Last year a disabled veteran came to see me for help with back pain. As we talked about his history, a familiar story arose. He got injured, experienced a lot of discomfort, was prescribed opioid painkillers, and became addicted to them. He described how, for several years, “I lost my personality and my life. I was barely a human.”
He lived in a numb haze, with no sense of humor or interest in anything, until a new doctor specializing in recovery treatment for all levels of addiction, finally recognized what was happening and began to wean him off these drugs. Much of the pain remained, but we were able to work on that. More importantly, he got his life back, and his friends and family got him back.
The familiar part of the story is the widespread long-term use of opioids and the unfortunate consequences. The uncommon part is that he got off of them. A 2017 study by the Centers for Disease Control called “Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use” looked at 1.3 million opioid users over 9 years.1 It found that the longer the initial prescription period, the higher the likelihood of long-term use. If someone used an opioid for 10 days, there was a 20% chance they’d still be using it a year later. At 35 days, the risk of yearlong use was about 45%. A 2014 study in the Clinical Journal of Pain came to a similar conclusion – the higher the initial dose and the longer the initial use of an opioid, the greater the chance of the patient developing a condition of abuse and dependence.2
It’s worth mentioning that both of these studies excluded patients with cancer pain (which is often expected to require ongoing medication, perhaps until death). That is, the great majority of those who were on opiates for several years were using it to manage back pain or joint pain (or to manage their dependency on opiates). Thus, we can assume that the prescribing doctors either didn’t know of an alternative method for pain relief or didn’t care. Do effective non-opioid alternatives exist? In the words of some ancient healer: Hell Yeah!
The first modality that comes to my mind, as you might guess from the story above, is acupuncture. Acupuncture is no longer a fringe therapy. Its effectiveness is well supported by clinical research (comparable to opioids in effectiveness3), it’s routinely offered by many hospitals in the U.S., recommended as a standard option for pain management by health systems around the world, and even adopted by the U.S. military (in a form called “battlefield acupuncture”) for severe pain.
If acupuncture has been unsuccessful at managing your pain, I advise that it isn’t always an instant miracle. Sometimes it takes several treatments to produce significant, lasting results. Also, practitioners vary in their specialties and level of skill. If you don’t experience any relief after a couple sessions, try someone else – and ask if they specialize in pain. Further, a licensed acupuncturist is almost always going to be more skilled and certainly has more training than a medical doctor or physical therapist who also does acupuncture.
While it’s great to receive acupuncture from a professional, it’s also useful to know how to utilize this system to manage pain on your own. Many acupuncture points can provide effective pain relief simply by pressing on them. Especially when traveling, or when needles weren’t available or practical, I’ve often utilized acupressure to successfully eliminate my own pain or that of friends and family. There are specific points for pain in different locations, though one of the most utilized for pain anywhere in the body is called Large Intestine 4, and it’s located in the muscular web between the thumb and index finger. If you press around in this area on the back of the hand, especially directing your pressure toward the hand bone that leads to the index finger (second metacarpal), you will find a tender spot. Pushing firmly on this spot while moving the painful area may alleviate your pain.
Mindfulness-based pain management techniques can also be very effective, and they have the added benefits of helping you live more in the present and experience more gratitude. These strategies were pioneered mainly by Jon Kabat-Zinn, and are based loosely on Buddhist meditation. There are numerous books and courses available in his Mindfulness Based Stress Reduction (MBSR) practice. The basis of these techniques is non-avoidance of discomfort – learning not to resist or mentally depart from the experience at hand, but to instead “turn toward” it and explore it willingly, whereupon it ceases to feel like suffering, and may even open us to a whole new dimension of experience.
Breathing is another vital practice for self-management of pain. How we breathe can profoundly affect both our mental state and the feelings in our body. I have witnessed people doing breathing exercises which, within a half hour, turned off pain that had persisted for decades. In a way, breathing through pain is similar to mindfulness techniques, in that we’re willingly bringing our attention to the experience. I feel that the power of the breath to reduce pain makes so much sense – it seems like an intelligent plan that we should all be equipped with the means to facilitate our own healing. In the most basic way, you can imagine that, with each inhale and exhale, you’re moving the breath – and energy along with it – through the painful area.
After years of teaching these and many other pain relief techniques to my patients, I decided to gather all my knowledge into an online course. In it, I teach a philosophy for understanding pain that will make sense and will illuminate your perspective of what’s happening. And I explain and demonstrate a huge array of methods for eliminating your own pain. As I was creating the course, in fact, the others who were involved in the project kept asking me, “How much more are you planning to include in this?!” But there are so many useful approaches, so many opportunities not just to overcome the pain, but to grow and evolve as a person, and that’s my real goal for participants in the course.
My greatest hope is to see fewer and fewer cases like that of my veteran friend – fewer cases of opioid dependence, fewer cases of pain relief at the expense of the joy of life. And more cases of people overcoming pain in ways that are empowering and even help them heal and awaken. If you’re in pain or know someone who is, check out the course. It’s called Live Pain Free. It’s affordable, and you’ll learn things you’ll use for the rest of your life.
1: Shah A., Hayes C. J., Martin B.C. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017;66:265–269. DOI: http://dx.doi.org/10.15585/mmwr.mm6610a1
2: Edlund, M. J., Martin, B. C., Russo, J. E., DeVries, A., Braden, J. B., & Sullivan, M. D. (2014). The role of opioid prescription in incident opioid abuse and dependence among individuals with chronic noncancer pain: the role of opioid prescription. The Clinical journal of pain, 30(7), 557-64.
3: Grissa, M. H., et al. Acupuncture vs intravenous morphine in the management of acute pain in the ED. The American Journal of Emergency Medicine, Volume 34 , Issue 11 , 2112 – 2116.