There is new evidence that mind and body interventions can help reduce pain in people taking prescription opioids – and lead to a reduction in the dose of the drug.
In a study published this month at JAMA Internal Medicine, the researchers reviewed evidence from 60 studies involving approximately 6,400 participants. They evaluated a range of strategies, including meditation, guided imagery, hypnosis, and cognitive behavioral therapy.
"Mindfulness, cognitive behavioral therapy, and clinical hypnosis all seem to be the most beneficial in reducing pain," says study author Eric Garland, a professor at the University of Utah. The dose reductions overall were modest, he says, but the study is a signal that such an approach is useful.
And, Pamela Bobb, who lives in Fairfield Glade, Tenn., Can testify about the benefits. She is 56 years old and has been in pain for decades. "Oh, I've suffered terribly for years," Bobb tells us.
She was born with a malformation in her pelvis that led to pain. Over a period of two decades, she underwent more than a dozen major operations, but none of them helped her; each procedure left more scar tissue and nerve damage.
"I felt desperate," Bobb says. "I didn't feel like I had any control."
She couldn't do basic things like cook – or take care of her family.
"I was completely weakened," Bobb says. "And when you get to that point, you can't see more than the pain – you just survive."
She was given high doses of opioids to relieve the constant pain, but then, a few years ago, she thought "there must simply be a better way." It didn't feel like a drug, she says. Finally, she found help in a clinic specializing in complementary and alternative medicine.
"We have various things to offer," explains Wayne Jonas, a physician who treated Bobb at the Fort Belvoir Community Hospital Hospital in Fairfax, Va.
"We offer physical therapy, behavioral medicine, acupuncture, yoga, and physical mind exercises," Jonas says. None of this is a cure, he added, but the idea is that there are plenty of tools in the tool that people can try out.
Jonas is a longtime advocate of an integrated mind-body approach to pain management, of which he is the author How healing works. a book describing the science behind these approaches.
He says that when one hurts badly, his body's normal defenses fall.
"There are various dysfunctions," says Jonas. Pain increases the level of cortisol stress hormone and also increases the inflammatory processes in the body. "This starts with a continuous loop of negative feedback that produces more pain," Jonas explains.
It's no surprise, he says, that techniques like meditation or yoga can be helpful. "If you engage in deep attention – and relaxation – it will counteract stress reactions," says Jonas.
Think of meditation as a form of mental exercise.
"It's almost like lifting weights for your brain," Garland says. Just as curling with a dumbbell strengthens the bicep, he says, "meditation is almost a way to curl the dip to reinforce self-control of the mind."
And that can change the way the brain experiences input from the body. "If you can change the way the brain receives signals from the body, you can actually change the pain as well," Garland says.
But here's the trick: Learning to meditate takes time, effort, and a little training – it's more complicated than swallowing a pill. Pamela Bobb clung to that. She tried a bunch of these alternative mind and body strategies, including acupuncture and biofeedback, and now she starts meditating every morning.
"It's 4:45 in the morning – and I just woke up," she says in a recording she made in her practice so I could listen to her. It sounds centered and calm. "I allow my body to feel as relaxed as it can."
Bobb also thoroughly reworked his diet, now eating much more greens, fruits and vegetables, and herbs and spices with anti-inflammatory properties. On the day we talk, she makes spinach sauce with ginger, mint and rosemary.
"I swear you can smell each of these spices, they smell so good!" she says.
Bobb is so free now that by just hanging out with her, you would never guess everything she endured. And she feels much better, she says.
"It's empowering for [have] Come all this way, "Bobb says. She says she made a fundamental transition in her mind: Instead of waiting for doctors to heal with surgery or injections, she now realizes that many of these alternative therapies have helped her.
"There's so much inside of me," she says.
Bobb accepts that she will never be completely painless, but now she feels she has control over her discomfort.
She reduced her opioid dose by 75%. He says he still benefits from a small, sustained dose of the drug. And her doctors say the benefits of the drug outweigh its potential harms.
In the midst of the opioid epidemic, Pamela Bobb's story may seem unlikely. But many people who have taken opioids for a long time have similar stories. And last month, the Ministry of Health and Human Services released new guidelines, urging doctors to deliberately begin reducing opioid doses for patients with chronic pain.
The guidelines point to potential harms that will drive patients to medication.
"The goal is not necessarily to get rid of all opioids, but to reduce it to a dose [that is] sure, "said Adm. Brett P. Giroir, physician and assistant secretary of health at HHS for NPR. We asked him about Pamela Bobb's case. He is not her doctor, but upon hearing her story he said," The fact that has been able to significantly reduce her opioids is a success story. "
Giroir says such a comprehensive approach that includes alternative therapies "could be a role model for what we want to do around the country." He points out that earlier this year, the Centers for Medicare and Medicaid Services suggested acupuncture for Medicare patients who have chronic low back pain.
As the evidence piles up, Giroir says, more attention will be paid to covering alternative therapies.
A 2017 Gallup poll found that 78 percent of people would rather try other ways to get rid of their physical pain before taking painkillers.
And physician groups such as the American College of Physicians recommend doctors offer more non-pharmacological treatments to patients suffering from pain, such as those who have chronic lower back pain.
Yet an article published last year reveals that most insurers have not adopted policies that are consistent with these guidelines, and many do not pay to cover these services. The accompanying editorial states that it is time to change that.
Clearly, when it comes to pain management, all the tools need to be taken from the tool. And when it comes to opioids, the access need not be all or nothing. Pamela Bobb says she has learned that the combination of medicine and mind-body therapy works best for her.