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Integrative Health Guide
Living Well With Chronic Pain Part 2: What NOT To Do For Chronic Pain
Living Well With Chronic Pain Part 2 What NOT To Do For Chronic Pain
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After sad experiences and “near-misses” with patients, relatives, and acquaintances, I am passionate about increasing awareness to help halt a dangerous situation in the U.S. We are experiencing a devastating man-made epidemic of overdose deaths from opioid pain relievers (OPRs).

According to the Centers for Disease Control and Prevention, 46 people die every day from an overdose of prescription OPRs.  The number of overdose deaths attributable to these painkillers has risen 3-fold since 2001, to over 16,000 in 2013, double the 8,200 deaths from heroin. Even more unsettling, 60% of these deaths are in patients who receive their prescriptions from one doctor, which means they are not “doctor shopping” to obtain the drugs, or taking or buying them from others.

Many of these deaths are in patients with chronic pain, who are often treated with high doses of these potent oral medications for extended periods of time. Some patients inadvertently or purposely misuse them, and experience respiratory depression ending in death. Some of the medications end up in the hands of people who abuse them, leading them to progress to outright addiction, which we now call opioid abuse disorder. Many patients become physiologically dependent on OPR’s, and suffer from distressing withdrawal symptoms if they are late with a dose, run out of pills, or try to stop them.

What went wrong with our attempts to care for patients with chronic pain, so that we began to rely on OPRs for treatment? Since most opioids that are misused and abused originate directly or indirectly from doctor’s prescriptions, how did we medical professionals let this tragic epidemic develop? I often ask myself these questions, and find the answers to be complex. Over the past 20 years, OPRs have been the main response of the medical system, and the pharmaceutical industry, to the huge problem of chronic pain.

We did not question the pharmaceutical industry’s involvement in our practices, and their marketing of these medications, which expanded their use from acute to chronic pain, without research to show effectiveness in this setting. We began to hold dear the attitude that pain in our patients needed to be treated at all costs, and even considered pain level to be a vital sign, like pulse and blood pressure.  We got into the habit of prescribing one or two week’s supply of pills routinely, even if the need was only for 2-3 days after surgery. This in effect stocked family medicine cabinets with leftover OPRs that could easily fall into the hands of teens and young adults likely to abuse them.

An underlying part of the answers to these questions is that we doctors are products of modern U.S. society, which places high value on ‘magic pills’ and quick fixes, even for complex problems. We hoped to please our patients holding these same values, and who often expect to be handed a prescription at every doctor’s visit, as opposed to considering therapies needing more time and self-motivation. We neglected the importance of continuing to look for underlying root causes or contributing factors for chronic pain in our patients, and we seemed to forget entirely that our bodies have amazing natural self-healing abilities that can be optimized without the use of drugs geared to covering up symptoms.

As a gynecologist focusing my practice on women with chronic pain, I became alarmed at the rapidly rising use of OPRs in women, and their increasing rate of overdose deaths. There has been a 4-fold increase in opioid overdose death rates in women since 1999, and now these overdoses kill more women than motor vehicle accidents.  More women suffer from chronic pain than men, leading to them being more likely to receive OPR prescriptions. Although the reason is still unclear, it is some researchers and clinicians' experience that women may also become physically dependent on opioids more quickly than men. In my practice, I was distressed to see new patients coming in for consultation already on OPRs, sometimes having been given little information on what the medications were and the risks involved.

Perhaps the risks of death and other adverse effects from taking OPRs would be worth it for some chronic pain patients, if they were actually helped by them. But unfortunately I found little benefit for my patients. My clinical experiences called into question much of what we believed over the years about benefits of treating pain with OPRs. I was glad that a systematic review of all the published studies of opioids in chronic pain was recently performed; the researchers also found no evidence of long-term benefit, but did expose the risk of serious harm.1

Why so many medical professionals continue to write these prescriptions, despite the evidence, is difficult to understand, but may be related to what they perceive as a lack of other options. Effective safe integrative approaches for chronic pain are often not in their clinical toolboxes. Increasing the awareness, of both doctors and patients, of the benefit of mind-body therapies that enhance self-healing and self-care is crucial. In my practice, once we determined together that a patient’s OPRs are not helping, and, because of adverse effects such as constipation and hormonal imbalance, may actually be increasing her pain, most patients want to stop them. With education, support, and the practice of mind-body therapies such as those in Body and Brain Yoga, most are successful in gradually tapering off OPRs.

