There is new evidence that body interventions can help reduce pain in 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. According to him, the dose reduction was modest overall, but the study signaled that this approach was useful.
And Pamela Bob, who lives in Fairfield Glade, Tennessee, can prove the benefits. She is 56 and has endured decades of pain. "Oh, I've been scared for years," Bob tells us.
She was born with a malformation in her pelvis, which led to pain. For two decades, she had undergone more than a dozen major operations, but none of them helped 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 cooking – or taking care of her family.
"I was completely exhausted," says Bob. "And when you get to that point, 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. She eventually found help in a clinic that specializes in complementary and alternative medicine.
"We have a variety of things to offer," explains Wayne Jonas, a doctor who treated Bob to a pain clinic at Fort Belvoir Hospital Community Hospital in Fairfax County, Va.
"We offer physical therapy, behavioral medicine, acupuncture, yoga and mental physical practices," says Jonas. None of these are easy for everyone, he adds, but the idea is that the toolkit has many tools for people to try.
Jonas is a long-time supporter of the integrated mind-body pain treatment approach and is the author of How Healing Works a book describing the science behind these approaches.
He says that when one experiences severe pain, their body's normal defenses diminish.
"It accumulates various dysfunctions," says Jonas. Pain increases the levels of the stress hormone cortisol and increases the inflammatory processes in the body too. "It starts all the time but negative feedback that causes more pain," Jonas explains.
It is no surprise to him that techniques such as meditation or yoga may be useful. "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 let my body feel as calm as possible."
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 spinach sauce with ginger, mint and rosemary.
"I swear you can smell each of these spices, they smell so good!" She says.
Bob is so calm now that just hanging out with her will never suggest everything she has withstood. And she feels so much better, she says.
"This 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 of these alternative therapies have empowered her to help herself.
"She's lying so much inside of 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 dose by opioids 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.
At the height of the opioid epidemic, Pamela Bob's story may seem unlikely, but many people who take opioids for long periods have similar histories Last month, the Ministry of Health and Human Services released new guidelines, urging doctors to take a deliberate approach to lowering opioid doses for patients with chronic pain. "The goal is not necessarily to remove all opioids, but to reduce them 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 after hearing her story, he said: "The fact that she has been able to significantly reduce her opioids is a success story.
Giroir says that this kind of holistic approach, which includes alternative therapies, can be a model of what we want to do nationwide. "He points out that earlier this year, the Centers for Medicare & Medicaid Services offered to cover acupuncture for Medicare patients who have chronic low back pain.
As evidence accumulates, Giroir says, he will turn around more attention to the coverage of alternative therapies
A Gallup poll in 2017 found that 78 percent of people would prefer to try other ways to deal with their physical pain before taking pain medication.
as the American College of Physicians recommends a cure ary to offer more pharmacological treatments to patients with pain, such as those with chronic low back pain.
However, a book published last year found that most insurers did not adopt compliant policies
It is clear that when it comes to dealing with pain, it takes away all the tools in the toolkit. And for opioids, the approach should not be all or nothing. Pamela Bob says she learned that the combination of mind-body medications and therapies works best for her.