You may have heard – there is an opioid epidemic in the United States. Your familiarity with this crisis may be anything from reading headlines, to knowing someone personally affected – but it is true. And your proposed solution to this epidemic may be government oversight, physician regulation, drug addiction resources, or funding for pain relief alternatives. All propositions with good intent.
And since everyone else I know has an opinion on the matter, I figured I should too. Especially since I am a physical therapist and embrace a less pharmaceutical perspective on healthcare. I also embrace the mantra – “Don’t complain about a problem, unless you can offer a possible solution”. Unfortunately, I do my share of complaining.
But before I get in to the nitty gritty, I think it’s worth putting some context on this list. First of all, I think the only true, long-term resolution to this crisis is reducing the frequency and volume of opioid prescription in the US. Meaning, we certainly need to create an infrastructure to help those currently addicted to opioids, but more importantly we need to reduce the number of people given opioids from this point forward.
Think of the old Saul Alinsky “babies in the river” parable – where a camper near a river notices a baby floating by, then two, then three, then another…at some point this camper needs to decide whether to keep rescuing each and every baby floating by, or investigate up river to find out who is putting the babies in the river to begin with. Similarly, if there was a serial arson on the loose, starting 10 fires a day in your town – you either need to hire 10x more firefighters…or 1 good detective. I wish I had less gruesome analogies, but that’s all I’ve got. Make sense though?
With that mindset, I propose a list of non-opioid pain relief alternatives to consider – with the obvious caveat and understanding that there are still some diagnoses and conditions which require pharmacological narcotic intervention. I live in a fairy tale world, but I still understand the real world.
Many dismiss acupuncture as an ineffective fringe alternative to pain relief, but I think we will see an increased acceptance of acupuncture with a government and a society willing to try anything prior to narcotic pain prescription. There is research to suggest acupuncture can help with everything from labor pain, to chronic illness, to internal disorders, to orthopedic conditions. As a PT, I’ve had several patients see benefit from acupuncture, that I could not provide.
Although acupuncture is a form of “dry needling”, not all dry needling is acupuncture. “Dry” needle means no injection is performed; and the dry needling techniques performed by a physical therapist, chiropractor, or physician have quickly grown in popularity for both pain relief and sports medicine application. Research has even expanded beyond rehab and is being utilized in the ER setting with some promising results, and a CO survey suggests inclusion of dry needling in your treatment plan can significantly reduce or eliminate the amount of medication needed (it’s worth the 3 minutes to watch).
Having practiced in both Colorado and Washington, empirically I’ve heard (and smelled) enough about marijuana and its benefits from my patients to consider it a potentially effective pain relief option. Don’t consider this an endorsement for recreational use and I’d never make any sort of recommendation to a patient (because it’s outside my scope), but envision a patient finding no benefit from other modalities considering narcotic use – not as egregious anymore. I think the mentality of some physicians may shift towards some of these options out of necessity and patient request. And after attending CSM and seeing medical marijuana as the cover page of the PT Journal – I think PTs will need to familiarize themselves with it as well.
In fact, Whitney Ogle PT, DPT, PhD at the Humboldt State DPT program is conducting research on the “Physical Therapist Attitudes and Patient Use of Medical Marijuana as an Adjunct to Physical Therapy” – and is recruiting both PT and patient survey volunteers.
If you are a Physical Therapist and interesting in participating – CLICK HERE.
If you are a patient and interested in participating – CLICK HERE.
Or you can follow them @hsuhiimr (iG) for up-to-date cannabis-related research.
If the last suggestion was at all controversial, I attempt to shift towards one more agreeable. Although possibly most logical, those considering opioid use likely see exercise as unrealistic or harmful – so what if I change the word to “movement”. And what if I agree there is possibly some sort of intervention needed to disrupt a pain cycle or perpetuated dysfunction prior to full immersion into the exercise realm? But ultimately exercise, physical activity, and movement is by far the MOST effective remedy to any sort of condition – from orthopedic, to chronic disease process, to post-surgical, to…well anything with a brain attached to it. And even if you are considering any other options for pain relief, I contend if you are not integrating some sort of movement prescription in to your strategy – long-term success will be compromised. Find someone (a PT, a chiropractor, an acupuncturist, or physician) who can help you move better – then move often.
Positive Neuroplasticity Habits
Those clinicians reading know this is not a specifically recognized singular or dose-able intervention, but is ultimately one of the most powerful aspects of either pain perseveration or pain relief. “Neuroplasticity” is actually a pretty generic term for the constant neural adaptation process all of us undergo constantly in either a positive or negative sense. The image below is one of the most concise, yet descriptive explanations to how everything we do has an ultimate effect on our mental health, cognitive ability, and physical function (or lack thereof). Social interaction, sleep, nutrition, physical activity – they all have the ability to improve your pain. Don’t get carried away thinking you need to do walking Sudoku with your well-rested kale-farming friends everyday – but if you can identify with 1-2 of the “negative” neuroplastic descriptors on this list, try implementing a very basic plan to improve. Re-assess in 2 weeks and truthfully consider if you’ve noticed a change.
To conclude – if you are someone struggling with chronic pain, or a clinician working with these individuals, I know it’s not as simple as a list could suggest. I’m not naïve to believe “if you follow these 5 easy steps” there will be an immediate change. I want you to know your pain is real, BUT it is not permanent and it can change. What may work or not work for someone else may not do the same for you. Whether you have considered alternatives on this list or not, finding a clinician committed to using ANY strategy within their expertise to get you moving better and living life with less pain can be life-changing.
If you have other suggestions that could help someone, or feedback based on your experience or expertise – let’s hear it!
Otherwise feel free to follow me (@DPTwithneedles – Twitter/iG) or us (@iDryNeedle – iG/@USDryNeedling – Twitter) and see what else we think!