance. Is it easy? No, but she’s making a concerted effort.
Patient-centered chronic pain care
Chronic pain management is in the spotlight because of the ongoing opioid crisis. This makes patient-centered care more important now than ever. If doctors talk to their patients about what their goals are in maintaining an active role in their own health, people can gain control back. While chronic pain is complicated, patient centered care is an important part of a treatment plan. Here are just a few categories to think about.
Cognitive: Relaxation, meditation, and cognitive behavioral therapy are all examples of pain management that could accompany medication or not. Pills alone do not stop negative thinking and psychological warfare. Work with someone who can provide the tools needed to cope with pain.
Physical: If exercise could come in a pill form, wouldn’t that be something? It would be the new “wonder drug.” Time and again, I’ve heard a friend of mine, who’s an advanced nurse practitioner, tell her heart patients that 30 minutes a day of exercise is the most important key to their wellness. This goes for any number of ailments, including depression, sleeplessness, anxiety, and all of the problems associated with chronic pain.
Acupuncture: There’s always debate on whether acupuncture actually works for chronic pain. Many people swear by it. A team of researchers gathered results of 29 studies involving 18,000 participants. Some had acupuncture, some had fake acupuncture and some had no acupuncture. The results showed that acupuncture relieved pain by about 50 percent, which indicates it’s a reasonable referral option.
Lifestyle changes: Quit smoking. Eat healthily. Get exercise. Surround yourself with positive people. Get enough sleep. These are the basic, yet important ingredients for improving pain.
Alcohol: Booze is easy to obtain, so, unfortunately, people with chronic and acute pain self-medicate with it. An estimated 25 to 28 percent of people use alcohol to alleviate acute pain or chronic pain from conditions such as Crohn’s disease or arthritis. Alcohol tricks the central nervous system into thinking the pain isn’t so bad. There is no direct pain-relieving properties of alcohol.
It’s amazing there’s no concrete system in place to effectively deal with chronic pain, other than relying on addictive medications that only mask symptoms. Non-pharmacologic treatments to control pain and improve the overall quality of life need to be more mainstream than they are today.