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Chronic pain dies with meditation and lower doses of opiates: shots



To deal with chronic pain, Pamela Bob's morning routine includes stretching and meditating at her home in Fairfield Glade, Tenn. Bob says that this awareness and body intervention has greatly reduced the painkiller needed.

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To deal with chronic pain, Pamela Bob's morning routine involves stretching and meditating at home in Fairfield Glide, Tan. Bob says that this awareness and body intervention has reduced the much needed painkiller. for NPR

There is new evidence that body interventions can help reduce pain in people who take prescription opioids – and lead to a reduction in the dose of the drug.

In a study published this month in the JAMA Internal Medicine researchers reviewed evidence from 60 studies involving about 6400 participants. They evaluated a number of strategies, including meditation, guided imaging, hypnosis and cognitive-behavioral therapy.

"Mindfulness, cognitive-behavioral therapy, and clinical hypnosis seem to be the most helpful in reducing pain," said study author Eric Garland, a professor at Utah University. He said the dose reduction was modest overall, but the study signaled that this approach was beneficial.

And, Pamela Bob, who lives in Fairfield Glade, Tenn., Can bear witness to the benefits. She is 56 and has endured decades of pain. "Oh, I've been scared for years," Bob tells us.

Bob was born with a malformation in his pelvis that resulted in pain. Over two decades, it has undergone more than a dozen major operations, but none has offered relief. "When you get to that point, you can't see beyond the pain," says Bob. "You just survive."

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Bob was born with a malformation in his pelvis that resulted in pain. Over two decades, it has undergone more than a dozen major operations, but none has offered relief. "When you get to that point, you can't see beyond the pain," says Bob. "You Just Survive."

Jessica Tezac for NPR

She was born with a malformation in her pelvis that led to pain. For two decades, she has undergone more than a dozen major operations, but none of them has relieved her; each procedure left more scars and nerve damage.

"I felt desperate," says Bob. "I didn't feel like I had any control.

She couldn't do basic things like cook – or take care of her family.

" I was completely exhausted, "Bob says." And by that time, , you can't see beyond the pain – you just survive. "

She was put on high doses of opioids to ease the constant pain, but then, a few years ago, she thought" there just needs to be a better way. " She didn't feel like a drug herself, she says, and eventually she found help at a clinic that specializes in additional drugs.

"We offer a variety of things," explains Wayne Jonas, MD. , who treated Bob at the Fort Belvoir Community Hospital Pain Clinic at the Fort Belvoir Pain Clinic in Fairfax County, Washington

"We offer physical therapy, behavioral medicine, acupuncture, yoga and mental physical practices," says Jonas. of these is the cure for everything, he adds, but the idea is that there are many tools in the toolbox that people can try.

Jonas is a longtime adherent of the integrated mind-body approach to pain management and is the author of How Healing Works a book describing the science behind these approaches.

He says that when one experiences severe pain, the body's normal defenses diminish. [19659030] Pamela Bob picks up some mint from her inner herb and lemon guard EurLex-2 en At her home in Fairfield Glade, Tenn. Changes in her diet – much more greens, fruits, vegetables, herbs and spices that reduce inflammation – are also part of her pain-reducing routine.

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Pamela Bob gathers a little mint from her indoor garden with herbs and lemons at her home in Fairfield Glade, Tenen. Changes in her diet – much more greens, fruits, vegetables and herbs and spices that reduce inflammation – are also part of her pain-a reduction routine.

Jessica Tezac for NPR

"It accumulates various dysfunctions," says Jonas. Pain increases the levels of the stress hormone cortisol and also increases the inflammatory processes in the body. "This starts a continuous cycle of negative feedback that causes more pain," Jonas explains.

It is no surprise, he says, techniques such as meditation or yoga may be helpful. "If you engage in deep consciousness – and relaxation – it will counteract these stress reactions," Jonas says.

Think of meditation as a form of mental exercise.

"It's almost like lifting weights for your brain," Garland says. Just as curling a dumbbell strengthens the biceps, he says, "meditation is almost a way of arranging the dumbbell of the mind to enhance self-control of the mind."

And this can change the way the brain perceives input from the body. "If you can change the way the brain receives signals from the body, you can actually change the experience of pain," Garland says.

