Does It Have to be an Opiate?

There are other ways to manage pain. Ask Heidi Klingbeil of the VA Medical System in the Bronx, New York. A runner, Dr. Klingbeil, who is Chief of Physical Medicine and Rehabilitation at her center, advocates a good diagnosis as a starting point.  Problems that need surgery, get surgery.  But following that, she uses a range of holistic medicine approaches to manage pain.  These include acupuncture, exercise, chiropracty and Reiki. These methods take more work and more “buy-in” on the part of both doctor and patient, but lead, says Dr. Klingbeil, to an improved quality of life.  (Heath Druzin, Stars and Stripes, April 1, 2015)

Doctors are conditioned to relieve pain and opiates offer a quick solution to chronic and acute pain. But patients can habituate to an opiate and require increasingly high dosages. When the pills get too expensive, or the doctor worries about the amount of drugs he’s prescribing and cuts the patient off, the Law of Unintended Consequences applies. We are increasingly aware that the “gateway” to heroin is often through addiction to opiate pain medication. The figures now seem to indicate that 80% of heroin users started with opiate pain medication.

There are other ways to treat chronic pain, but they all take effort and “buy-in,” things that may not be so attractive in this “I want it, and I want it now” society.  When there is an App (or a pill) for everything, who is willing to go to physical therapy several times a week? Or do the work at home between physical therapy appointments?

Rather than jumping immediately to pain medication, there are other avenues to treat chronic pain, including acupuncture, biofeedback, hypnosis, relaxation therapy, massage, and physical therapy. Changes in diet or exercise patterns can be helpful. Therapy for depression (because pain can be correlated with depression)  may prove helpful for some people.

Being fully aware of the possible long-term effects of opiates is a good first step. Discuss the use of opiates with your doctor and tell him if you have a history of addictive behavior.  Ask good questions, and ask the doctor for recommendations that avoid prescription medication. Doctors are increasingly aware of their part in the opiate epidemic and should be willing to take the time to discuss it fully before giving you a prescription.