Patients Seek Out Alternatives To Opioids In Treatment Of Chronic Pain

Opioids are often considered mandatory for treatment of chronic pain, but many patients would prefer an alternative. Doctors say those alternatives may also work better in some cases.

KELLY MCEVERS, HOST:

Chronic pain affects more Americans than cancer, heart disease and diabetes combined. And we have talked a lot about the opioid epidemic in the U.S., but there are many who say that what we actually have is a pain epidemic, one that's not being treated effectively. In other words, that the opioid problem is a byproduct. Naomi Gingold explains.

NAOMI GINGOLD, BYLINE: Today was a typical day for Britt Johnson. She woke up at 5 a.m. in so much pain that...

BRITT JOHNSON: I couldn't stand to be in my bed anymore. I lay there trying to convince myself that, you know, I could breathe through it and that after 30 minutes of being absolutely miserable, I decided to call it quits. And that's when I chose to take tramadol.

GINGOLD: Tramadol. That's considered a safe low-level opiate medication. Johnson is 31. She's had intense pain and autoimmune arthritis since she was 7, and when her preventative meds aren't doing their job, she manages by going up on the opioids.

JOHNSON: I've had people say to me, well, you're just high all the time or that, oh, yeah, I guess it would be really nice just to eradicate your pain. I'm neither high nor rid of pain.

GINGOLD: That's not what they do for her.

JOHNSON: It's just sort of like putting earmuffs on, if you will, to the pain. But it definitely doesn't treat it. It just takes it down a notch to where I can function.

GINGOLD: Make food, brush her teeth, go to work most days. Johnson also meditates, does yoga, breath work, spends time researching alternative treatments. Like many chronic pain patients, she doesn't want to be on opioids. But when she goes to her pain specialists, they offer her medication, opioids and short-term numbing injections. She's the one to suggest alternatives.

Johnson's pain doctors didn't want to be interviewed for this story. Dr. Lonnie Zeltzer runs an integrative pain clinic at UCLA and was an author on a prominent national report on the research and treatment of pain. She says generally injections and pills are standard treatment, but there are helpful alternatives, things like biofeedback, acupuncture, cognitive behavioral therapy, alternative physical therapies. A big problem she says, though, is even if doctors know of them...

LONNIE ZELTZER: They'll find out the insurance won't cover it, and so they're back to needing drugs.

GINGOLD: Recently with the increased regulations and media coverage on opioids, there's been a rising climate of fear. Doctors are sometimes afraid to prescribe them even when necessary. Johnson's had pharmacists accuse her of being an addict or tell her they can't refill her medication. Dr. Zeltzer says focusing on opioids, though, is missing the underlying issues.

ZELTZER: There is not enough attention paid to educate clinicians about appropriate treatment of chronic pain.

GINGOLD: That can lead doctors to overly prescribe. She says the public often thinks bad pain requires opioids, but opioids don't cure pain. They mitigate some of the distress. Certain kinds of pain they do nothing for, can even make it worse. And by themselves, they are not a long-term solution. But patients who are still hurting can think more is better and overdose. There's a lack of research on treating pain.

ZELTZER: We don't know how to treat it as a country. We don't treat it effectively.

GINGOLD: Zeltzer also echoes many specialists who say mostly it's not the chronic pain patients who are overdosing. But there's actually very little data on who is. Currently, chronic pain patients are often bearing the brunt of new regulations while not being presented with other viable options. And even amongst that community, there's a rift overtaking opioids. And Britt Johnson feels it internally.

JOHNSON: I think at times I feel weak for taking it, and that's a stigma that I place on myself.

GINGOLD: But, she says, until our modern health care system restructures itself and values treating pain and the patient from a whole body perspective, this problem with opioids is not going to go away. For NPR News, I'm Naomi Gingold.

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