But here's a trick: Learning to meditate takes time, effort, and a little training – it's more complicated than eating a pill. Pamela Bob clung to him. She has tried a bunch of these alternative mind-body strategies, including acupuncture and biofeedback, and now begins her meditation practice every morning.

"4:45 in the morning – and I just woke up," she says in a recording she made of her practice so I can listen to it. It sounds centered and calm. "I allow my body to feel as calm as possible."

After several surgeries failed to ease her pain, Bob couldn't do basic things like cooking – or take care of his family, she says, "I was completely exhausted." The inclusion of mind-body techniques has completely changed this, she says.

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After several surgeries failed to ease her pain, Bob couldn't do basic things like cook – or take care of his family, she says. "I was completely exhausted." The inclusion of mind-body techniques has completely changed this, she says.

Jessica Tezac for NPR

Bob also reworked his diet, now eating much more greens, fruits and vegetables, and herbs and spices with anti-inflammatory properties. On the day we talk, she makes a spinach honeycomb with ginger, mint and rosemary.

"I swear you can smell each of these spices, they smell so good!" He says.

Bob is so calm now that just hanging out with her, you will never guess everything she's been through. And she feels so much better, "she says."

"That gives [have] the right to come this way," says Bob She says she made a fundamental transition in her mind: Instead of waiting for doctors to cure her with surgery or injections, she now realizes that many

Pamela Bob is still taking medication to help manage her pain and other health issues, but she cites meditation as key to helping her reduce her opioid dose by up to 25 percent from the amount she took once. Learning to meditate takes time, effort and a little workout – it's more complicated than eating a pill. But she stuck to that.

Jessica Tezac for NPR


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Jessica Tezac for NPR

Pamela Bob is still taking medication to help manage pain and other health issues, but she cites meditation as key to helping her reduce her opioid dose by up to 25 percent of the amount she once took. Learning to meditate takes time, effort, and a bit of exercise – it's more complicated than eating a pill. But she stuck to that.

Jessica Tezac for NPR

"So much of it all lies within me," she says.

Bob accepts that she can never be completely painless, but now she feels she has control over the discomfort.

She reduced her opioid dose by 75%. She says she still benefits from a small maintenance dose of the drug. And her doctors say the benefits of the drug outweigh its potential harms.

In the midst of the opioid epidemic, Pamela Bob's story may seem unlikely. But many people who take opioids for an extended period have similar stories. And last month, the Department of Health and Human Services released new guidelines, urging doctors to take a deliberate approach to lowering opiate doses for patients with chronic pain.

The guidelines indicate the potential harm of forcing patients to discontinue medication.

"The goal is not necessarily to remove all opioids, but to reduce it to a safe dose [that is]," NPR adm. Bret P. Giroard, physician and assistant secretary of health at HHS. We asked him about Pamela Bob's case. He is not her doctor, but upon hearing her story, he said: "The fact that she was able to significantly reduce her opioids is a success story.

Giroir says that this kind of comprehensive approach, which includes alternative therapies, can be a model of what we want to do nationwide. "He points out that earlier this year, the Medicare & Medicaid Centers offered to cover acupuncture for Medicare patients who have chronic lower back pain.

Bobb massages his feet with sweet smelling lavender oil – another part of her morning routine, successfully alleviating long-term pain, she finds all the tools in her toolbox.

Jessica Tezac for NPR


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Bob massages her feet with sweet smelling lavender oil – another part of her morning routine. Successfully alleviating long-term pain, it takes all the tools in the toolbox.

Jessica Tezac for NPR

As the evidence accumulates, Giroir says, more attention will be paid to the coverage of alternative therapies.

A Gallup poll for 2017 found that 78 percent of people would prefer to try other ways to deal with their physical pain before taking pain.

And medical groups like the American College of Physicians recommend doctors offer more non-pharmacological treatments for patients with pain, such as those who have chronic lower back pain.

However, a book published last year most insurers have not accepted policies that comply with these guidelines and many do not pay to cover these services. An accompanying editorial says it's time to change that.

Clearly, when it comes to dealing with pain, it takes away all the tools in the toolbox. And for opioids, the approach should not be all or nothing. Pamela Bob says she has learned that the combination of medicine and mind-body therapy works best for her.


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