CCSAD | Holistic Approach Provides Effective Pain Recovery

Pain is the No. 1 reason patients present to physicians and more than 100 million Americans struggle with chronic pain, but as Ashley Addiction Treatment co-CEO Greg Hobelmann, MD, explained to Cape Cod Symposium attendees on Thursday, a holistic pain management program can provide significant relief and help patients avoid the dangers associated with opioid misuse.

Hobelmann clarified some of the differences between acute pain, which typically lasts 3 to 6 months and is a result of tissue damage from injury, surgery or exacerbation of disease, and chronic pain, which persists beyond the typical timeline of tissue healing. Whereas acute pain has a purpose—to make us aware of an injury and allow us time to heal—chronic pain does not, Hobelmann said.

For a 20-year period starting in early 1990s, prescription opioids were a frequently used intervention for the treatment of chronic pain. A massive increase in opioids prescribed, however, led to a massive increase in opioid addiction. Opioid prescriptions began to decline midway through the 2010s, but prescription opioid-involved overdose deaths gave way to heroin-involved overdose deaths, as pain patients, dependent on opioids and desperate to avoid withdrawal, sought an easier-to-obtain, less expensive and more potent alternative.

“Making that leap from a prescription medication to heroin is actually much easier than one might perceive,” Hobelmann said.

Beyond the risks of addiction and overdose associated with prescription opioid use, opioids have been found to cause several other side effects, including constipation/bladder disfunction, weakened immune system, depression, decreased bone density in women and decreased energy in men, as well as a lower tolerance for pain.

Despite their potential drawbacks, opioid medications can be an effective analgesia when prescribed responsibly, Hobelmann said.

“With proper patient selection, proper dosing and very close monitoring, there are some patients who can do well, and the guidelines speak to that,” he said. “This isn’t to say no one can take an opioid for chronic pain, particularly those 2 million people currently prescribed opioids and struggling to find continued care. We have to think about how to treat those patients very carefully.”

Ashley Addiction Treatment has implemented a holistic pain recovery program that has resulted in a 37% reduction in pain rating scores by patients, as well as 63% fewer prescriptions written for pain medications, and a reduction in healthcare use, welfare benefits, sickness benefits and pensions.

Hobelmann said a pain recovery program should include:

• Evidence-based treatment modalities
• A recovery-friendly environment
• Smallest effective doses of medications or interventions necessary
• An individualized and strategic treatment plan
• A continued care plan that is carefully mapped out to keep patients engaged after their formal treatment concludes

Hobelmann offered several other tips for working with chronic pain patients:

Always take pain complaints seriously, and gather a thorough patient history that includes the patient’s psychological history, and use imaging as needed.

Make sure patients understand change is needed, and that they are willing to give up their perceived control and start making behavioral and cognitive changes. “You do want to make sure patient is ready and willing. Very often, they will say, ‘I am taking X dose of opioids and I do X, Y and Z,’ and they perceive things are OK when it’s family and friends urging them to make changes. If it doesn’t come from the patient themselves, it’s much harder to get them better,” Hobelmann said.

Avoid discussions of “real pain vs. fake pain,” laziness, and accusations of patients looking for money or attention.

Pain recovery should aim to reduce pain in 4 areas:

Physical pain, which is accomplished by weaning opioids and incorporating treatments such as physical therapy, exercise, acupuncture and massage.

Emotional pain, which may require a psychological intervention for trauma, grief and/or mood disorder, as well as support with empathy and active listening, and motivational interviewing.

Cognitive pain, challenging patients’ preconceived notions so that they understand what is happening, why previous interventions have been ineffective and why a new approach could yield better results.

Spiritual pain, helping patients find meaning and purpose in their lives, reshape their identity and make peace with their pain. This can be accomplished through meditation, mindfulness, group therapy and self-help groups.