A World of Hurt: Why You Need More Than Painkillers to Feel Better
Painkillers like oxycodone are harder than ever to get—which means that if you’re dealing with chronic pain you’ll have to come up with something else.
Sharon Harris was barely out of college when she got a devastating diagnosis: She had lupus, a chronic autoimmune disease that causes pain, inflammation, and damage to various parts of the body. Harris’ doctors limited her pain-relief drugs to over-the-counter versions, so she soon figured out she had to find other ways to cope with “flares” when her symptoms worsened. “I’ve always been skeptical of taking medication [so] I enlisted the help of yoga and massage experts,” remembers Harris, now 34 and living in Detroit. “I read countless stories about how the two techniques helped minimize pain.”
At the start, Harris found yoga painful and difficult to do, but over time it got easier. “Yoga encourages you to stretch muscles that you never knew you had,” she says. “It also pushes you to meditate and visualize ‘pushing out’ your pain using concentrated breathing techniques.” After a class Harris says she feels “renewed, more aware, and more relaxed,” adding that she goes for a massage once a month: “I carry a lot of pain in my back and neck; massages tend to alleviate those aches and pains.”
For many of the millions of Americans dealing with chronic pain—the American Academy of Pain Medicine puts the total at 100 million—Harris’ pain management program, which combines few or no drugs with alternative and mind-body therapies, isn’t at all unusual. One reason is that abuse of painkillers—especially powerful opioids like oxycodone—are becoming harder than ever to get, even if you have a legitimate reason to use them. Recently, the Food and Drug Administration (FDA) decided against approving a generic version of oxycodone, which goes by the brand name Oxycontin. That means, among other things, that the price of this powerful narcotic painkiller will remain high.
The FDA’s decision to only allow a brand-name, abuse-resistant version of oxycodone is based on data showing that painkiller abuse is rampant and growing. According to the Harvard School of Public Health, the 2009 National Survey on Drug Use and Health found that nearly two million Americans were dependent on or abusing prescription pain relievers—five times greater than the number of people addicted to heroin.
Between physicians prescribing these and other drugs less often or in lower amounts to avoid abuse, and the high and rising cost of many prescriptions, the upshot is that fewer pain patients who need relief are likely to get it. This means they need to turn to over-the-counter pain relievers like acetaminophen, aspirin, and ibuprofen, and drug-free approaches like Harris’ yoga-and-massage regimen, as well as acupuncture, biofeedback, and other therapies.
Akash Bajaj, M.D., a pain specialist in Marina del Ray, California, says concerns about addiction have pushed him to often try other modalities instead of starting with narcotic pain relievers. That’s especially true, he says, with patients in their 20s and 30s, who could be on pain meds for decades if injury damage is permanent, or they develop chronic pain conditions like arthritis or migraines. “Always, my go-to is other types of pain relief, including physical therapy, chiropractic, and nerve blocks that go right to the source of the pain, as well as combinations of treatments for maximum effect,” says Dr. Bajaj. He says those patients for whom he does prescribe strong pain relievers must come back to see him again soon after the first visit so he can reassess their medication needs. “That also allows me to give out just a few pills at first, which can lessen the likelihood of addiction, since then they don’t have the pills on hand to use after they’re no longer needed for pain relief,” he explains.
Dr. Bajaj adds that while handing out drugs is a quick encounter between a patient and doctor, it can irretrievably alter someone’s life if addiction develops. So he also considers a patient’s emotional state, because intractable pain affects mental and emotional health, too. “I tell my patients there are two models of pain relief—a rehabilitee model and a palliative model. With the palliative model, we only address the immediate pain relief. But with the rehabilitative model, the patient becomes a part of the team and takes on some of the responsibility for getting better.”
There’s good evidence that taking a more action-oriented approach to pain relief works better for many pain patients. It’s certainly helped Harris, who says her spiritual beliefs have helped too. “As I combat lupus I strongly believe that there is a spirit/mind connection,” she says. “I’ve noticed that I always feel better after a church service or after I’ve read Bible scriptures.” And it’s that holistic—body, mind, and spirit—approach that may offer the most lasting relief from a life full of pain.
