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How to Cope with Chronic Pain

Healthy alternatives to overprescribed opioids

by Fred Cohn

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If you’re afflicted with chronic pain, you may believe that opioids come with the territory. Such thinking is misguided and can be dangerous—more about that in a minute—but it’s understandable. While in the past opioid drugs like oxycodone or hydrocodone were used mostly for surgery recovery or end-of-life care, more recently they’ve become the go-to treatment for the pain associated with musculoskeletal ailments, lower-back conditions and sciatica. In fact, sales of prescription opioids in the U.S. have nearly quadrupled since 1999, according to the Centers for Disease Control and Prevention.

While opioids can be very effective when used as intended, the results of opioid overprescription can be tragic. Sadly, it sometimes takes a celebrity death to capture the public’s attention. When Prince succumbed to a fentanyl overdose this spring, sources say he wasn’t following the stereotypical rock star party-hard, die-young scenario. Rather, he got his medications by prescription, reportedly for the treatment of chronic hip pain. “Prince wasn’t a drug abuser,” says Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing (PROP). “He was a clean-living guy; when they were on tour, he wouldn’t even let his band members drink or smoke pot. But he ultimately lost his life because of his addiction.”

See also: Is Back Pain Killing Your Chance for Life Change?

Part of the challenge is a surprisingly careless attitude on the part of some doctors to the perils of opioids. “If somebody is just a few days out of major surgery or if somebody has metastatic cancer, the benefits may outweigh the risks,” Kolodny says. “But doctors are prescribing them for fibromyalgia, for lower back pain, for headaches.”

“If you take an opioid every day, within a few days you can get addicted.”

Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing

“Somebody comes in to have their tooth pulled, and the dentist gives them 90 Percocets because he doesn’t want them calling him over the weekend—and they could probably make do with Advil,” says Don Mathis, case manager with the Harford County (Maryland) Office of Drug Control Policy. “Prescription policies have got to be sensible, reasonable and geared to the individual’s needs.”

A doctor may assume that patients are able to monitor their own painkiller consumption and proceed wisely. That view, it turns out, is overly optimistic and blind to the addictive potential of opioids. Says Kolodny, “If you take an opioid every day, within a few days you can get addicted.”

Addiction concerns aside, there is also the problem that after a while, prescription painkillers can stop working. As the patient builds a tolerance, they do an ever-less-efficient job of holding pain at bay. In some cases, opioids induce hyperalgesia, a sensitization of the nervous system that actually increases pain rather than diminishes it. In other words, the drugs themselves add to the pain. As a result, many sufferers find themselves living a kind of shadow existence, debilitated by both the pain itself and the addictive effects of its treatment.

It doesn’t need to be that way, says Mel Pohl, coauthor of The Pain Antidote: The Proven Program to Help You Stop Suffering from Chronic Pain, Avoid Addiction to Painkillers—and Reclaim Your Life. Pohl is medical director of the Las Vegas Recovery Center, whose chronic pain treatment program is a 28-day post-detox program that helps patients find holistic solutions to cope with pain. But his book shows that it isn’t necessary to check into a clinic to reap the benefits of the latest thinking about pain management. The Pain Antidote includes a four-week “Jump Start Plan,” suggesting a variety of healthy, commonsense habits—good nutrition, plenty of physical exercise and sleep, and breathing exercises—that can immeasurably help pain sufferers who’ve weaned themselves off of opioids. (Note: In all cases, withdrawal from opioids requires medical supervision.)

Pohl acknowledges that the treatment of pain and addiction is as much a psychological process as a physical one. In many cases, emotional causes like grief, anger, childhood trauma or a dysfunctional upbringing can act as incubators that nurture a propensity toward letting pain take over one’s life. In order to move past opioid dependence, pain sufferers often need to do the hard work of dealing with feelings that have long been buried. As Pohl puts it, “The emotional abscesses need to be drained.”

By embracing healthy, restorative habits—both physical and mental—patients can significantly reduce their musculoskeletal pain, often by as much as 50 percent. But it’s not always easy to convince people to take this road. “It’s counterintuitive,” Pohl says. “People think, ‘If my pain is high with the medications, imagine what it will be like without.’ In fact, the pain gets lower—and helping people see that is part of the motivation for change.”

See also: Using Your Mind To Heal Your Body-Even Lower Your Back Pain

The pain-management system Pohl proposes is not a panacea. He does not promise to banishpain, but instead to alleviate it. At the core of his treatment is the goal of diminishing the rolepain plays in the lives of people who experience it. To that end, he makes a vital distinction between pain and suffering. “Suffering,” he says, “is a response to pain. What’s painful as a sensory experience doesn’t have to make you suffer. It’s the way we thinkabout the pain that’s important. You get consumed with the injustice of it all, the unfairness.”

The truth, Pohl says, is that “pain is a condition like many others. The question is, how do you want to respond to it? Do you want to live your life as a victim or do you want to find alternatives? Some people in pain get on with life; others are incapacitated. You don’t have to succumb.”