There is new evidence that mind-body interventions can help alleviate the pain of people who have taken prescription opioids – and reduce the dose of medication.
In a study published this month in JAMA Internal Medicine researchers reviewed evidence from 60 studies involving approximately 6,400 participants. They evaluated a range of strategies, including meditation, guided imaging, hypnosis and cognitive behavioral therapy.
"Mindfulness, cognitive-behavioral therapy, and clinical hypnosis seem to be most useful in relieving pain," says study author Eric Garland, a professor at the University of Utah. Overall, the dose reductions have been modest, but the study is a signal that this approach is beneficial.
Pamela Bobb, who lives in Fairfield Glade, Tennessee, can confirm the benefits. She is 56 and has been in pain for decades. "Oh, I've suffered terribly for years," says Bobb.
She was born with a pelvic malformation that caused pain. Within two decades, she had been operated more than a dozen times, but none of them helped her. Each procedure left more scar tissue and nerve damage.
"I felt desperate," says Bobb. "I did not feel I was in control."
She could not do basic things like cooking – or take care of her family.
"I was completely weakened," says Bobb. "And when you get to that point, you can not see beyond the pain – you just survive."
To relieve the constant pain, she was given high doses of opioids a few years ago, thinking, "There just has to be a better way." She did not feel like a drug user, she says. Eventually, she found help in a clinic specializing in complementary and alternative medicine.
"We offer a variety of things," explains Wayne Jonas, a physician who treated Bobb at the Fort Belvoir Community Hospital Pain Clinic in Fairfax County, Va.
"We offer physiotherapy, behavioral medicine, acupuncture, yoga and body exercises for the mind. "None of this is a panacea, he adds, but the idea is that the toolkit contains a variety of tools for people to try out.
Jonas is a long-time proponent of an integrated mind-body approach Pain Management and the Author of How Healing Works a book that describes the science behind these approaches.
He says that when someone has severe pain, the normal defenses of his body are disturbed.
"It Jonas finds pain increase the level of the stress hormone cortisol and increase inflammatory processes in the body as well It continues A negative feedback loop that causes more pain, "explains Jonas.
It's no surprise that techniques like meditation or yoga can be helpful. "When you engage in deep mindfulness and relaxation, it counteracts these stress responses," says Jonas.
Imagine meditation as a form of mental exercise.
"It's almost like weightlifting for your brain," he says garland. Just as curling a barbell strengthens the biceps, he says, "Meditation is almost a kind of rolling up the dumbbell of the mind to strengthen the mind's self-control."
And this may change the way the brain perceives the input from the body. "If you can change the way the brain perceives signals from the body, you can actually change the pain experience," says Garland.
But here's a trick: Learning to meditate requires time, effort, and some training – it's more complicated than swallowing a pill. Pamela Bobb stayed with it. She has tried a number of these alternative body-mind strategies, including acupuncture and biofeedback, and now begins a meditation exercise each morning.
"It's 4:45 am – and I just woke up," she says in a shot she made of her training so I can listen to her. It sounds centered and calm. "I let my body feel as relaxed as possible."
Bobb has also revised her diet and has now eaten much more greens, fruits and vegetables as well as herbs and spices with anti-inflammatory properties. On the day we talk, she makes a spinach with ginger, mint and rosemary.
"I swear, you can smell any of these spices, they smell so good!" she says.
Bobb feels so good now that if you just hang around with her, you never know how much she endured. And she feels so much better, she says.
"It gives her the opportunity to move forward [have] in this way," says Bobb. She says that she has undergone a fundamental change in her mind: instead of waiting for doctors to cure her with surgery or injections, she now realizes that many of these alternative therapies have enabled her to help herself.
"So much of that lies in me," she says.
Bobb admits that she may never be completely free of pain, but now feels uncomfortable.
She has reduced her opiate dose by 75%. She says she still benefits from a small maintenance dose of the drug. And her doctors say that the benefit of the drug outweighs the potential harm to them.
In the midst of an opioid epidemic, Pamela Bobb's story seems unlikely. But many people who have taken opioids for a long time have similar stories. And last month, the Department of Health and Human Services published new guidelines urging physicians to deliberately lower opioid doses for chronic pain patients.
The guidelines point out the potential disadvantages of diverting patients from the medication.
"The goal is not necessarily to get rid of all opioids, but to reduce them to a safe dose [that is]," said Adm. Brett P. Giroir, a physician and deputy secretary for health at HHS, told NPR. We asked him about Pamela Bobb's case. He is not her doctor, but after hearing her story, he said, "The fact that she was able to significantly reduce her opioids is a success story." A role model for what we want to do nationwide. "He points out that earlier this year, the Centers for Medicare & Medicaid Services proposed treating acupuncture for Medicare patients with chronic low back pain.
With the evidence emerging, Giroir says the treatment of alternative therapies will increase Paid attention
A 2017 Gallup survey found that 78 percent of people would prefer to use other methods to alleviate their physical pain before taking painkillers -pharmacological treatments for pain patients, eg for patients with chronic low back pain
However, an article published last year found that most insurers did not introduce any guidelines that are consistent with these guidelines and many do not pay to cover these services Editorial is the time to do this
When it comes to fighting pain, all tools in the toolkit are needed. And when it comes to opioids, the approach does not have to be all or nothing. Pamela Bobb says she has learned that the combination of medicine and body-mind therapies works best for her.