Possible reactions from your patients if suggested alternative pain relief

[DesiDani]

I was listening to NPR and some doctor said that doctors need to suggest acupuncture, massage, and other things instead of opioid pain medication.

I know there is an epidemic, but how can experts say "oh just tell people to take yoga". I've seen patients get violent cause the nurse told them the dr refused to up their dosage. You think that person wants to hear "why don't you try a massage"? And what about people with chronic pain, do you think they haven't tried alternatives?

[shibaowner, MSN, RN, NP]

The treatment for pain depends on the cause. There are many other medications besides opioids that treat pain. Acute pain is treated differently from chronic pain. Chronic arthritis pain is treated differently than nerve pain. There are also various injections and procedures, from minimally invasive to major surgery, depending on the cause of the pain. For example, a bad knee may eventually require knee replacement surgery.

Chronic pain is complex, often with psychological components. For example, long term pain and depression often go hand in hand. So, psychological issues also need to be addressed.

Ergonomic adjustments can also be helpful - desk height, chair type, seat cushions, posture, etc can all be very helpful.

Alternative treatments such as yoga, acupuncture, massage, PT and OT, can be very helpful, but they don't work for everyone. I also wouldn't tell someone in severe pain to just go do some yoga.

Pain is complex, which is why pain management is a speciality. There are great pain management specialists out there who only use opioids as a last resort and then only in the smallest dose possible.

[catsmeow1972, BSN, RN]

At the moment I am awaiting a certain surgery that will reduce the size of thing one and thing two that sits upon my chest. Due to the errr....size, my neck hurts, my back hurts and i have managed to completely throw my posture out of whack. The result is a pretty constant state of pain. I am paying out of pocket for this lovely procedure so my wait will be shorter than most but that is more because insurance sucks than any other reason.

Given the near constant state of pain, most (including a certain PCP at a time when i had no insurance but could scrape up $75 for an office visit) doctors merely threw a prescription for a narcotic at me. Not really helpful in the least. Just took up space in my medicine cabinet. Now, with insurance and a few more monetary resources, I have a few more options. A few visits with PT, i am currently sitting at my desk with a rolled towel behind my back. I have had some massage and ultrasound sessions that have focused on those specific muscle areas that have spasmed due to my crummy posture and I have received advice on how to consciously monitor my posture in the short term. This is all in addition to some significant gym time. Am i completly out of pain? No. Can I function better. Why yes, much better. All has been an immense help and none has involved pharmaceutical pain relief.

My point is that not only are we up against the only thing people have known (I have pain, take a pain pill) we are also up against the seemingly quintessentially American idea that we should be able to totally eliminate pain. I don't know how many times i've had to explain to patients when i am treating their acute post op pain, that if i were to take away their pain completely, they'd be dead. The pain medicine is meant to take the edge off enough for them to get out of bed and sit up and walk and get the healing process started, not lie there like a stoned lump. People think they are supposed to have complete absence of acute pain which would = more and more pharmaceutical pain relief= higher and higher tolerance= more and more physiological need thereby crossing the line into psychological addiction for those with that predilection. Add in unsavory prescribers, etc into the recipe along with $$$$ opportunists ($$$$ being a very important ingredient) and we have a nice warm opioid epidemic.

[LibraSunCNM, BSN, MSN, CNM]

I agree with the other posters that many chronic pain patients (and I'm not familiar with this NPR piece but I'm assuming that that's who they were talking about, not acute patients) would actually welcome a thorough conversation about alternative pain relief options from their doctors. Some patients would probably sneer, yes, but I think more would be open to it, particularly with all of the attention on the devastations of the opioid epidemic lately. I hate to point fingers but MDs who aren't willing or able to spend a little more time with patients, who don't stay up to speed on the latest research about the topic, and who, as a result, inappropriately prescribe opioids are a huge part of this epidemic (among other factors, without doubt).

[angeloublue22, BSN, RN]

The alternative pain treatments do actually help. You would also be surprised that people haven't actually tried them and I can see why because there are barriers to care which I'm seeing trying to get my husband help. Insurance doesn't always cover a chiropractor, massage therapy, or acupuncture so it can be costly to seek this care. We had to get special authorizations from our insurance to get them to cover some of the acupuncture. The process can be confusing and lengthy, thus creating another barrier. If my husband wants pills then it's as easy as calling his provider but if he doesn't want to be on pills for the rest of his life and try something else, it's like pulling teeth. I'm an addictions nurse so I know all to well where that road takes you. Medications aren't the only things that help treat pain. I have hip dysplasia and if I sat down for too long I couldn't walk properly for about 30 minutes from the intense pain and my knees were always in pain. I tried yoga and it completely resolved the issue. I only get pain if I stop doing yoga for too long. The last barrier is bias toward alternative treatments which I see in this thread. There are many scientific studies that support these alternative treatments as helpful for pain and anxiety.

[mmc51264, BSN, MSN, RN]

I have chronic pain and yoga helps. A lot. It's very much like PT but not so focused. I get deep tissue massages, and I also have a PT person that I work with that i found out does "dry needling" I think it is similar to trigger point injections, but no injection: just the needle. Different than acupuncture.

I am all about alternatives. We even have a PA that is doing work with aromatherapy. (on an ortho unit). Some pts are really into it, some not-so much. Doctors give their blessing.