What can we each do to halt this epidemic of death and injury from OPRs?  Primary prevention, which means discouraging new use of opioids in almost all clinical settings, is key. “Start at the beginning and keep opioid-naive patients opioid-naive” is what Dr. Lewis Nelson and co-authors recently urged medical professionals in the Journal of the AMA.2 This will require education to retrain clinicians, patients, and society at large, so that opioids are no longer the easy go-to element of the doctor’s toolbox, and expectations about preventing, experiencing, and treating pain become realistic. We all have a role to play in curbing this epidemic, by declining OPRs ourselves, by advising and supporting our family and friends to use integrative approaches for pain relief, and by sharing our practice of Body and Brain Yoga with other people with chronic pain.

On a personal note, I am relieved to hear good news about a young relative of mine, who became physiologically dependent on OPRs inadvertently, by taking them frequently when partying with his circle of college friends.  He has entered a 90-day residential rehab program after unsuccessfully trying to stop them on his own and now has hope he will get back on track to a useful fulfilling life.

Next month I will return to the bright side and discuss safe and natural strategies to help live well with chronic pain.

Stay tuned and be well,

Deborah

Common opioid pain relievers (OPRs): generic and brand names. Most people who have had surgery or a dental extraction have been prescribed one of them.

OPIOID PAIN RELIEVERS:

 

GENERIC NAMES

EXAMPLE BRAND NAMES

codeine

Tylenol#3
fentanyl Duragesic patch
hydrocodone Vicodin
morphine MS Contin

oxycodone

Oxycontin, Percocet

oxymorphone

Opana

tapentadol

Nucynta

tramadol

Ultram


  1. David B. Reuben, Anika A. H. Alvanzo, Takamaru Ashikaga, et al. National Institutes of Health Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain. Annals of Internal Medicine, 2015; DOI:10.7326/M14-2775.

  2. Lewis S. Nelson, MD; David N. Juurlink, MD, PhD; Jeanmarie Perrone, MD. Addressing the Opioid Epidemic. JAMA October 13, 2015 Volume 314, Number 14:1453-54.


