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The best way to treat it without opioids

Sean Stephens was by his own admission an old man in a young man's game.

In 2006, at 38, he joined the Army National Guard, "a little older, a bit used," he says, but he did not get in the way of his duties in Afghanistan. He could still keep up with the 19-year-old double-timing through the desert with 110 pound packs, still standing for 12 hours just behind a Humvee manning .50-cal. Sure the pain at the end of the day was not washed away with some Advil and a good night's sleep as it used to, but he could do it.

When his fourth tour rolled around, his work caught him. He was 42, and the hours he spent on quad bikes trained Afghan police on the eastern border took their toll. What began as a strange click in the neck and a twinge in the back became a hurting, debilitating sensation, and soon the head no longer felt the connection to the back. His hands began to fail him, the result of 1

8 months of seizing the machine gun. By 2011, when he was evacuated medically from Afghanistan, he couldn't even tie his own shirts.

Pain – the earliest of our hardships, a state from which no one escapes – is a hell of a thing. It is one of our oldest legacy traits, an evolutionary system designed to protect us: burn yourself once and you will probably not put your hand in the fire again. Pain in a sick way is good for us. Pain, annoying, makes sense.

But sometimes, against all evolutionary inclinations, the system goes haywire. When Stephens returned from Afghanistan, his pain did not diminish. Afraid to hurt himself further, he limited his movements. His doctors prescribed tramadol, an opioid that brings sweet relief from the pain, says a surgical wound, but at best it was a fleeting escape from the constant companion that his pain had become. He took three to five pills a day, but the headache at the bottom of his skull blurred the rest of the world, but his hands would still not work. He wanted to "lose his shit", he remembers when anger and stress and anxiety consume him.

We know how to treat chronic pain. We have known since the seventies.

This is chronic pain – the tissue is healed, the wounds are scarred, but the silent scream radiates. About 50 million Americans suffer from it, the majority of them between 45 and 64 years. The experience is well-known: the bum knee you blew on skis in the 30s, your back you can just blow up by getting out of bed wrong no matter what you did 20 years ago to hurt your shoulders all the time now. However, for nearly 20 million people like Stephens, the disorder is really debilitating. This pain costs jobs and relationships and life.

For a patient with a broken leg or an open wound, modern medicine has made extraordinary progress over the years as whiskey and leather belt have provided room for anesthesia and OxyContin. But in America, chronic pain treatment is in a creepy scary. The treatment is often injections, surgery with a questionable success rate, or what Stephens got after his four trips in Afghanistan: potentially addictive pills that soothe the pain, but ignore the underlying problems.

However, this is the case. We know how to treat chronic pain. We have known how since the 70s. But chances are that you are not getting the best treatment. With effort, you can approximate it yourself, but to do this you need to know a little about the inner effects of chronic pain.

Why it hurts

If you hurt your toe, the nerve endings in your foot end with electrical impulses to your brain: Something bad has happened down here. Your brain works with specialized nerve cells in the spinal cord to find out an answer. Was it a burn? Better get the leg out of the box. Have we just broken our ankle? Let's turn up the pain call and hurt it for a few weeks so we stay away. When the injury is healed, the brain turns down and stops sending these enhanced pain messages to your body. The evil, blissfully, disappears. But with chronic pain, neural circuits remain amplified – your brain has actually rewired itself – keeping the pain named up to 11, even though the damage has been repaired. "Chronic pain," says John Loeser, MD, former director of a legendary pain management center at the University of Washington, "nature has failed."

John Bonica, MD, the father of pain medicine, knew nothing of this when he began treating injured soldiers returning from the Pacific at a military hospital south of Seattle 75 years ago. There apparently cure patients or those with missing limbs would confuse their doctors with complaints of incessant pain. Dr. Bonica, who wanted to continue writing the first modern text on pain, realized that something complex – something not quite physical – was at work. He saw that anxiety, depression and PTSD were common bedfellows of chronic pain, suggesting that the pain was affected by emotions as much as tissue damage. Much later, research will find that regions of your brain associated with anxiety and depression are also associated with your fear and pain response.

