Now, perhaps more than ever before, there’s a need for non-narcotic pain management within the framework of addiction treatment.
Consider a recent staggering revelation: Over the course of 2006 to 2012, pharmaceutical companies flooded America with 76 billion opioid pills [1], enough to supply every man, woman and child in the country with 36 pills per year. PT in Motion, a publication by the American Physical Therapy Association, notes [2] that “the presence of pain is one of the most common reasons people seek health care. National surveys have found that chronic pain — defined as pain lasting longer than 3 months — affects approximately 100 million American adults and that the economic costs attributable to such pain approach $600 billion annually.”
And prescription opioids have long been used to treat chronic and acute pain. While opioid prescriptions have dropped since their height in 2012, the Centers for Disease Control and Prevention notes [3] that in 2017, “there were still almost 58 opioid prescriptions written for every 100 Americans,” and “more than 17% of Americans had at least one opioid prescription filled, with an average of 3.4 opioid prescriptions dispensed per patient.”
What follows, according to the National Institute on Drug Abuse [4], has grown from a problem into an epidemic: “Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them,” and “between 8 and 12 percent develop an opioid use disorder,” or an addiction. As a result, many pain patients who do become addicted are reluctant to seek help.
A partnership with Total Rehabilitation
Dr. Don Reagan
“When they come to treatment for addiction, and they’re in pain and told they can’t take opioids anymore, they feel hopeless,” says Kristina “Nena” Hall, a Certified Therapeutic Recreation Specialist with Cornerstone of Recovery. “They ask, ‘What am I going to do?’”
That’s where Hall and Logan Magan, a Cornerstone therapist, enter the picture. As leaders of Cornerstone’s Non-Narcotic Pain Management Program, they’ve conceptualized a new therapeutic tool that’s now a part of the Cornerstone arsenal, and like other therapies, it’s designed with one goal in mind.
“We want to give patients hope,” Hall says.
To achieve that, Cornerstone of Recovery has partnered with Total Rehabilitation, a division of Maryville, Tennessee’s Blount Memorial Hospital, which recently opened an outpatient clinic on the Cornerstone campus to meet the needs of patients with pain management. Dr. Don Reagan and his team of Total Rehabilitation specialists see Cornerstone clients on Mondays and Wednesdays to provide physical therapy for the management of pain issues that may have precipitated their substance abuse issues.
“My experience is in general orthopedics, sports medicine and strength and conditioning, and what I hope to do is to work with patients who are going through this genuinely large personal transformation who are ripe for change,” Reagan says. “I want to help people through relationships, through education, through empowerment, through self-efficacy and through movement. I love helping people.”
Cornerstone of Recovery’s Non-Narcotic Pain Management Program is an ideal fit for Reagan’s passion. In September, the facility will mark its 30th year as a drug and alcohol treatment center, and from the beginning, Cornerstone has sought to combine traditional 12 Step recovery with evidence-based therapies and treatment modalities to give addicts and alcoholics the best chance at sustained recovery. While Cornerstone treats patients who are addicted to alcohol and all drugs, those whose addictions begin with prescription opioids given for pain management often refuse to seek help because they fear giving up their medication and exposing themselves to greater pain.
The brain-body connection
The Non-Narcotic Pain Management program, conceived by Clinical Director Dr. Scott Anderson and Director of Residential Programs Anne Young, is designed to both change that mindset and to give patients the tools to manage pain outside of pharmaceuticals.
“Narcotics mask pain, but they don’t relieve it,” Hall says. “It’s been proven that opioids, when you take them, will mask the pain by about 30 percent. But with diet, exercise and mindfulness, you can get up to 70 or 80 percent relief, so it’s a huge difference — and it doesn’t come with the side effects of opioid use.
“The biggest thing to learn about chronic pain is that it does not equal tissue damage. It is actually reactivity to pain and the way our brain processes it. We talk about phantom limb pain as an example how much pain is related to the brain instead of tissue damage, and we also use the example of a hot tub: When you get into a hot tub, it’s so hot that it feels like a thousand degrees, but the longer you sit there, the more your body becomes used to it. The temperature stays the same, but your body starts a process called habituation, which is basically tolerance.
“When your body gets into habituation with pain, it actually gets better at producing pain,” she adds.
Patients can be recommended for the Non-Narcotic Pain Management Program throughout their stay at Cornerstone. Therapists, counselors, medical personnel can all make that suggestion, or patients can inquire about it individually. The process begins with a processing group, followed by a lecture. The groups focus on the nature of pain and the understanding of it, while the lectures focus on Cognitive Behavioral Therapy skills as a management tool, along with how to deal with flare ups and the pain activity cycle.
“We talk about how sometimes you may feel like you don’t want to do anything, but it actually increases your pain if you do nothing,” Hall says. “We talk a lot about sleep and nutrition, where we promote an anti-inflammatory diet and talk about sleep hygiene and how you get good sleep.”
A life bigger than pain
Patients can then request an appointment with Reagan, whose offices are located in the Cornerstone Fitness Center. Currently, Reagan sees patients from 1-5 p.m. on Mondays and Wednesdays, but as the program develops and matures, he hopes to expand those hours. It’s not a cure-all, he cautions; one of the biggest misconceptions patients have is that physical therapy will “fix” them, or that trying it is pointless because it hasn’t worked in the past.
“And that’s just a defeatist attitude,” he said. “There are a lot of different approaches and plans of care, and I’m coming here to empower and to educate. Lifestyle management has more to do with pain control, and the biggest question we ask patients is: Do they want to get better? Do they want to change?”
If the answer is “yes,” then the program won’t just provide pain relief, Hall points out — it will become a lifestyle transformation.
“We just want to give patients hope, because their pain has gotten so big that it’s taken over,” Hall says. “The goal of our program is not to be pain-free, but it is to have less pain. That’s the hope, and that’s how they’re going to grow their lives to where their lives are bigger than their pain.”
SOURCES
[1]: https://www.npr.org/2019/07/17/742818899/opioid-epidemic-road-map-shows-76-billion-pills-distributed-between-2006-and-201
[2]: http://www.apta.org/ptinmotion/2018/10/feature/opioid/
[3]: https://www.cdc.gov/drugoverdose/data/prescribing.html
[4]: https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis