In response to the opioid epidemic, some health care providers are rethinking pain management – Chesterfield Observer

As doctors shift away from large and frequent doses of addictive painkillers to stem a surge in deaths by opioid overdose, clinicians prescribing alternative treatments tout a range of options but agree that exercise improves almost every regimen in which alleviating pain and restoring functionality are the goals.

In Chesterfield County, opioid overdose deaths are climbing. Excluding cases in which the Virginia Medical Examiners Office also detected fentanyl, a synthetic opioid added to increase the potency of illegal heroin, Chesterfield had 66 deaths from opioid overdose in 2019, 100 in 2020 and 56 in just the first half of 2021. Opioid addiction isnt always obvious or preceded by other forms of substance abuse; many victims of overdose are people with jobs and stable lives who find themselves hooked on drugs prescribed legally.

Stacy, a 60-year-old Goochland County resident who wants to remain anonymous to protect her interests in an ongoing lawsuit, had minor knee trouble before a car crash a few years ago. She controlled the pain of an expanding airbag hitting her knee with over-the-counter analgesics and physical therapy. I had difficulty walking for any period of time. Just sitting down, getting up, the knee would catch and the last time it did, I fell down the steps, she recalls. Barely able to walk, she decided to have her knee replaced.

Stacy suffered both major categories of pain: Before surgery she endured chronic pain, the sort lasting more than eight weeks, associated with conditions like a tricky knee, bad back, arthritis or fibromyalgia. Post-operation, Stacy had acute pain, the short-term sort that comes after an incision, broken bone or deep bruise. For this acute pain, she took narcotics prescribed by her doctor.

However, she discontinued using them after a week or so. Like many, she feared the possibility of addiction. Instead, shes relied on ice to numb her healing joint and vigorous exercise on a stationary bike to keep it loose. I was very conscious of drugs, Stacy says. I knew I didnt want them.

Now, she manages her residual pain from the injury stiffness caused by inactivity by trying to exercise regularly.

Anchoring treatment for pain with physical therapy is common. Its the grandfather of drug-free pain therapy in modern medicine. Physical therapists use rehabilitative exercise, joint manipulation, massage, applications of heat and ice, ultrasound, electronic stimulation and other techniques to reduce discomfort and improve strength and range of motion.

Physical therapy is relatively inexpensive and sometimes a prerequisite for other treatments. Lisa Berman is a physical therapist at the Sheltering Arms Rehabilitation Centers outpatient therapy clinic in Chester, one of seven in the region. As it gets tougher to access opioid drugs, she says, patients are desperate to find other ways to manage their pain.

Berman also uses a technique called dry needling. To the untrained eye, dry needling appears to be the same as acupuncture. In both treatments, thin stainless steel needles are pushed through the skin. The similarity ends there. Developed in China over centuries, acupuncture presumes pain and illness are caused by an imbalance in the bodys energy, and that application of needles along energy pathways can ease pain and promote healing.

Dry needling was developed in Europe in the 20th century by doctors using scientific methods. Energy pathways arent the targets. Dry needling stimulates or relaxes muscles directly. I use dry needling for recalcitrant kinds of pain, like pain that doesnt respond to other kinds of treatment, Berman says, adding that she isnt surprised that alternative treatments are growing in popularity. New therapies for pain management are attractive because people are increasingly aware of the danger of opioid addiction.

At JNT Dental, Dr. Joseph Tregaskes uses lasers as an alternative to narcotics in painful craniofacial conditions. Laser therapy was first developed in the late 1960s and involves placing a light source on or close to the skin to manipulate tissue and cells in the body.

Tregaskes treats headaches temple mandibular joint pain, muscular issues, nerve issues, ligament and tendon issues, and cervical spine issues. Adjusting a lasers power, pulse and wavelength allows the lights energy to penetrate the skin and reach places where pain begins, according to Dr. Nelson Marquina of Laser Biotech International, a Richmond-based company that sells the equipment to the medical market.

It stimulates at the cellular level, Tregaskes explains. And it works really well on pretty much all tissues. You work on nerve tissues, vascular structures, your ligament and tendon issues. Lasers can also reduce inflammation. Because the energy is delivered at the cellular level, lasers can even stimulate broken bones to heal, he says.

Doctors also promote therapies that target how we feel about ourselves when burdened by pain. These include meditation and even hypnosis.

Dr. Benjamin Seeman at Integrative Pain Specialists in Henrico says theyre essential: Mindfulness is incredibly important Studies have demonstrated the link between stress and pain, and mindfulness can be an excellent way to reduce stress.

Seeman says attitudes about opioids are changing among both practitioners and patients. When we are able to convince a patient to try a different approach, or at least decrease their dosages, they find they are able to enjoy an improved quality of life and decreased pain.

Berman says insurance companies usually require a patient to try other mitigations for pain, such as physical therapy, before authorizing more novel approaches, which can be more expensive.

Whether drugs are part of a pain management therapy or not, she emphasizes the power of exercise. Motion is lotion, she says. Even going for a walk is extremely therapeutic. I really encourage people to just be active. Im big into yoga Im big into any kind of movement.

Seeman agrees: Exercise is very important. I encourage all my patients to stay as active as possible.

Opioids arent the only solution.

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In response to the opioid epidemic, some health care providers are rethinking pain management - Chesterfield Observer