But after his observations, Dr. Bonica that chronic pain was such a complicated, multi-faceted animal that it required all kinds of caregivers. Two decades after World War II, he opened the country's first "interdisciplinary pain clinic" – the famous at the University of Washington. "It was not something that a single person could solve," says Dr. Loeser, who ran the clinic after Dr. Bonica had gone back. "The main line was that this should be a team." The goal of the complete eradication of pain was out, and instead a group was formed to teach patients to handle their symptoms and improve their quality of life from all angles. A physiotherapist showed you how to move again, a psychologist taught you not to be afraid of your pain, an occupational therapist helped you figure out how to cope with your anxiety at work, a dietician helped you lose weight and Take some stress out of your joints, a nurse case manager kept everything running smoothly, and a doc monitored the entire team and your overall progress. The combined approach was revolutionary in chronic pain management and it did something that no other treatment did: It worked.

In the late 1990s, there were more than 1,000 interdisciplinary chronic pain management programs across the country. They were expensive places; Treating a complete complement of experts can run up to $ 30,000. Yet many studies showed that this approach not only succeeded but also paid for itself. Having healthy people who are able to work proves that society costs much less in the long run.

In 1995, Purdue introduced Pharma OxyContin. It was an instant hit. A few early studies suggested tantalizingly – and falsely – that OxyContin could be an effective, non-addictive treatment for chronic pain. Insurance companies recognized a quick and cheaper solution as they saw one. "They just said give them the medicine, the opioids," says pain expert Michael Schatman, Ph.D., director of research and networking at Boston Pain Care.

In 2015, there were 20 million opioid-dependent patients in the US and 56 remaining interdisciplinary pain clinics.

Treat pain without pills

Sean Stephens was nervous. The Veterans Health Administration had gone on the same opioid prescribing binge as the rest of the American medical system and a swell of veterans with opioid use disorders – 68,000 of them – filled the series by 2015. Veterinarians were twice as likely to die from an accidental overdose as other Americans, and a judgment came down from the high: opioids were out of favor. When Stephens reached an agreement at the San Francisco VA Medical Center in 2010, his doctor, Karen Seal, M.D. said they should start working to reduce their dose of tramadol. His pharmaceutical crutch, the opioid he had depended on through the days, was being pulled out beneath him. "I was afraid."

In the two decades since Oxy's almost all interdisciplinary pain clinics closed, VHA has become a surprising leader to keep this approach alive. Other clinics are mostly at large institutions, such as the Mayo Clinic and the Cleveland Clinic, because Schatman says these places can afford to lose money on poorly repaid pain management. But VA does not have to make money. It is responsible for treating its patients for life, and over time, pain handles less expensive than endless pills and procedures.

Dr. Seal happened to be the head of VA's integrated pain team, and she was now responsible for tailoring pain management regimes that did not involve unlimited meds replenishment. Her message to Stephens was non-nonsense: "Pharma tells you that you can take a pill to correct everything." But not here, she said. Here, there would be a goal to help manage pain without relying solely on opioids. Here they would work with him to get his life back.

