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Managing Pain

Thursday, July 13, 2017

The U.S. has 4 percent of the world’s population and consumes 80 percent of the world’s opioids, resulting in more than 16,000 deaths per year— more than from motor vehicles accidents— and they kill more people than heroin and cocaine combined. Figures from the Substance Abuse and Mental Health Services Administration in Rockville, Maryland indicate that opioid addiction has reached epidemic proportions in the United States.

Fifteen million Americans are taking opioids regularly and 2 million are misusing or are addicted to these powerful drugs.
This national opioid epidemic has drawn the attention of scientists as well as legislators.  

A few weeks ago (June 19) I was asked to appear before a US congressional committee because of their interest in an article I had written for this column on opioids in milk. The congressman who questioned me asked why so little was being done to alert the American public about the easy availability of narcotics, and why physicians themselves were part of the problem, as overprescribing of these drugs in the U.S. has been linked to the unprecedented epidemic of opioid addiction.

The traditional treatment for musculoskeletal pain tends to be drugs and surgery, both of which carry risks.  Painkillers are meant to take the pain away, but unfortunately, in a large number of instances, the opioids end up delaying healing. These potent drugs work well for acute pain from injury or surgery but with protracted use, they lose their effectiveness and cause multiple side effects.

Alternatives to drugs for pain treatment have included acupuncture, hypnosis and herbal remedies. Less known is a technique of autosuggestion known as imagery.

The connection between chronic pain and diet revolves around inflammation. Foods that increase inflammation and chronic pain include preservatives, sugar and some grains, fried foods, artificial sweeteners and some vegetables like tomatoes and potatoes.  Foods that reduce inflammation include certain fruits like red grapes, cherries, blueberries and cranberries, walnuts, green vegetables including kale, watercress, spinach and broccoli, green tea, oily fish and cocoa. It is imperative to drink enough water. It is also important to avoid toxins such as nicotine and alcohol.

As injuries (from trauma or surgery) heal, pain is gradually relieved or reduced. Drugs, such as narcotics, provide temporary relief of pain in the acute phase of healing, but actually prolong or delay the healing process. If one can avoid the use of drugs of any kind during this period, the body will heal itself naturally. If one uses drugs, one tends to use the injured part because the pain is numbed, but doing so actually delays healing, and may actually produce more injury.

Let me tell you about imagery and relaxation. Relaxation relieves pain or keeps it from getting worse by reducing tension in the muscles.  Imagery is the technique of using ones imagination to place oneself mentally in another – more pleasant – place. I have used this technique personally, imagining myself relaxing in the sun on a tropical beach while a root canal was being done without anesthesia.  Seriously.  The oral surgeon needed reassurance during the procedure, but I didn’t.

With imagery, one thinks of the pain as “clean” and “self-limited”. When the injury is over, there is no after effect to worry about, and the pain is just a memory. The take-home message, think of pain as positive and enjoy the experience.

Spencer Thornton, MD