Real Alternatives to Opioids for Pain Management

By Healthcare Attorney Alex Scarbrough Fisher

Healthcare providers are aware of the current opioid epidemic in the United States, as well as the risks—both to the provider’s patients, and to the provider’s licensure—of prescribing opioids to patients for the management of chronic pain. So, what do we do about it? 

Healthcare providers know that opioids can be harmful to patients long-term, and harmful to providers who may face licensure discipline due to strict regulations surrounding the prescribing of narcotics. However, patients are still showing up at healthcare providers’ offices complaining of very real, chronic pain. How should healthcare providers address these patient concerns if they aren’t going to use opioids?

1. Yoga.

Yoga is scientifically proven to gradually loosen the muscles and connective tissues around bones and joints, bring oxygen and blood to cartilage, and increase blood flow to all cells in the body, improving their functionality. Although yoga can be expensive, depending on the city you live in and where you choose to practice, yoga can also be free–or close to it. Yoga videos can be found for free on youtube.com, most YMCAs offer a few yoga classes a week, and some cities have free community yoga classes around town. If you live in the Nashville area, Small World Yoga, a local non-profit, offers several free yoga classes each week.

2. Weight Loss.

Studies show that obesity negatively impacts the musculoskeletal system, and increases mechanical stress to the joints and tissues of the body. Many healthcare providers may be reluctant to address weight with patients, as this may seem like a matter of physical attractiveness rather than a legitimate health concern to many patients. However, any personal discomfort in initiating such a conversation should be superseded by a desire to improve a patient’s wellbeing by frankly and compassionately discussing the physical stressors on a patient’s body as a result of obesity. A dietitian can support a patient’s weight loss, as well as in-person and online support groups, such as Weight Watchers.

3. Cessation of the Use of Tobacco.

Researchers have found that smoking can cause chronic pain by contributing to osteoporosis and the deterioration of spinal discs, and actually interfering with a smoker’s nervous system, causing an increase in a smoker’s perception of pain. Similar to weight loss, smoking cessation can be done by the individual on their own, or with the assistance of prescription or over the counter smoking cessation aides, as well as in-person and online support groups.

4. Therapy.

Emotional stress can lead to the tensing and constricting of muscles, leading to muscle fatigue and inefficiency. Further, traumatic events can lead to the overstimulation of the sympathetic nervous system, resulting in increased cortisol levels (a stress-related hormone), and a decreased ability of the body’s immune system to respond to illness and heal the body. Patients who have experienced a traumatic event (for example, the death of a loved one, a serious illness, or who were the victim of a crime) may be experiencing emotional stress that, at the very least, may contribute to chronic pain. Such underlying emotional stress or trauma can be addressed with a mental healthcare professional. Most health insurance providers include mental health services, and many cities have mental health services for free or a reduced cost based on a patient’s income.

Pain is an important tool of evolution. It’s our bodies’ way of saying, “Hey listen up! Something is seriously wrong!” When the main form of treatment by healthcare providers is to mask pain signals to a patient’s brain, rather than addressing the underlying conditions, we are simply kicking the can down the road, and this may result in more pain and decreased mobility for patients long-term. By contrast, when healthcare providers compassionately address patients’ underlying causes of chronic pain—obesity, nicotine use, trauma—patients have a higher likelihood of reducing their pain, and improving their quality of life in the long-term. That’s a win for everyone–except the makers of opioids. And I’m not too worried about them.

Thoughts? Feel free to email Alex directly at alex@thompsonburton.com, or comment below.

 

Alex Scarbrough Fisher is an associate attorney at Thompson Butron PLLC. Her practice area focuses on litigation and administrative law. Alex's administrative law practice's emphasis is in health care related boards, including the Tennessee Board of Medical Examiners and the Tennessee Board of Nursing. 

 

 

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Comments

Sure. Just make sure your behind bullet resistant glass when you make these suggestions.

Rusty Shackleford MD

Yes that all sounds great but the challenge is convincing your patient that yoga and weight loss are substitutes for pain meds.

David Caulfield ARNP