An Alternative to Opioids: A Mind-Body Approach to Pain Management

A recent webinar discussed one approach to reducing reliance on dangerous opioids for pain management

By Roger Rabb, J.D.

The opioid epidemic is perhaps the biggest health crisis facing the U.S today, as an estimated 115 Americans die from an opioid overdose each day. At the very least, this epidemic should serve as a cautionary tale against the sometimes all-too-quick reliance on drugs and pills for relieving the chronic effects of physical injuries. The question then becomes: what are the alternatives? In a recent OutFront Ideas webinar sponsored by Safety National and Sedgwick, participants discussed pain management techniques that might serve to reduce dependence on opioids and other pills, focusing primarily on the mind-body relationship and behavioral and psychological factors that might be addressed when seeking to reduce chronic pain.

To provide some context to their approach to the topic, participants first noted the importance of adverse childhood experiences, or ACE, to the way that individuals cope with pain. These are experiences occurring from early childhood through early adulthood and might include, for example, physical abuse or neglect, an alcoholic parent, or substance abuse. While it might not be immediately obvious how these experiences might relate to pain management, the participants noted that these types of experiences early in life can create very negative psychological beliefs about pain, reinforcing within an individual that pain is something that is always terrible and never gets better. This belief then can become a self-fulfilling prophesy, predisposing that person to deal poorly with pain.

Participants also discussed what they referred to as prehabilitation, which they described as a “readiness for surgery, in particular in the pre-surgical phase,” and the patient’s skills for coping with the particular mental and physical stressors that can accompany surgery. One participant listed six key components for prehabilitation evaluation of a patient to ensure that the patient has in place the necessary coping mechanisms:

1. The patient’s medical literacy, or the ability to understand the information provided by the involved doctors.
2. The patient’s nutritional background, whether he or she generally consumes a diet high in quality nutrients rather than a high fat, low nutrient diet.
3. The patient’s exercise routines, important for preparing the body physically for any rigors of the post-operative period.
4. The patient’s pain preparedness and state of mind, such as whether the patient believes, as described above, that the experience will result in never-ending pain, or whether the patient believes that he or she will quickly recover.
5. The patient’s exposure to toxins, such as alcohol, cigarettes, or drugs, which might create unnecessary risks for the body.
6. The extent to which a patient’s residence is prepared for the patient recovering from surgery, including whether potential hazards have been eliminated and whether any necessary assistance will be available.

Another participant also noted the importance of the person’s emotional and psychological environment at the time of surgery and immediately after, whether there is additional personal or financial stress in the person’s life, and the person’s stress management skills generally, suggesting that the ability to cope successfully with these stressors can help facilitate a quicker recovery.

As noted, these concerns support an alternative approach to the problem of pain management that stresses the interconnectedness of the mind and body. As one participant described the core problem:

“If we take an injured worker or someone who develops a lasting pain problem, there is a ton of information that is being received into their brain all the time. And in the case of chronic pain, this information is almost always being interpreted as unpleasant or dangerous. It is accompanied by fear which prioritizes that information in the brain even further. And what we now know is this information starts to become memorized by the brain. It is designed to be helpful, but in the case of chronic pain it backfires. Chronic pain is a problem the brain can't solve. … What we do in interventions for chronic pain that are nondrug, we are using the power of the brain to uproot these dysfunctional [neural] pathways.”

The alternative approaches to pain management that the participants touch on attack the problem at that source, by calming these “overactivated pathways in the brain.”

For example, one seminar participant noted that some patients allow fear accompanying an injury to restrict their movements, resulting in a deconditioning and tensing of the muscles, which in turn generates pain when the muscles are used. In addition, she notes that mental and physical tension and stress caused by an injury can also result in a lack of quality sleep that the body needs to relax and restore itself. Addressing this “psychology of pain,” as this participant described it, requires understanding what the patient believes about his or her pain and the body’s reaction to that pain and then helping the patient to a better understanding that removes the mental roadblocks to recovery.

Therapeutic techniques that they mention include things like physical therapy, occupational therapy, exercise, yoga, acupuncture, and mindfulness or relaxation therapy, although they stress that part of the reconditioning-the-brain battle is getting the patients to understand and actually believe in the benefits provided by these types of activities. Importantly for this “cognitive behavioral therapy,” patients are also made to understand that the other stressors in their life—feelings of isolation from family and friends, loss of work activities, feelings of depression or anxiety—trigger chemicals in the brain that make their pain worse. As such, as one participant describes, a primary goal of this approach is to teach the patient “how to examine their thoughts, their feelings, what they are doing in response to their pain, and how they are accidentally making it worse through their thinking processes and behavioral processes.”

These therapies will not necessarily look like the more traditional medical or pharmaceutical treatments that are usually prescribed. However, as noted in the seminar, in addition to the costs in human lives that this dependence on pills, specifically opioids, is having, long-term opiate use that does not result in death can still result in damage to the brain and condition the body to become more sensitive to pain stimuli, even relatively mild stimuli, thus effectively creating the reverse long-term effect from that desired.

Nonetheless, as currently managed, more traditional injury response programs such as workers’ compensation are more likely to approve pills than these alternative treatment techniques, which admittedly deal with root problems that may vary from patient to patient and are harder to isolate or quantify. These seminar participants make the case, however, that while the traditional response programs “have been very quick to pay for a pill,” the more “out-of-the-box” approach that they champion for combatting chronic pain might pay dividends without the high real world costs that have been found to accompany the pill-dependent approach. While some types of mental health coverage are often available now, more specific screening provided early in the treatment period might be necessary to address the specific concerns discussed here.

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