Chronic pain and prescription opioids are two topics that have been making national headlines over the last few weeks. The CDC announced a new set of recommendations for prescribing opioids and the FDA has required new warnings on opioid medications to ensure labels include more descriptions of the risks, especially for abuse, addiction, and overdosing.
With all the news about the issues with opioids, there has been more interest in alternative strategies toward chronic pain management. In the past, comprehensive chronic pain management programs were a preferred strategy. Over the past ten years, most programs have disappeared due to a lack of insurance coverage. The cornerstone of all these programs is combining conservative use of medications, interventions, and the strong input of physical therapy and behavioral health treatments.
Different Pain Treatment Options
Physical therapy (P.T.) is one of the essential needs of everyone with pain in order to develop a daily exercise program. Further therapy can maximize overall capability and improve the ability to function. The goals of therapy are three-fold. To work on overall strengthening and core muscles, aerobic conditioning, and stretching. Muscle strength allows one to be able to hold up the body and perform activities. Core muscles give the spine the ability to be upright, and most of us do not have good strength in these groups, and with a strong core, spine pain is much better controlled. Pain is often caused by tight muscles, so stretching keeps the muscles at the right length and decreases spasms. All three activities are necessary. It is like a three legged stool; Without doing one of the three, the stool tips over. You need all three bases to be stable.
The next method is a behavioral health intervention, and the goal is to train the brain to help control the interpretation of sensory signals. The brain has incredible power to manage all the signals it receives. Pain sensations are specific sensory signals, and the interpretation of the signals can be consciously modified. Normally the brain would just read these sensory signals as painful. If the brain is receiving many painful sensory signals, a short circuit can occur and the pain can become centrally amplified and intensified. Using techniques taught by psychologists, one can learn to modify the perception of the pain signals and essentially ignore them. Multiple different techniques have been used successfully including progressive relaxation, self-hypnosis, mindfulness, cognitive behavioral therapy and distraction. Again, to be successful with any of these therapies, one has to be interested and willing to put in the time and effort to make the techniques work.
Acute and chronic pain can be very successfully treated and managed with a variety of techniques. Opioid medications in reality are only a very small tool to control these symptoms. Controlling the opioid misuse requires patients to move beyond the want for a simple solution that takes no work. Chronic pain is not well treated with opioids for the long-term. It takes time and effort to control chronic pain, if one does not put in the work, there likely will not be a good solution.
Thomas Cohn, MD
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