Moving Beyond Opioids for Pain Management
April 17, 2022
Article was written by WholeHealth Living
We all know what pain feels like – it can be steady, throbbing, stabbing, aching, pinching, acute, or chronic – but do we know what pain is?
“Where does it hurt?” a mother will ask her crying child. Mothers often play a game when a child is hurt, touching places, “Does it hurt here? Or here? or here?” And as if by magic, the child will settle down and switch gears – from feeling immense emotions to regaining objective awareness.
Today, pain researchers are exploring the multidimensional nature of pain – does it hurt here or here? Is pain coming from the injury or some inexplicable place in the mind?
For over a decade, Norman Doidge, author of The Brain’s Way of Healing, has been exploring how pain lives not at the injury site, but in the brain. In so doing, he has found that the brain is capable of transforming the sensation of pain. Doidge tells the story of a doctor in chronic pain from a crippling neck injury who taught his brain to block out pain using visualization techniques, forcing those “brain areas” that felt pain to “process anything but pain, in order to weaken his chronic brain circuits.”1
This emerging field, called neuroplasticity, may explain how integrative therapies like acupuncture, exercise, massage therapy, physical therapy, and other mind-body therapies alleviate pain by “re-wiring” the pain circuits.
Researcher, Dr. Eric Garland, PhD, LCSW is pursuing mindfulness to help patients manage chronic pain:
“We ask a patient to focus in and to break down the experience of pain into sensations of heat, or tightness, or tingling. And then to notice whether the pain has edges, whether it has a center, and to notice the spaces in between the sensations.
“We also teach people how to use mindfulness to reclaim a sense of healthy pleasures, joy, and meaning in life, in spite of pain,” Dr. Garland says. “What the data shows from multiple studies now is that this is actually happening in the brain and body.”2
As the nation grapples with an opioid epidemic from over-reliance on pain drugs, these bigger questions of “what is pain” are coming into play – especially as it becomes clear that opioids may be ineffective for long-term pain management.
A Sensation of Pain Far Beyond the Actual Injury
Shannon Hubbard never imagined that rolling her ankle during an Army training exercise would unleash a long-term debilitating condition called “complex regional pain syndrome.”
The condition causes the nervous system to create a sensation of pain far beyond the actual injury. After increasing complications, the complex pain syndrome fully emerged after surgery on her foot. Shannon’s pain doctors tried 60 different medications and combinations.
“None even touched the pain,” the 47-year-old veteran told Kaiser Health News. “My leg feels like it’s on fire pretty much all the time. It spreads to different parts of the body.”3
Doctors prescribed short- and long-acting opioids to provide enough relief for her to start physical therapy. But four years ago, that changed; her pain doctor suddenly lowered her dose. A new Arizona opioid law limited the type and quantity of opioids her doctors could prescribe.
The 2016 Opioid Prescription Limits
In 2016, to stem the opioid epidemic, more than two dozen states implemented laws or policies limiting opioid prescriptions in some way.
“All bad actors will be held accountable — whether they are doctors, manufacturers, or just plain drug dealers,” Arizona Governor Doug Ducey said in his 2018 State of the State address.4
What is the Misconception About Pain Management?
The key concern that prompted the 2016 opioid restrictions was the risk that these drugs are addictive. Today, we are moving toward giving doctors more flexibility in developing programs for managing short-term acute pain and long-term chronic pain differently. We have learned that opioids do not work well for chronic pain in many patients, and in some cases, they can actually increase the feeling of pain.
The Mystery of Hyperalgesia
Counter-intuitively, over time, opioids can heighten pain sensitivity. The brain may even start interpreting normal sensations as painful. The term for this is “hyperalgesia.” Patients with hyperalgesia may feel more pain than the average person in response to any new injury or painful condition they may experience.5 It’s similar to neuroplasticity to the degree that the brain and nervous system are shaped by the pain experience.
Hyperalgesia is sometimes confused with drug tolerance – the decreased efficacy of medication with repeated use. Physicians and patients often try to offset drug tolerance by increasing the dose. While this might offer short-term relief, it inevitably triggers the need for ever-higher doses for pain relief. With opioid-induced hyperalgesia, increasing the dose will not only fail to provide relief, but it may also make the pain worse. Many times, both processes (hyperalgesia and tolerance) occur together.
