Pain is the most common reason that Americans enter into the healthcare system; it affects more people than diabetes, heart disease and cancer combined.1 Pain is the most common cause of long-term disability and costs our economy between $560-$635 billion annually, making pain management a critical topic for discussion.
Conventional pain medications range from over-the-counter (OTC) options, including acetaminophen and NSAIDs, to prescription pain relievers like corticosteroids and opioids.
All of these treatment options come at a cost, both medically and financially, and some much more so than others. Across the nation, the opioid addiction epidemic makes weekly headlines with prescription opioid drug overdose as the leading cause of accidental death in the US.2 These statistics are no surprise when one considers that health care providers wrote 259 million prescriptions for painkillers in 2012!
While they may be effective for acute and short-term management of pain and discomfort, even OTC options for pain relief come with their own set of concerns in terms of side effects and increased risk for negative outcomes. Acetaminophen is a popular analgesic and anti-pyretic that can cause severe liver damage; also, overdose of this medication is the leading cause of acute liver failure in the US. Gastrointestinal distress (nausea, ulcers, etc.) and compromised renal function are two well-known potential side effects of NSAID use. Since 2005, the FDA has required warning labels on non-aspirin NSAIDs regarding the increased risk of heart attack and stroke. Earlier this year, the FDA required manufacturers to strengthen the warnings to let consumers know that heart attack or stroke can occur as early as the first weeks of using an NSAID. It is important to note that the risk is even present in those without a previous history of heart disease or risk factors for heart disease and that there is an overall increased risk of heart failure with NSAID use.
Fortunately, there are many other effective treatment options outside of NSAIDs and opioids that can be used to help your patients alleviate pain and suffering. To help expand your pain management toolbox, Dr. Brenden Cochran, ND, the Medical Director of Interactive Health Clinic in Lynnwood, WA, who specializes in pain management, shared some of his insights in working with patients with chronic pain.
Q&A with Dr. Brenden Cochran, ND
Emerson: Which therapeutics do you find most effective for pain management?
Dr. Brenden Cochran: Treating pain requires a broad approach. I use a combination of anti-inflammatory dietary changes, balancing hormones, correcting structural issues and mitigating chronic infections. I find a combination of oral vitamin / herbal support in conjunction with injections (such as perineural injections, prolotherapy and platelet rich plasma / PRP therapy) and ozone therapy is critical to addressing structural pain issues. Finally, intravenous therapy is critical to providing nutrients that allow regeneration of tissues, especially with so many people in this population having nutrient deficiencies secondary to poor gastrointestinal health and compromised absorption.
Emerson: What advice do you have for integrative practitioners who are looking for effective alternatives to opioids for pain management?
Dr. Brenden Cochran: Truly, it is an integrative process that you have to be patient with. Using bridge medications, along with natural treatments, will optimize your results. Understanding the patient’s entire picture, including mental / emotional issues, is critical to success. Choose appropriate referrals to support your goals and understand the biochemistry of the opioid medications, so you can choose effective agents for the transition process.
Emerson: Have you found specific therapeutics to help patients who are on opioids for pain transition off opioids?
Dr. Brenden Cochran: Specific therapeutics that I use for all patients on opioid medications includes injections (prolotherapy and PRP) and intravenous therapies (B vitamins, magnesium and amino acids). Other important things I commonly use during opioid transitions are taurine, glycine, theanine, DL-phenylalanine, magnesium, methylated B-Vitamins, anti-inflammatory herbs, such as curcumin, and enzymes, such as bromelain. Other critical agents I would consider using in the more difficult cases include low-dose naltrexone and cannabinoids.
Emerson: What are common mistakes that you see that cause failure in opioid transitions?
Dr. Brenden Cochran: Optimal care requires a combination of the doctor allowing time for treatments to work and consistent patient compliance, along with a strong support system for the patient. As an integrative pain doctor, your treatments need to be aggressive at times and I find most failures are not because the wrong agents were given, but rather they weren’t given in high enough dosages or with enough frequency. One example is taurine, an agent used to calm the opioid taper. Most patients need to be dosed up to 6-10 grams per day or more, but many practitioners will recommend dosing far below the therapeutic threshold needed in these situations.
Addressing the individual needs (mind, body and spirit) of the patient with multiple modalities will support enhanced patient outcomes. Additional therapeutics to consider include acupuncture, chiropractic manipulation, biofeedback, laser therapy, diathermy, electrostimulation therapy, meditation and therapeutic massage 3,4,5. Consider setting up a pain referral network to make these services available to your patients for a multi-modal approach for effective and sustainable integrative pain management.
By Tina Beaudoin, ND
- Center for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, Mortality File. (2015). Number and Age-Adjusted Rates of Drug-poisoning Deaths Involving Opioid Analgesics and Heroin: United States, 2000–2014. Atlanta, GA: Center for Disease Control and Prevention.
- Eid et al. Effect of Electromyographic Biofeedback Training on Pain, Quadriceps Muscle Strength, and Functional Ability in Juvenile Rheumatoid Arthritis. Am J Phys Med Rehabil. 2016 May 4.
- Patil et al. The Role of Acupuncture in Pain Management. Curr Pain Headache Rep. 2016 Mar;20(4):22.
- Cotler et al. The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain. MOJ Orthop Rheumatol. 2015;2(5). Ghildayal et al. Complementary and Alternative Medicine Use in the US Adult Low Back Pain Population. Glob Adv Health Med. 2016 Jan;5(1):69-78.