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The best way to treat it without opioids



Sean Stephens was, as he confessed, an old man in the game of a young man.

In 2006, at the age of 38, he joined the Army National Guard, "a bit older, a bit used". he says, but he did not allow it to get in the way of his duties in Afghanistan. He could still keep up with the 19-year-olds with two hundred kilo packs through the desert, who were still standing for 12 hours on the back of a Humvee who had occupied the .50 cal. Sure, the pain at the end of the day had not gone away with Advil and a good night's sleep, but he could handle it.

When his fourth tour, however, did his job, it caught up with him. He was 42 years old, and the hours he trained for quad motorbikes on the eastern border took their toll. What started as a strange click on the back of his neck and a sting in his back turned into a seething, debilitating feeling, and soon his head was no longer connected to his spine. Even his hands failed him, the result of 1

8 months, in which the machine gun was clamped. When he was evacuated from Afghanistan in 2011, he could not even button his own shirts.

Pain – the earliest of our sufferings, a state from which no human escapes – is a hell. It is one of our oldest properties, an evolutionary system designed to protect us: burn yourself and you probably will not put your hand in the fire anymore. Pain is good for us in a sick way. Pain makes annoying sense.

But sometimes the system is completely confused with all evolutionary tendencies. When Stephens came home from Afghanistan, his pain did not abate. He limited his movements for fear of further injury. His doctors prescribed tramadol, an opioid that would provide a sweet relief to the pain of a surgical wound, but it was, at best, a fleeting escape from the constant companion that his pain had become. He took three to five pills a day, but still the headache on the underside of his skull blurred the rest of the world, his hands still did not work. He has "lost his shit", he remembers when the anger, stress and fear consumed him.

We know how to treat chronic pain. We know it since the seventies.

These are chronic pains – the tissue is healed, the wounds are scarred, but the silent scream radiates. About 50 million Americans suffer from it, the largest of them between the ages of 45 and 64 years. The experience is familiar: the knee that you blew when skiing in the 30s, the back that you can blow when you get out of bed Whatever you did 20 years ago to hurt your shoulders all the time to let. However, for nearly 20 million people like Stephens, suffering is really debilitating. This pain costs jobs and relationships and lives.

For a patient with a broken leg or an open wound, modern medicine has made extraordinary progress over the years as whiskey and a leather belt have given way to anesthetics and OxyContin. But in America, the treatment of chronic pain is in a base chaos. Often remedied by injections, a questionable success rate operation, or what Stephens got after his four trips to Afghanistan: potentially addictive pills that relieve pain but ignore the underlying issues.

Here is the thing. We know how to treat chronic pain. We know how since the 70s. But chances are you probably will not get the best treatment. With effort, you can approach it yourself, but to do that, you need to know a little about the inner workings of chronic pain.

Why it hurts

If you hurt your toe, the nerve endings in your foot fire electrical impulses to your brain: something bad has happened here. Your brain works with specialized nerve cells in the spinal cord to find a reaction. Was that a burn? Get the leg better from the hearth. Have we just broken our ankles? Let's turn the pain on and hurt for a few weeks, so stay tuned. Once the injury heals, the brain turns the dial down and no longer sends these amplified pain messages to your body. The pain dissolves blissfully. However, with chronic pain, the neural circuits remain amplified – your brain has actually rewired itself – and the pain is set to 11, even if the damage has been repaired. "Chronic pain," says John Loeser, MD, former director of a legendary pain management center at the University of Washington, "means that nature has failed."

John Bonica, the father of pain medicine, knew nothing about it. Back then, 75 years ago, he began treating injured soldiers returning from the Pacific Ocean at a military hospital south of Seattle. Apparently healed patients or those with missing limbs would complain their doctors with unrelenting pain. Dr. Bonica, who would write the first modern text on pain, realized that something complex – something not quite physical – was at work. He saw that anxiety, depression, and PTSD were common bedridden in chronic pain, suggesting that pain as well as emotions are affected by tissue damage. Much later, research would find that areas of the brain associated with anxiety and depression are also related to your anxiety and pain response.

But then, according to his observations, Dr. Bonica that chronic pain was such a complicated, multi-faceted animal that all kinds of caregivers were needed. Two decades after the Second World War, he opened the country's first "multidisciplinary pain clinic" – the famous one at the University of Washington. "It was not something a single person could solve," says Dr. Loeser, who led the clinic after Dr. Bonica had withdrawn. "The end result was that this would be a team approach." The goal was to completely eradicate the pain, and instead a squad was formed to teach the patients how to deal with their symptoms and improve their quality of life from all sides , A physiotherapist showed you how to move again, a psychologist taught you not to be afraid of your pain, an occupational therapist helped you figure out how to handle your anxiety at work, a dietician helped you lose weight Losing and breaking your joints A nurse case manager ran smoothly, and a doc overseen the entire team and all of your progress. The combined approach was revolutionary in treating chronic pain and achieved something that no other treatment did: it worked.

In the late 1990s, there were more than 1,000 interdisciplinary programs for treating chronic pain nationwide. They were expensive places. Treatment by a full group of experts could reach up to $ 30,000. However, numerous studies have shown that this approach was not only successful, but also paid off. It has been shown that healthy people who can work cost society much less in the long term.

In 1995, Purdue Pharma introduced OxyContin. It was a hit right away. In some early studies, it was strikingly – and wrongly – suggested that OxyContin could be an effective, non-addictive treatment for chronic pain. Insurance companies realized a quicker, cheaper solution than they saw one. "They said they should only give them the medications, the opioids," says Dr. Michael Schatman, Director of Research and Network Development at Boston Pain Care.

. By 2015, there were 20 million opioid-dependent patients in the US and 56 remaining interdisciplinary pain clinics.

Treat pain without pills

Sean Stephens was nervous. The Veterans Health Administration had the same opioid prescribing spurt as the rest of the American medical system, and a barrage of veterans with opioid disorders – 68,000 of them – completed the series by 2015. Veterinarians died twice as often from an accidental overdose as other Americans, and a verdict came from above: Opioids were out of favor. When Stephens showed up at the San Francisco VA Medical Center in 2010, his doctor, Karen Seal, M.D. that they would start lowering his tramadol dose. His pharmaceutical crutch, the opioid he had relied on to get through the days, was just getting out of his way. "I was scared."

In the two decades since Oxy, nearly all interdisciplinary pain clinics have been closed, and the VHA has become a surprise guide to keeping this approach alive. Other clinics are mostly located in large institutions – such as the Mayo Clinic and the Cleveland Clinic – because Schatman says these places can afford to lose money through poorly reclaimed pain treatments. But the VA does not have to make any money. It is responsible for the lifelong treatment of its patients and, over time, the treatment of pain is cheaper than endless pills and procedures.

Dr. By chance, Seal was the head of the Integrated Pain Team in the VA, and now she was responsible for adjusting pain therapies that did not involve unlimited drug replenishments. Her message to Stephens was no nonsense: "Pharma tells you that you can take a pill to fix everything." But not here, she said. There are goals here that can be used to treat pain without relying solely on opioids. Here they would work with him to get his life back.

Some of the treatments that Dr. Seal Stephens was clearly enough (physical therapy, non-addictive drugs, simple goals such as 20-minute training), but others were the kind that made men tough (yoga, deep breathing, meditation), cognitive-behavioral therapy. Stephens vaguely knew there were other ways to treat pain. He had tried Pot, but he did not like it. He knew that yoga was something, but he did not consider himself a yoga type. "I was not interested in finding another solution to pain," he says. "But these people talked to me about what we can do to overcome this point. It was this very aha moment. I've never put together that stress reduction can be pain relief.

  Focused man practicing yoga in yoga classroom

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One of the most intricate components of interdisciplinary care by men is likely to see a therapist treating physical pain with cognitive-behavioral therapy It may sound like BS of the new age, but the brain is a strange thing: Show devout Catholics a picture of the Virgin Mary during laboratory-controlled pain studies and they give less pain to make them believe they are close to it To relieve pain, the brain will release natural opioids to block the pain from constantly updating our basic ideas about pain. Tor Wager, Ph.D., a neuroscientist at the University of Colorado Boulder, has recently discovered that the brain will trigger more pain when the brain expects more pain due to injury. "If you expect more pain, you really feel more pain," he says. And when you live in constant pain, you are afraid to feel more of it. You get a feedback loop that really makes the pain worse. Learning to think differently can help break this cycle.

Combined with physiotherapy, gentle training, and emotional support, this holistic approach has delivered dramatic results across the United States. So far, the agency has reduced the number of opioid-dependent veterinarians by about 40 percent, and a study by Dr. med. Seal showed that patients in interdisciplinary clinics were 50 percent more likely to significantly lower their dosages. "I almost became an Evangelist," she says. "If you no longer have opioids, you get your life back."

For Stephens, the procedure helped him to take control. "The pain is still there," he says. "My wife still needs to button my shirt." Now he's in charge of his pain – not the other way around. Today he breathes deeply all day long. He has a therapy dog ​​that keeps him calm. And he pauses for ten minutes to de-escalate every time he feels the pain rising and his fear rising. "That gets me past the pain," he says.

For millions of non-veterinarians who suffer, there is a similar way to find relief, but it takes some effort. Another thing, says Stephens, is courage. The courage to be the "Old One" in your first yoga class is ready to try something that sounds independent of your pain, like deep breathing. Because in the end it is much less painful than a life in constant pain, when you feel confident in the Y or embarrassed to go to the therapist.

How to Take the Pain

"The best way to treat chronic pain is to treat it as a team sport," says Dr. med. Sean Mackey, chief of pain medicine at Stanford University. You need different players to manage different positions. If you do not have access to an interdisciplinary pain clinic, you can do the following:

Talk to a social worker or therapist.

"The burden of pain lies mainly in the brain," says Dr. Mackey and a psychologist specializing in pain can help you understand this in a relatively short time. It's not a hocus-pocus, either. "Your beliefs, emotions and thoughts about your pain play a big part in your pain experience," he says, and he's got the brain scans to prove it. Chronic pain cords into your brain, and therapy can help reverse this rewiring. Dr. Mackey says, "It can not eliminate the pain, but it can improve it and give you back control."

Consider PT

. "What do you think, first and foremost, what the team doctors do for the 49ers, if they're a guy, is the knee blown out and undergoing surgery, the answer is a physical rehabilitation," Dr. Mackey says, although it can hurt "You need to strengthen your muscles and support the painful area." Studies show that PT reduces pain in the long run and insurers often cover it.

Do not be taciturn 19659036] Managing your pain is a long-term effort and many insurers offer self-help groups: In or around major cities, there are often free meet-ups where you can learn how others handle pain.

Relaxation Measures

Reduce stress by reducing stress Your pain, Dr. Mackey says, Free apps like Headspace can guide you through mindfulness lessons, YMCA can offer meditation classes, and acupuncture helps many Humans, your pain may never completely disappear, says Dr. Mackey, but that's not the point. By putting all this together, you can take control and prevent pain from dominating your life. You win; Not pain.


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