Our communities continue to struggle with an epidemic of opioid misuse and abuse. This epidemic has many causes. One contributing factor is our healthcare systems’ overreliance on pain medications to treat a large number of patients with chronic pain. Unfortunately, our current workforce does not include an inadequate array of behavioral and non-opioid options for the large populations of patients with chronic pain. Alternative treatments and models of care needed now, not later.
We are excited to introduce you to an innovative and important project in our community. We have organized a consortium of independent practitioners from various disciplines to participate in a project to respond to the needs cited above. The consortium includes skilled psychologists and other experienced clinicians as well as others who are interested in gaining such experience. Continue reading “Greater Portland’s Response to the Opioid Crisis”
The problems with pain medications are not new ones. The epidemic that many talk of in terms of opioidaddiction is real. Many states in response to this problem have created new guidelines and requirements for the prescription of these medications. Some physicians have simply stopped prescribing them because they may not agree with or want to work with the new guidelines. This has left some patients without a prescriber.
A few months ago I posted a blog about non-pharmaceutical interventions for the treatment of chronic pain. The response to that blog was in general positive, but I got a number of angry responses from people who felt I was saying that pain medication should be replaced with these non-pharmaceutical interventions. That is not what I was saying. Unfortunately, people can become so dependent upon these medications they firmly believe there is no way they could manage without them. And for some that may be true. Continue reading “Addiction to Pain Medications”
How the skills and attitudes of resilience can help manage chronic pain.
Attitude alone cannot cure chronic illness or chronic pain. Positive attitude and certain self-management skills can make it much easier to live with. In previous blogs, we have discussed chronic pain and its relationship to the opioid epidemic. In the next couple of blog posts, we are going to be discussing situations that people find themselves frequently when they experience chronic pain. And we will discuss the ways in which the skills and attitudes of resilience can help you manage the pain.
There is a great deal of research that shows that the experience of pain can be modified by circumstances, beliefs, mood, and the attention we pay to the pain symptoms. For example with arthritis of the knee, how depressed the person is better predicts how disabled, limited and uncomfortable they will be. What goes on in a person’s mind is often more important than what is going on in their body.
In the past few posts, I discussed a number of pharmaceuticals that can be used in treating pain. Most recently, CBD has received a great deal of attention and press, but there is still a lack of consistent research findings to support many of the claims being made. I also discussed the use of non-pharmaceutical interventions to treat pain. But before we talk more about these, we will talk about what pain is.
The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage.” Acute pain is usually transitory and resolves quickly. Pain that lasts a long time, usually 3 to 6 months, is called chronic or persistent. Continue reading “Living in Pain”
Part One of Two: A look at the many causes of this epidemic
As you are undoubtedly aware our communities continue to struggle with an epidemic of opioid misuse and abuse. In 2016 42,000 people died of an opioid overdose. Apparently, 11.5 million people misuse prescription opioid painkillers. Almost 950,000 people used heroin and 2.1 million people suffered from opioid use disorder in the United States.
This epidemic has many causes. One contributing factor is our healthcare system’s over-reliance on narcotic pain medications to treat a large number of patients with chronic pain. Most physicians receive little training in the treatment of chronic pain. Opioids are most effective in the treatment of acute pain but in the treatment of chronic pain, pain that goes on for 3 to 6 months, opioids, in the end, may actually make the pain worse. Most individuals who develop an opioid addiction received opioids initially through a prescription from their physician.
In many communities, primary care physicians provide most of the care for chronic pain patients. They are often unaware of nonpharmaceutical interventions for chronic pain. To be fair those who provide these interventions such as psychologists, physical therapists and acupuncturists have not done enough to educate other providers or the public about the effectiveness of these interventions.
There is little evidence to support the use of long-term opioid therapy in the treatment of chronic noncancer pain. Considering the risk of harm posed by the misuse of opioid prescriptions and the lack of evidence to support opioids for chronic noncancer pain the Centers for Disease Control and Prevention recommend nonpharmaceutical treatments or non-opioid pharmaceutical treatments to be considered as the initial treatment approach for chronic pain. Non-opioid alternatives include, but are not limited to, acetaminophen, anti-inflammatory drugs, membrane stabilizers such as gabapentin, and muscle relaxants. And there are others. Recent research has indicated that these non-opioid alternatives are at least as effective as opioids for low back pain and are less associated with adverse events.
The most widely studied and effective interventions for chronic pain that are nonpharmaceutical include cognitive behavioral therapy and other interventions such as acceptance and commitment therapy, exercise, physical therapy, and interdisciplinary rehabilitation. Depending on the pain condition other therapies with evidence of efficacy include yoga, biofeedback, acupuncture, spinal manipulation, and massage.
The American Psychological Association is encouraging its members to become better educated and trained in these nonpharmaceutical interventions and to educate other providers in the community and the public about these interventions. We will be talking more about these interventions in future posts.
This article was originally posted to Psychology Today, “In the Face of Adversity”, by Dr. Ron Breazeale, Ph.D. With his permission, we will share a series of posts on the Chronic Pain and related issues as a prologue to introducing what Maine has to offer for treatment options.