[JOHN BACKMAN, Ph.D.]
“What’s the alternative?” is the question often asked by patients for whom chronic opioid treatment is dangerously ineffective in alleviating persistent pain. Chronic pain incapacitates. Period. Sufferers seek relief by any means. Since the 1980s doctors have treated pain with the potpourri of opioid preparations developed and sold aggressively by the pharmaceutical industry. As patients, their families and the Country cope with the tolerance, dependence, adverse side effects, respiratory depression and overdose deaths inherent in chronic opioid use, prescribing providers are also asking “what’s the alternative”?
Andrew Weil, M.D. succinctly summarized the dilemma: “Too many people are taking too many medicines — something that has been building steadily through the past century. There’s a deep-rooted mindset on the part of both doctors and patients that medication is the only legitimate way to treat disease. People expect to be medicated when they go to doctors, and this is all doctors are trained to do. They’re not taught other methods for managing common conditions. The efforts of big pharma contribute to this situation, both by upping the expectations of patients and by shaping the behavior of doctors.”
But wait, what’s the alternative? Two recent, well designed studies suggest there are viable treatments for chronic pain that do not rely on opioids at all. In one, the authors concluded that meditation and cognitive therapy may be an effective treatment option for patients with chronic low back pain. And in the other, researchers measured pain intensity and disability with well-validated questionnaires and found yoga works as well as physical therapy for relieving back pain.
So the evidence-based, non-pharmaceutical alternative, at least for some people and some pain conditions, involves realigning bodily mechanics (via yoga) in conjunction with improved stress management (via meditation) and altered thinking that minimizes pain catastrophizing (i.e., the tendency to describe pain in more exaggerated terms than the average person).
For those opioid dependent, chronic pain patients at high risk for both ineffective pain management and adverse outcomes, this alternative is imperative.
JOHN BACKMAN, Ph.D.
Placerville
