Possible reactions from your patients if suggested alternative pain relief

brownbook · Oct 28, 2017

I am assuming this is not intended for patients in an acute care hospital, especially with sudden acute pain or fresh post op.

Perhaps it's maybe something for a doctor and patient to think about, discuss, in a doctor's office if the patient is not getting good pain relief and or needing more and more opiods.

Confession, I have never had chronic pain. And I'm not a fan of alternative medicine. However I am beginning to accept that opiods don't always work for long term chronic pain and opiods have side effects that may exacerbate the original insult.

Pain and opiods need to be reevaluated. The same way medicine has come to realize common bacterial infections and antibiotics ended up doing way more harm than good.

Emergent, RN · Oct 28, 2017

I have chronic pain. Being active and busy is super helpful. The more I move, the better I feel.

Guest219794 · Oct 28, 2017

There are many patients who will welcome this approach.

And, if we stop reflexively going to narcotics, and making patients believe that there is a pill to fix every problem with no personal effort, some patients will be happier and healthier.

But, there is a huge group that will go kicking and screaming.

Davey Do · Oct 28, 2017

The majority tend to go for the easiest, simple solution, like medication, to deal with discomfort.

Like Emergent, I have chronic pain and keep active. I do some kind of workout every day, whether it be weights and/or the elliptical or bicycle. These methods are sometimes inconvenient and time consuming, but I'd rather put up with that then the effects of not exercising.

The thing with most People in pain is that it hurts just to move and analgesics decrease that discomfort. Those of use who use activity for pain relief have probably always been active- we just didn't allow our injuries to keep us sidelined very long.

I often attempted to resume activity too soon and prolonged the healing process.

And I tell you what: When I'm on my bicycle, I feel no pain and I owe that to being an avid bicyclist since I was 21 years old.

For me, exercise is a big part of my lifestyle.

elkpark · Oct 28, 2017

I didn't hear the specific NPR report you are referencing, OP, but I highly doubt that any "expert" actually said, "Oh just tell people to take yoga." I work I a large academic medical center and, as a member of the psychiatric consultation and liaison team, I often find myself working with members of the medical center's pain management team (we overlap on a lot of cases). The savvy pain management people in this country will tell you that opioids are not the be-all, end-all of pain management, and are often actually counterproductive in treating chronic pain (try reading up on "hyperalgesia"). Most feel that the most effective regimen for most people is a multimodal approach that includes a variety of medications besides (or instead of) opioids as well as things like, yes, massage, yoga, acupuncture, and other kinds of nonpharmacological approaches. In my experience, the people who are serious about treating their pain are eager to try things that may be more helpful for them than just opioids and, yes, I talk all the time with people who have chronic pain who haven't tried any other approaches, because a) they don't know any better, all they've heard from society all their lives is that the only thing that that will help people is "pain pills" (opioids), and b) their PCP has been treating them all this time and has never suggested anything other than a steady diet of opioids. In my experience, the people who really fight against this are the people for whom the process is more about getting and taking opioids than about actually treating the pain.

LovingLife123 · Oct 28, 2017

I have chronic pain. I have since I was 15 years old. It's taken years and years of doctors and trial and error to get me to where my pain is manageable. I use a combo Therapy of exercise, massage, and opioids. The opioids are low dose and compliments my exercise.

Massage is something I do but I have to go once a week for it to be effective. The first several trips are extremely painful for me and I am in pain for several days afterwards. But once it gets going, I do get some relief.

People can shy away from massage and exercise because it's hard to be active when it hurts to move. Opioids are not my only meds though. I take gabepebtin and a couple of other things that help.

My pain gets so debilitating that I can't get hugs from my family. It hurts to take a shower or brush my teeth. My pain management routine allows me to be a productive member of society and live my life with my family.

allnurses Guide · Oct 28, 2017

I think the key is to look at that person in those circumstances, and proceed from there. Non- pharmaceutical strategies are always better in the longterm, but I have read so many accounts of the way people who have no alternative to narcotics for pain control are treated at times, very judgementally, and sometimes denied while pain gets harder to get ahead of and withdrawal symptoms set in.

allnurses Guide · Oct 28, 2017

Ok so I do have chronic pain that is often debilitating and exhausting. When I wasn't getting good results from opiates I had to initiate a conversation with my doctor. I will say she was a bit surprised that I wanted to try an alternative but she helped me research and find some things that work. She even wrote a TAR/Authorization for acupuncture (which she admitted she didn't really believe in) . I get two treatments a month 1 acupuncture , 1 massage and I just recently got a portable TENS unit which I use daily. I still take some opiates but have greatly reduced the amount I have to take. A word of warning to those thinking of using CBD oil. I tried it and was told that I WOULD NOT TEST POSITIVE FOR THC. Well one week into using it and it was very effective I, out of curiosity did a home UDS and guess what - tested strongly for THC. So don't believe everything the snake oil salesmen are saying. I stopped taking it because even though it is legal in my state for bot medical and recreational use - I won't risk my license.

My point here is that I had to initiate the conversation and be open to changing the initial treatment plan. Doctors on average spend less that 15 minutes with their patients in today's HMO driven environment and alternatives are expensive so not suitable for the under insured of uninsured. The patient must also believe that something different might work.

Hppy

allnurses Guide · Oct 28, 2017

Or we could just address this question with a gif

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Hppy

LadysSolo · Oct 28, 2017

I have chronic pain, and I use chiropractic once a month, ibuprofen and acetaminophen if I need it in between, and am very active. I believe, however, that most people would react very negatively if providers suggest alternatives to opioids.

KatieMI, BSN, MSN, RN · Oct 29, 2017

I visited today a fairly large local craft/small private enterprize show. Among 100+ stalls there were at least 15 offering various non-pharm options for pain relief, from ointments and salves to "magnet bracelets", massage devices and back support systems. In the surrounding area's population, roughly 1 out of each 5 adults is on chronic opioid therapy. So, there has to be public demand for non-drug options.

Being a fibromyalgia patient fully controlled by CAM alone and a huge fan of yoga, I freely discuss it with my patients for management of back pain, fibromylagia and even migraines. They almost always appreciate when I tell them, in details, what is going on with them (turned out, many of them have no idea whatsoever about what is norm and what is not for human spine, muscles, nerves and pain sensation). I always warn that someone with no knowledge of anatomy should not just buy a DVD and "do some yoga" in front of TV. People with fibromyalgia, for one example, should, within limits, "work through the pain"; people with isolated low back pain should not do that. Certain poses and sequences are not appropriate for patients with specific pathologies - for example, no one suffering from sciatica should attempt popular among beginners "lower dog" unless well enough prepared and has help available, as it stretches the sciatic nerve. Most patients appreciate this teaching. They shared with me that they feel tired of office and pharmacy visits, unpleasant side effects, stigmas, fears of losing jobs, crashing their cars, opportunity for their kids to find pills and overdose, etc. - and all that with relief often just enough to keep them afloat, so they would like to try something else. Many of them actually have very resonable expectations in terms of what pain relief they can expect and what risks are acceptable.

Once when I was on clinicals, my preceptor almost fainted after opening the door and seeing my and the patient's butts up in the air as we were doing "cat", one of the best back pain relievers. Before I finished that clinical, two local yoga groups popped up :)