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Beyond Opioids: Alternatives for Pain Management

In this article from the May 10 Arkansas Democrat-Gazette, Dr. Vic Snyder, corporate medical director for external affairs at Arkansas Blue Cross and Blue Shield, discusses alternatives to opioid use for pain management.

In 1985, motivated by the wisdom and decency of Harry Belafonte and others, music and hunger merged as international musical superstars raised large sums of money to help in the famine relief efforts going on in multiple areas including Ethiopia.

The song “We Are The World” was released in March, followed in July by the international Live Aid concert simultaneously occurring in London and Philadelphia. For three months that year, I worked as a refugee camp doctor in Sudan near the Ethiopian border. We were blessed to have Harry Belafonte visit our camp as he continued his efforts to educate the world on the needs of impoverished people.

Not long after I returned to Arkansas, I became sick, as sick as I had ever been. I was diagnosed with Hepatitis E, a kind of hepatitis found in Africa. The nausea, throwing up and overwhelming puniness was bad enough, but the worst symptom was the achiness. I couldn’t keep medicine down to relieve the pain.

And that’s when I encountered another musical superstar, Linda Ronstadt. She didn’t make house calls and I never met her, but for hours I listened to “What’s New,” the first album she made with Nelson Riddle; and that encounter became much more intense than the visit with Harry Belafonte.

It was pretty much just the title cut. Over and over I played it, anytime the achiness and pain elevated my misery meter. Her music, her voice opening that song with the lyric “What’s new?” immediately made my symptoms tolerable. I could feel my body letting go of its misery.

Was it relaxation? Was it distraction? Was it self-hypnosis? I don’t know, but it worked. Thank you, Linda Ronstadt!

For too many years, we doctors were quick to prescribe an opioid for both acute and chronic pain. That was certainly appropriate for many patients with some forms of cancer or end-of-life issues. But not for most bumps, bruises, and the wear-and-tear of life.

This was in the days when it was common for doctors to see 30, 40 or even more patients a day. There wasn’t time for much else than a quick discussion, exam and prescription. The unfortunate result was that too many patients received inappropriate opioids, and too many people became addicted.

But now, more providers take the time to talk with patients regarding treatment goals and possible solutions other than a medication. It is important to set realistic goals. Not all pain will completely go away, and the side effects of trying to eliminate all pain may be worse than the underlying problem.

There are non-pharmacologic therapies that work for some people in some conditions. Physical therapy may be helpful for knee-strengthening exercises, or as a conservative treatment for an acute back strain. And it is important as much as possible to not let an acute injury lead to a period of complete physical inactivity.

Non-opioid medications such as acetaminophen or ibuprofen may reduce pain if there are no contraindications. In fact, for dental pain, ibuprofen has been shown to be more effective than opioids for most conditions.

In Arkansas, too many of us have undiagnosed or untreated underlying behavioral health issues such as anxiety or depression. Resolving pain issues may be difficult without also understanding and appropriately treating the behavioral health issue. Incidentally, that is true for a variety of chronic medical conditions such as diabetes: Getting behavioral health challenges under control helps medical management.

There are painful conditions that benefit from long-term management by a pain specialist, but alternatives to opioids for both acute and chronic conditions are worth discussing with your doctor. She may know you well enough to suggest some possibilities.

And if she agrees, consider pampering yourself: a massage, a slow walk with a friend, or your favorite old movie. If it buys some time for your body to heal, or gets you through an episode of pain, do it.

Maybe my old friend Linda will come by and watch it with you.

 

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