Some of the treatments, Dr. Seal had prescribed for Stephens, sounded obvious enough (physical therapy, non-addictive drugs, simple goals like training for 20 minutes straight), but others were the kind that could make men scratch (yoga, deep breathing, meditation, cognitive behavioral therapy). Stephens knew vaguely that there were other ways to treat pain. He had tried pot, but he didn't like it. He knew yoga was one thing, but he didn't think of himself as a yoga guy. "I wasn't interested in finding another solution to pain," he says. "But these people talked to me about all the things we can do to get past this point. It was this real moment aha. I never put it together that stress relief can be pain relief." [19659022] <img alt = "Focused man practicing yoga in yoga class studio" title = "Focused man practicing yoga in yoga class" class = "lazyimage lazyload" data-src = "https:? //hips.hearstapps. com / hmg-prod.s3.amazonaws.com / images / focused-man-practicing-yoga-in-yoga-class-studio-royalty-free-image-705003117-1549902518.jpg crop Getty Images Hero Images [19659024] One of the hardest components of interdisciplinary care for men logging in is likely to be a therapist. The treatment of physical pain with cognitive behavioral therapy may sound like New Year's visit, but the brain is a strange thing. during laboratory-controlled pain tests, and they will report less pain e. Give people a placebo to make them believe they are receiving pain relief and the brain will actually release natural opioids to block the pain. New brain imaging studies a consistent upgrading of our most basic ideas of pain. Tor Wager, PhD, neuroscientist at the University of Colorado Boulder, recently found that if the brain expects to receive more pain from an injury, it will exert more sensations – regardless of physical injury. "When you expect more pain, you really feel more pain," he says. And when you live in constant pain, you're afraid to feel more of it. You come in a feedback loop that really makes the pain worse. Learning to think differently – can help break this cycle.

The couple with physical therapy, mild exercise and emotional support has had dramatic results across VA in this holistic approach. So far, the agency has reduced the number of veterinarians dependent on opioids by approx. 40 percent, and a study by Dr. Seal showed that patients in multidisciplinary clinics were 50 percent more likely to significantly reduce their doses. "I've become almost evangelistic about this," she says. "When you are out of opioids, you get your life back."

For Stephens, the approach helped him to take control. "The pain is still there," he says. "My wife still has to print my shirt to me." But now he has the responsibility for his pain – not the other way around. Today he makes deep breathing all day. He has a therapy dog ​​that keeps him calm. And he pauses ten minutes to de-escalate when he feels the pain that is rising and his fears cresting. "It will get me past any pain," he says.

For the tens of thousands of non-veterinarians suffering, there is a similar way of finding relief, but it requires some effort. Another thing it requires, says Stephens, is gut. The courage to be the "old guy" of your first yoga class, to be willing to try something that sounds independent of your pain, like deep breathing. Because one finally feels self-conscious on Y or is embarrassed to go to a therapist, it is much less painful than a life of constant pain.

How To Take Off Your Pain

"The best way to tackle chronic pain is to treat it as a team sport," said Sean Mackey, MD, Ph.D., Head of Pain Medicine at Stanford University. You need different players to control different positions. If you do not have access to an interdisciplinary pain clinic, then this is what you have to do:

Talk to a social worker or therapist

"The stress of pain is mainly in the brain," says Dr. Mackey, and a psychologist who specializes in pain, can help you understand this in a relatively short period of time. Nor is it mumbo jumbo. "Your beliefs, feelings and thoughts about your pain play a major role in your pain experience," he says, and he has brain scans to prove it. Chronic pain rewires your brain, and therapy can help undo this switch. It cannot remove pain, says Dr. Mackey, "but it can improve it and give you control back."

Consider PT

"What do you think the first thing doctors for the 49s do when a guy blows out the knee and needs surgery? The answer is physical rehab," says Dr. Mackey. needs to get these muscles strengthened and support the area that is painful. "Studies show that PT reduces long-term pain and insurers often cover it.

Don't do it in silence [19659036] Managing Your Pain is a long-term effort, and many insurance companies offer support groups.In or near major cities, there are often free meetings where you can find out how others handle pain.

Take Steps to Relax [19659031] Reducing Stress Reduces Your Pain, Dr. Mackey says Free apps like Headspace can guide you through mindfulness lessons, a YMCA can offer meditation classes, and acupuncture facilitates lots of people, your pain can never completely disappear, says Dr. Mackey, but that's not the point. By putting everything together, you can take control and stop pain from dominating your life. You win; pain does not.

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