Combining Integrative Therapies for Pain Relief
Patients need a range of options that are safer and more effective to get their pain under control. As part of a recent initiative, the National Center for Complementary and Integrative Health (NCCIH) is currently studying how treatments such as mindfulness, acupuncture, and massage can address chronic pain while reducing the need for opioids. They are seeking the best way to offer these treatments in combination to better help patients. NCCIH Director Helene Langevin, M.D., explained why an effective pain treatment plan can require more than pills.
“We know that nondrug options for pain, such as acupuncture, cognitive behavioral therapy, and mindfulness-based techniques are recommended as the first line of treatment,” Dr, Langevin explained. “The problem is that these types of treatments are not always implemented.”
The NCCIH is researching the interconnections of the pain experience to develop multifaceted approaches to pain management:
“We look to research that essentially connects all those various parts of the pain experience together: physical, emotional, and behavioral,” Langevin continued. “Some of the institutes at the National Institute of Health tend to focus on one organ system at a time, but at NCCIH, we are really interested in the connections between the organ systems as well as how emotion and behavior come into play.”6
WholeHealth Living® is Bringing Nonpharmacologic Therapies to Health Plans
WholeHealth Living is helping health plans bring these nonpharmacologic and alternative therapies to their members through a managed network of Physical Medicine and Integrative Health benefits. WholeHealth Living identifies, builds, contracts, credentials, and manages a network of licensed practitioners. The network includes chiropractors, acupuncturists, massage therapists, physical therapists, and naturopathic practitioners.
WholeHealth Living is uniquely positioned to help health plans implement nonpharmacological pain management.
Does Integrative Medicine Reduce Prescribed Opioid Use for Chronic Pain?
A systematic literature review of 23 studies published by “Pain Medicine” found:
“…positive preliminary evidence that the Integrative Medicine approach, including Complementary Alternative Medicine therapies, can help in reducing opioid use. As the opioid crisis continues to grow, it is vital that clinicians and patients be adequately informed regarding the evidence and opportunities for Integrative Medicine/ Complementary Alternative Medicine therapies for chronic pain.”7
Researchers found that the multidisciplinary program was associated with significant clinical improvements across all outcome measures, including pain severity, depression, and anxiety at discharge, six months, and 12 months of follow-up.
WholeHealth Living is Ready to Offer Non-Opioid Options
WholeHealth Living has a program already in place that provides non-opioid options to health plan members:
“We are excited to play an instrumental role in helping health plans implement Integrative Health solutions as a nonpharmacological alternative to pain management,” said Tommy Lewis, Executive Vice President, Chief Operating Officer at Tivity Health®. “The integration between WholeHealth Living and SilverSneakers® gives physicians and health plans a broad tool kit of therapeutic and exercise options as recommended by the CDC”.8
WholeHealth Living Offers Effective Methods to Address Your Members’ Pain
Tivity Health’s WholeHealth Living program offers a turnkey solution for health plans that address their members’ pain, reduces the cost of expensive treatments, decreases members’ reliance on opioids, and allows members to return to the lifestyle they love. Payers nationwide are offering access to the WholeHealth Living network of chiropractors, acupuncturists, massage therapists, and naturopathic practitioners.
The program is backed by nearly 30 years of clinical and operational expertise. It is delivered through Tivity Health – the same company that offers SilverSneakers – the nation’s most recognized and respected fitness program specifically designed for older adults. In this critical area of health care, the WholeHealth Living team bridges the gap between specialty practitioners, health plans, employers, and the broader medical community to improve clinical outcomes, create savings, and enhance member satisfaction.
To learn how WholeHealth Living makes Physical Medicine and Integrative Health benefits available to health plan members, visit WholeHealth Living at www.wholehealthliving.com.
[2] https://magazine.medlineplus.gov/article/from-opioids-to-mindfulness-a-new-approach-to-chronic-pain/
[3] https://khn.org/news/patients-with-chronic-pain-feel-caught-in-an-opioid-prescribing-debate/
[4] https://azgovernor.gov/governor/news/2018/01/governor-ducey-calls-unity-during-state-state-address
[5] https://www.hss.edu/conditions_opioid-induced-hyperalgesia.asp
[7] https://academic.oup.com/painmedicine/article/21/4/836/5637803
[8] Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain