The expression, ‘take a chill pill' might be good advice for injured workers with chronic pain. Instead of reaching for an opioid, or benzodiazepine, or any other pain-masker, a natural ‘medication' may do the job better and without the side effects.
The concept is fairly simple, and we see it all the time in our work with injured workers with chronic pain. Once they — and their medical providers — understand a few things about chronic pain and some of the myths about opioids, they can truly begin to heal and take back control of their lives.
To help injured workers get off opioids it's helpful to understand why they are taking them in the first place. The idea of prescribing opioids as a first line treatment for chronic pain really didn't take off until the late 1990s, when a confluence of factors created something of a perfect storm that led to what many of us see as the gross overprescribing of these drugs.
Patient advocates and pain specialists argued that the medical profession was undertreating what was increasingly becoming a problem for many Americans. They said common forms of pain, such as backaches, could be safely treated with opioids. A couple of studies in the 1980s by well-respected physicians backed up their claims and led to support from organizations including the Joint Commission on Accreditation of Healthcare Organizations and the Department of Veterans' Affairs. The American Pain Society introduced a campaign to make pain one of the essential body functions, along with heartbeat, breathing rate, temperature and blood pressure.
The advocates were successful in getting states to relax their laws and regulations regarding the prescribing of opioids. Adding to the issue were increasing pressures on physicians to see more patients per day, along with marketing by pharmaceutical companies that manufactured opioids. Ultimately, there was a dramatic increase in prescription opioid sales.
Unfortunately, all of this ignored the very real risk factors that are present in many individuals. We now have a national opioid epidemic, with efforts on federal, state and local levels to address the problem.
But all of this begs the question: Are these opioids actually helping people with chronic pain and, if not, what benefits are they getting?
Why Not Opioids
Chronic pain is an odd phenomenon. Unlike acute pain that alerts the body to a threat of severe harm or even death, chronic pain is more of an annoyance. It is a combination of physical stimuli, psychosocial factors and environmental influences. It can be debilitating for many people, leading them to seek any remedy that promises quick relief.
Medication treatment for chronic pain target specific receptors in the brain, such as the opioid receptors, GABA receptors, cannabinoid receptors. For example the opioid medications target the opioid receptors that renders the injured worker in a state of dissociation such that he doesn't care about the pain. He notices it less — until the drug wears off.
We know that not only does the effect of opioids wear off, leaving the injured worker once again in pain, it also produces a host of unpleasant side effects. Clearly, opioids are not the answer to chronic pain that was touted a couple of decades ago.
Working with a trained expert, the injured worker can then learn cognitive behavioral therapy (CBT) and other methods that teach techniques to change his thoughts and behaviors, which ultimately allows him to manage and cope with his pain, while returning to function.
CBT techniques alter the neurochemistry of the brain that create neurotransmissions that also counteract pain, unfortunately not as fast as a medication, but also in a manner that is more permanent.
Here are a few of the ways injured workers can achieve a ‘natural' counteraction to chrnic pain:
Dopamine. This neurotransmitter, also called the ‘reward molecule' helps control the reward and pleasure centers in the brain. It also helps people take action to move toward rewards. An injured worker can be distracted from his chronic pain by getting a bit of dopamine. To do that, have him set a goal and achieve it. It should be something fairly simple and doable, but challenging enough so he feels the reward. The more he can set and achieve goals, the more dopamine will flow through his body. The dopamine will distract his attention from his pain.
Endocannabinoid is a molecule that puts someone in a blissful state. There are literally dozens of these molecules that work on receptors of the cannabinoid system. Exercise helps someone experience the benefits of these. Runner's high has been associated with these. Meditation, mindfulness and laughing recreate this experience.
Oxytocin. Intimacy is a key to helping us feel happy. The oxytocin molecule is related to human bonding and associated with increased trust and loyalty. Skin-to-skin contact and affection are great ways to release this molecule in the body, but not the only ways. Being in a group environment, such as a gym is one way. There's also evidence that cuddling – even with a pet — can increase oxytocin.
Endorphins. Injured workers who can self produce this molecule may find themselves feeling little or no pain. These actually resemble opioids in the way they are structured. Physical or sexual activity or acupuncture are ways to produce them.
The human body has an extraordinary capacity to heal itself. In the case of chronic conditions, including pain, complete elimination may be impossible. But just as our brains can play tricks on us — leading someone to feel chronic pain when there is no longer a physical cause — we can also use our brains to help ourselves.
In the case of injured workers with chronic pain, they can learn how to release various molecules to distract their thoughts from the pain; and they can change the ways their brains work, allowing them to retake control over their lives and return to function.