Written by Deborah Coady, MD
Deborah Coady, MD, is Clinical Assistant Professor of Obstetrics and Gynecology at NYU Langone Medical Center. She devoted a major portion of her medical practice to caring for pelvic pain, and currently writes, lectures, and mentors to promote integrative approaches to pain and chronic illness. As a five-year member of Body and Brain Yoga/Tai Chi, Deborah attributes her success in living with persistent cancer to this practice.
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I have been a practitioner for over 4 years now and have seen significant improvements in my life.  I never dealt with chronic physical pain, but I used to have definite anger and anxiety issues.  Through the practice, I have developed confidence, groundedness, a deeper connection to my body and can handle my emotions more effortlessly than ever before.
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user
Through consistent practice of deep stretching, 300 intestine exercises, vibration, and Life Particle Meditation I have been pain free: migraines, joint pain, sinus infections, and free from Ibuprophen and Sinus medications for about 5 years! Experience Dahn Body and Brain Yoga to tap into deeper levels of healing your body! You can do it! Do it daily and you will heal  yourself, feel pain-free, and medication free too! 
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Great news Heather!
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user
It is so alarming and yet not surprised. My experience was taking painkiller for plantar fasciitis. But since i am more in tune with my body, i can feel the effect of the painkiller in my stomach and intestines. So since then, i choose natural healing. My coworker was once surprised that she can get rid of her headache without painkiller. Let's bring awareness and share body and brain healing method to others!!!!
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user
I had no idea that the death rate was so high for overdosing on OPI's. It is encouraging for doctors like Dr Coady to offer healthier solutions to patients. I had chronic back pain, gall bladder issues, intestinal problems and high blood pressure for over ten years. I am not sure what condition I would be in now if I had not allowed my body to get better naturally through Body and Brain techniques. I am very grateful every day that I feel so strong now. 
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user
I suffer from frequent pain associated with hard labor at my job & I became very user to popping a pain pill instead of acknowledging my pain. Once I found Body & Brain I found ways to strengthen my body and pay attention to my body. I have been pill free for 6 years! 
Thank you for sharing Dr. Coady! 
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user
In addition to my previous comment, it's only by some miracle that I did not overdose on opioids and narcotics in my earlier years as a pain patient. I blacked out once and landed face down and needed stitches on my face and never had any recollection of this event. I inadvertently took too many of my pain meds. That scared my family and young children to death. These pain meds did little to help my pain and in my opinion made my pain worse. I have been off of pain medication for several years and although I am still in pain (but mostly manageable) I am grateful to be following a healthy lifestyle that is comprised of a healthy diet, supplements, breathing, meditation, yoga and work that is directed at helping others with chronic pain. There is no magic pill. I am grateful that Dr. Coady, who is a pioneer on so many medical frontiers, has spoken out on this vital topic!
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user
It is easy for chronic pain patients to accidentally overdose on their potent opioids. Many complain of a "foggy brain" from these medications, which may lead to forgetting that a dose was already taken, and then repeating the dose. Respiratory depression can happen quickly: my daughter experienced a near-lethal overdose after surgery while in the hospital! Her dose had been miscalculated. If you or a household member is being treated with opioids, it is crucial to have a kit of naloxone (Narcan) nasal spray in the house to use immediately in case of an overdose, while emergency care is on its way. 17 states now allow buying these kits directly from a pharmacist; the other states requires a physician's prescription. For more info see:http://www.narcannasalspray.com/how-to-get-nns/consumer-access/ All my best, Deb
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user
Dr. Coady is one of the most enlightened doctors in the area of chronic pain. I suffer from chronic pain but lead a productive and satisfying life by following her integrative approach. We need more practitioners like Dr. Coady who understand that handing out meds is not the most helpful way to help those in pain. Kudos again to Dr. Coady for serving as a guiding light.
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user
As someone who mostly avoids taking pain killers, I'm shocked to read about the OPI death rate! As far as chronic pain goes, I had daily pain in both elbows that lasted more than a year. I tried many additional healing modalities, like weekly body work and dietary changes, but made no progress. I was already doing yoga several days per week. Finally, a special once a week program at Body and Brain Yoga called Dahn Mu Do cleared up the pain in less than 1 month. Less than 1 month!! That was about 2-3 years ago and the pain never returned 
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user
I cannot agree more.   As a dentist I occasionally run into patients who think they need OPRs for their toothache that doesn't really require OPRs for the most part.   Some if not many of those patients seem to have been previously prescribed OPRs with relative ease from other medical professionals for other type of pain.   And as such they tend to take it for granted that OPRs are needed for even moderate toothache.    As the epidemic of death from OPRs is increasing at alarming rate I too think it is necessary for all health care professionals to educate patients so that they understand OPRs may not be the best way to handle their pain or best yet they are not needed.  

On a personal note, I had developed chronic wrist, neck and back pain, which are very common as occupational hazards for dentists.   Thanks to the help of body and brain yoga, though, I was able to significantly improve those conditions in relatively short period of time without needing to take any pain medicines.   In fact, I have been pain free for over a year now!   I too believe that body and brain yoga can help those with chronic pain and I personally share it with family, friends and some of my patients.

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user
I struggled with chronic sciatic pain for 5 years before finding Body & Brain Yoga and Tai Chi. I relied on OTC drugs to help me sleep and get through the day. I realized through the practice that the condition of my intestinal health greatly effected the level of pain I would experience day to day. As I made a habit of doing a daily practice of dahn jon tapping and intestinal exercises, and sleeping tiger I have been pin free for 12 years now! 
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