Chat with us, powered by LiveChat
Is There a War on Pain?

Is There a War on Pain?

Back in 2016, the Centers for Disease Control and Prevention (CDC) issued new guidelines for opioid prescribing. Aimed at mitigating risk, the recommendations sought to lessen the volumes of opioid prescriptions, thus reducing the incidence of opioid-related overdose and death.

With more than 115 deaths attributable to opioid overdose every single day, something had to give. However, the response has left many people wondering just how far things have to go before the remedy becomes more deadly than the underlying cause.

Are judges and insurers qualified to dictate medical treatment?

Though the guidelines were meant for doctors, they have influenced state regulators, disability administrators, and insurers, prompting them to start making some pretty tough across-the-board decisions that have had a significant impact on a very vulnerable population.

Many people who suffer from chronic pain and other debilitating conditions have since been denied access to these medications, and in some cases, this means losing the ability to cope with the daily tasks of living that most of us take for granted.

In one example, a man who had worked 25 years for GM was forced to retire early because of a back injury. His surgery failed—a not-uncommon occurrence—and subsequent therapies only worked for a short time or not at all. The pain medication he was prescribed worked consistently, allowing him to lead a relatively normal life, but a judge who was reviewing his workers’ compensation disability case decided that his medications should be reduced to an extreme degree.

Now barely able to walk or leave his home because of his reduced mobility and pain, this man’s life as an independent human being is in peril. His doctors, fearing that they will lose their license or ability to prescribe, will not intervene.

Unfortunately, his story is not unique.

“What we meant to say is …”

In June of 2019, the CDC clarified its position on opioid prescribing, recognizing that some physicians had misinterpreted the guidelines and had taken the recommendations too far. They iterated that patients undergoing cancer treatments or having pain following surgery should not be affected by the 2016 guidelines because such conditions fell outside the scope of the report.

They said that if doctors were to set hard limits on opioid prescribing that they were not applying the guidelines as they were intended. These guidelines, they stated, were meant to focus on primary care physicians who were treating patients with chronic pain.

So, what were their recommendations? It was suggested that:

  • Doctors should prescribe the lowest possible dosage of pain medication in every situation.
  • Avoid prescribing more than the equivalent of 90 “morphine equivalent units” per day.
  • If the dose was raised to that level, the rationale must be “carefully justified.”
  • Patients at or above that dose should be continued if deemed necessary.
  • Doctors should avoid abrupt tapering or discontinuation to prevent pain and psychological distress.

They also allowed as how hard-and-fast policies conflict with the ability to provide individualized assessments of the benefits and risks, given the specific circumstances of each patient.

Doctors sanctioned, patients at risk

Following the release of the 2016 report, many doctors were disciplined. Clinics and practices were forced to close, leaving a large number of pain sufferers out of options.

Though the guidelines have been revised, it has not helped those doctors who faced action during the crackdown. Some have even served jail time, arguably, just for doing their job.

The general consensus is that there is a lack of innovation in pain medication, and methods do not exist that will accurately quantify pain. This is a significant barrier in bringing new solutions to the table, and there is still a lot at stake.

Chronic pain is not a crime

While doctors have been let off the hook following the CDC’s 2019 review, chronic pain patients continue to feel the pinch.

When state regulators make decisions that affect how doctors can proceed, there is a ripple effect that is driving more profound disabilities in some chronic pain patients.

For instance, if an individual who suffers from chronic pain is on disability or workers compensation, they are subject to the decisions of an adjudicator. For non-acute pain, it is easy for such decision-makers to conclude that a long-standing prescription is no longer necessary because there has been little or no improvement in the patient’s condition.

Weighing the risks against the benefits, the conclusion is often that the medication should be drastically reduced, resulting in reduced mobility, increased pain, and ultimately, a significant decrease in the quality of life.

The state’s role in the war on pain

Across the nation, 33 states have responded to the opioid crisis by passing laws that limit opioid prescribing. In some cases, this means that doctors are limited to a three-day, five-day, or a seven-day supply. In Florida, physicians are required to register their practice as a “chronic pain clinic” to be able to prescribe more than a three-day supply of opioids.

Though the federal guidelines have been revised, doctors continue to fear disciplinary action at the state level, and many will refuse to treat or will drop patients with chronic pain; patients who now crowd the lobbies of pain clinics looking for relief.

Why adequate pain management matters

It is impossible to generalize chronic pain. Each patient’s experience is vastly different from the next, and if doctors aren’t part of the solution, they are part of the problem.

New approaches often delay adequate pain management, but they are aimed at developing a better understanding of what works well for the individual patient as opposed to applying a standardized solution. In other words, pain doctors are taking a more comprehensive and systematic approach, trying alternative therapies like physical therapy, acupuncture, injections, cognitive behavioral therapy (CBT), and psychological counseling to shape the course of ongoing treatment.

Reducing the risk

When patients can self-manage their pain, either through behavioral modification, pacing, modified activities, or a combination of several modalities, it eases the burden, both on the medical system, and on the patient’s own health and potential for optimized wellbeing.

If pain can be managed in ways that either do not include opioids or if a combination of therapies result in decreased reliance on opioids, the risk to the patient is reduced, as is the potential for dependence and abuse.

The ultimate goal, no matter what treatments are prescribed, is to improve the patient’s quality of life, to support their independence, and help them maintain their productivity. In many cases, if their pain is well-managed, these patients won’t be forced to give up their jobs or the things they love to do. It helps them stay off of benefits and continue as a contributing member of society, and even if they do experience pain episodes that prompt them to intervene with opioid pain medications, the reliance on them is significantly reduced.

Many doctors, however, still need to be educated about pain and addiction. While most stakeholders can agree that regulators had to do something to address the opioid crisis—deemed the biggest public health crisis in history—a balance still needs to be struck between over and under-prescribing. At its core are a lot of good people in unfortunate circumstances, and they deserve a chance to live life to its fullest, just as much as anybody else.

If you are struggling with chronic pain, we can help. Reach out today to get started.

Chronic Pain: The Evolution of How We View It

Chronic Pain: The Evolution of How We View It

In recent years, the incidence of chronic pain has reached epidemic proportions. Unfortunately, there is a long history of discrimination related to pain, which has not only spurred controversy, but it has also changed the way we—and our doctors—approach its treatment.

Pain: the fight or flight effect

Pain, in and of itself, is a necessary part of life. Pain warns us about danger. It prevents us from doing things that our bodies were not meant to do. It signals injury and illness and, ultimately, it  keeps us from doing more harm.

In this sense, pain is a good thing. We need it to survive. It is imprinted on our DNA and, like an animal, we instinctively know that when we feel pain, we’re doing something wrong.

This model, however visceral it may be, is no longer the only construct of pain. In today’s society, we are increasingly sedentary. In many cases, we live in environments that are filled with airborne pathogens, we consume highly-processed foods, and put other things in our bodies, like drugs, that are not meant to be there. This situation has led to widespread nutritional imbalance, an epidemic of disuse syndromes, and a general decline in health due to inflammatory and immune conditions.

The global pain epidemic: where it really hurts

Without getting any more technical, these are contributing factors to the worldwide pain phenomenon, and it’s not going to get better any time soon.

For the pain sufferer, this is a mitigating issue that often drives them to seek relief. Some may attempt to self-medicate, and some may seek medical intervention, but in many cases, the exact cause of the pain is unknown.

Though there have been significant advances made in the medical profession in terms of how we understand pain and what treatments work best, those who suffer from the worst kinds of pain often receive little or no relief; this sort of approach, in itself, is a product of the modern age.

As doctors have become better acquainted with new philosophies on pain physiology, the various subtypes of pain, and options for treatment, they are confronted with an ever-increasing regulatory framework that continues to strengthen in response to the fallout of the pain epidemic – namely, overprescribing of pain medications and the resulting addictions that can, understandably, be seen as a state of emergency.

Whereas once, pain was an issue to be taken seriously, it is now often dismissed by the very people who have the power to heal it.

What is chronic pain?

There are, in general, two types of pain. Acute pain is the kind that is felt when we injure ourselves, from a burn, a fall, an injury, a strain – something tangible. It is a situation where you can say “I did this, and it hurt.” The pain can be attributed to something specific. Usually, if you look after it appropriately—set the broken bone, put ice on it, take a Tylenol—the pain will subside, and eventually, the hurt will heal.

Chronic pain is different than acute pain. For anyone who does not suffer from it, it may be challenging to understand. Chronic pain lingers even after the injury has healed. Sometimes, it has no connection to an injury at all, but even when it does, it is often seen as vague and unbelievable, a stigma that is neither new nor modern, at all.

Take, for instance, the case of “railway spine,” a 19th-century phenomenon that was related to injuries sustained (you guessed it) on trains. In this situation, patients presented themselves with multiple pain issues and complaints, but since no visible injuries could be found, doctors were hesitant to treat the pain. The railroads, of course, were then reluctant to provide compensation for the victims. After all, if you can’t see what’s causing it, maybe it doesn’t exist.

Sound familiar?

How we approach chronic pain today

Sadly, in many cases, this perception has not changed. People who suffer from legitimate pain, such as whiplash from a car accident, or spinal injury, will often be disregarded, leading the patients either to suffer needlessly or seek other alternatives, some in the form of physical therapy and alternative treatments, and some in the form of drugs, like opioids, that provide at least some relief.

The opioid conundrum

The unfortunate thing about opioid painkillers is not that they don’t work, but that they are not meant to be used for an extended period. For acute pain, they can be very helpful, such as in the days following a bad injury, or while recovering from surgery.

However, opioid tolerance builds up quickly, and pretty soon, the user will find they aren’t doing nearly as good a job as they once did. The pain from the injury might be gone, but the brain continues to tell the body that it still exists, resulting in cravings for more drugs and eventually turning into an addiction.

A more sustainable approach to chronic pain

Today, we know more about the psychology of chronic pain. We know that certain stimuli trigger pain flares and that, in many cases, it is possible to control pain in ways that do not involve opioids.

Some of the ways we approach chronic pain today include:

Counseling

As stress, anxiety, and depression are chronic pain triggers, evidence shows that counseling helps to mitigate pain. Through techniques such as mindfulness, cognitive behavioral therapy, and self-hypnosis, many lifelong sufferers of chronic pain have found relief.

Physical therapy

In many cases, chronic pain was precipitated by an injury. Once the injury healed, the pain continued. Physical therapy can help by strengthening the joints and muscles around the area of pains, leading to better support and less pain. For example, many who suffer from lower back pain have found relief through core-strengthening exercises like yoga, tai chi, and Pilates.

Increased physical activity

Beyond physical therapy, increased physical activity has also proven to be very helpful for chronic pain. The simple act of walking for 15 to 20 minutes a day can vastly improve both the pain response and general mood. When your mood is better, the pain decreases as well.

Changes in diet

Eating a lot of highly processed foods and sugar can exacerbate an array of chronic diseases, including diabetes, obesity, and conditions that are related to inflammation, like multiple sclerosis, arthritis, lupus, uveitis, and Crohn’s disease. Studies show that changing the diet to eliminate processed foods and substitute fresh fruits, vegetables, whole grains, and healthy fats can reduce chronic pain and inflammation.

The role of medications in chronic pain intervention

Chronic pain is a complex subject. No one solution can be applied to its relief, and medicine still plays a vital role.

Depending on the cause of the pain—if one is identified—tens machines, nerve blockers, steroid injections, stem cell treatments, and medications that target neural receptors should also be considered as front-line therapeutic options.

If the objective is to live independently without pain, there may yet be a long road ahead. However, working closely with a care team that includes alternative practitioners such as chiropractors, acupuncturists, physical therapists, massage therapists, and psychologists, relief is within reach.

There is no question that the perception of chronic pain in the medical field must change. With access to the latest research and a multitude of proven intervention options close at hand, there is no reason why we can’t all get better.

Are you suffering from chronic pain? We can help. Reach out today to get started.

 

How Treatment for Opioids in Long Beach has Changed 

How Treatment for Opioids in Long Beach has Changed 

Opioid addiction in America has risen to crisis proportions in recent years, affecting people from all demographics and all walks of life.

According to a recent study released by the US Department of Health and Human Services, 130 people die every day from opioid overdose from drugs that include prescription pain medications like oxycodone and morphine, synthetic opioids like fentanyl and hydromorphone, and street opiates like heroin.

Opioid addiction can affect anyone

It often starts innocently enough. Following an injury or after surgery, patients are prescribed pain medication to help them cope as they heal. What is supposed to be a temporary intervention quickly turns into a physical addiction.

If the doctor refuses to renew the prescription, patients often turn to the street, often ending up with counterfeit drugs, some laced with deadly doses of fentanyl. Those who do not overdose become even more addicted.

While some manage to maintain their jobs and go on with their lives in spite of it, many lose everything to their addiction, spending all of their time trapped in the cycle of getting money for drugs through crime or deception, looking for drugs, using them, and recovering from them.

For these individuals, there is little choice. The withdrawal symptoms are severe enough that they will do just about anything to keep themselves well – which means, continuing to use. When desperation sets in, any promise of relief will do, leading even the most cautious into dangerous territory.

Opioid addiction treatment Long Beach

While you might think the opioid crisis is a recent phenomenon, addiction has threatened public health several times over the past few centuries. Every time it takes hold, scientists come up with newer versions of the drug that are supposed to be safer.

Many of these formulations, like heroin, and more recently, methadone, have actually been invented to treat addiction. The philosophy is that if a doctor can control and monitor the dosage, it will be easier to manage. In reality, what they are really doing is transferring the addiction to a different form of the same thing and continuing the cycle. While some may respond to this treatment and move past their addiction, many become stuck in it for years, never truly breaking free.

What’s different in today’s opioid treatment?

Today, we better understand the mechanisms of addiction and pain. We approach treatment and recovery differently than in the past, putting the focus on the patient and helping them return to a functional, productive life.

Medications we now use to treat opioid addiction, like buprenorphine, Suboxone, and Subutex, are highly advanced, alleviating the symptoms without causing the opiate “high.”

At our Long Beach opioid treatment center, we combine drug therapy with a multi-disciplinary therapeutic approach that includes psychological counseling, physical therapy, and educational support to help individuals get their lives and their joy for living back on track.

While medications are an important intervention in addiction treatment, we place an equal focus on the underlying cause, whether that is rooted in chronic pain, psychological behaviors, outside stressors, or other forms of mental illness. This type of combination therapy has helped many people overcome the bonds of opioid addiction and return to a healthy, productive, and happy life.

Opioid treatment Long Beach

If you or a loved one is struggling with opioid addiction, we can help. Reach out today to get started.

 

Workplace Injuries and Opioid Dependence

Workplace Injuries and Opioid Dependence

Workplace injuries happen everyday, and more often than not, the injured worker will be prescribed an opioid as a way to help ease the pain and lasting issues associated with the immediate injury. Whether the ultimate treatment for the injury involves surgery, physical therapy, or another treatment, medical professionals often turn to opioids like Vicodin or Oxycodone to placate the injured worker’s reported pain.

Risk of Opioid Dependence

As well as they may work to reduce pain levels, the unfortunate truth about opioids is that they are highly addictive, and they have been shown to increase pain sensitivity, called Opioid-induced hyperalgesia (OIH), which creates a vicious cycle of increased pain, increased dosage, increased tolerance and increased risk of dependence and overdose. Several studies, including one in JAMA, show that as many as one-third of workers who begin using opioids for a workplace injury become addicted to them — which can hinder both the treatment and recovery for the injury, as well as their timetable to return to work and living a productive life.

One report from the CDC found that among adults (non-cancer patients) who received a prescription for opioids, the likelihood of chronic opioid use started after just three days of the medication, and increased with each additional day of medication supplied. The most dramatic increase among these patients was seen after the fifth day of taking opioids, and the highest probability of continued opioid use at 1 and 3 years was seen among patients who were prescribed long-acting opioids like Fentanyl or Morphine.

Increased Time Off Work

The research is strong enough that some medical groups have begun recommending against prescribing opioids for less severe injuries, as developing an addiction after a workplace injury has become a growing concern in industries around the world. Although some medical communities may see opioids as the best (or only) option for getting injured workers back to work — particularly for injuries that can’t be resolved with surgery and will likely linger for an extended period of time — opioid use triples a worker’s time spent on disability, on average.

Considering that the time spent on disability doesn’t even factor in other possible side effects of becoming dependent on opioids, the risks associated with the popular painkillers can make them a dangerous choice for anyone suffering from a workplace injury. Although they may seem necessary for a physician who has “tried everything”, finding an alternative source of pain relief could spare employees, employers, and workers compensation carriers all over the world from the weeks, months, or even years of suffering that opioids can lead to.

Alternative Treatments

There are evidence-based alternative treatments for pain that focus on changing one’s beliefs and removing fear around pain – altering the pain experience. An effective and integrated pain recovery program, like Roots Chronic Pain Recovery, utilizes approaches including mindfulness, cognitive behavioral therapy, psychoeducation, EMDR, and art therapy, and integrates yoga, tai chi, physical therapy, family therapy, and other modalities.

“The goal is to get people moving again”, says Dr. Michael Aquino, PT, DPT, “The less people move out of fear of further injury, the more pain they will experience.”

Roots Chronic Pain Recovery has developed a mind-body approach to treat chronic pain and opioid dependency. With personalized treatment and an interdisciplinary team, we can help you regain control of your body – and your life.

Take The First Step Now

For immediate assistance, please call our Admissions Specialists at +1(562) 473-0827 or +1(866) 766-8776.

For more information or to start admissions – fill out the form below and we’ll reach out to you as soon as possible:

Aftercare and its Role in Longterm Recovery

Aftercare and its Role in Longterm Recovery

Like any chronic health issue, the long-term aftercare that follows detox or inpatient treatment can be just as important as the initial treatment itself. If you look at recovering from addiction through the lens of a chronic condition, it is clear that long-term recovery requires similar steps to that of treating hypertension or diabetes: diagnosis, stabilization, continuing care, and of course, lifestyle changes.

Detox and Inpatient

The first step after seeking help might be to go into a medical detox or inpatient program for a period of time, where professionals can evaluate and observe you while withdrawing from a substance. During the inpatient portion of treatment, feelings, thoughts and behaviors will no doubt surface in the absence of the substances we use to escape these normally. This period of stabilization provides you with a solid foundation to begin addressing these issues as you develop your treatment plan for long-term aftercare.

Aftercare Planning

After receiving comprehensive inpatient or residential treatment, and you’ve chipped away at the physiological and psychological hold that chemical dependency can have on you, it is critically important to find the proper outpatient aftercare program for the weeks, months, and years ahead. Considering that recovery from addiction is not a single episode, enrolling into aftercare for groups and individual therapy sessions at an intensive outpatient or day treatment program significantly lowers the risk of relapse.

Relapse Prevention

Often times, people will complete a 28-30 day inpatient program with a renewed sense of self-efficacy, that “I got this” feeling, and will return home without seeking aftercare. As we touched on earlier, this period is intended to lay a foundation for treatment – it is not the end all, be all for recovery – and people are at the greatest risk for relapse and overdose following detox and inpatient programming. Research suggests that continuing care in an intensive outpatient program (IOP) produces the greatest outcomes for people following detox and inpatient treatment.

The statistics are widely known that approximately half of those who go through some type of addiction treatment will likely relapse at some point in their lives, but that number drops significantly among those who regularly attend aftercare treatment, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). 

Benefits of Aftercare

Aftercare or continuing care in an IOP presents incredible benefits for someone in early recovery: addressing trauma, developing coping skills, finding balance, connecting with our bodies, mending broken family ties, improving communication, etc. And in addition to these revelations in personal development, maintaining regular contact with recovery and healthcare professionals as well as engaging with a recovery support community with peers who are faced with the same challenges, help to set you up for long term success and recovery.

Why Roots?

At Roots Through Recovery, we understand the importance of finding a personalized aftercare plan that works for each person. We know that the inpatient treatment is a crucially important step, and it is the beginning of the long journey of recovery, along with aftercare or continuing care in an intensive outpatient program. Roots believes that no two individuals are the same, and neither are their journeys, so if we aren’t appropriate for you, we will ensure we find the right place to meet your individual needs.

Take The First Step Now

For immediate assistance, please call our Admissions Specialists at +1(562) 473-0827 or +1(866) 766-8776.

For more information or to start admissions – fill out the form below and we’ll reach out to you as soon as possible: