- Opioids are very effective pain relievers, but the risk of dependency is significant.
- Carilion Clinic has developed a comprehensive pain management program that brings multiple medical specialties together.
- Interventions range from acupuncture and art therapies to nutrition and psychiatry.
Nearly 1,500 Virginians died from opioid overdoses in 2020. Deaths from drug overdoses are the main cause of unnatural deaths in the state, according to the Virginia Department of Health.
Some of those deaths involve patients who were initially prescribed opioids to treat chronic pain.
A Different Approach
How can we as a caring society meet the needs of patients in pain while also guarding against addiction to pain-killing drugs?
At Carilion Clinic, a team of Pain Management physicians and advanced practice practitioners has been tackling this problem.
The result is a Carilion Clinic Pain Management program that gives us more ways—besides medication—of treating chronic pain.
They include:
- Acupuncture
- Massage therapy
- Reiki
- Art therapy
- Music therapy
- Nutrition
- Pain education
- Yoga
- Behavioral health services (psychology and psychiatry)
- Aromatherapy
Because the focus of the program is to restore function for patients, Carilion is calling its approach “functional restoration.”
A Whole-Person Focus
The rising number of deaths from opioid overdoses and the sheer human toll of addiction shows the limits of our traditional pain management methods, according to Carilion physicians studying the problem.
Fortunately, there are also hopeful signs that patients can be helped to better cope with their pain.
A study published in Health Affairs showed that greater coordination of care and regulation of pain clinics reduced opioid prescriptions by 8% and opioid overdose death rates by 12%.
Carilion’s program offers chronic pain patients that kind of coordinated care.
The program also allows doctors like Elizabeth Russo-Stringer, MD, and Yaohua Lu, MD, to customize pain intervention options for each patient using a holistic approach.
The Role of Nutrition
Nutrition therapy is one of the cornerstones of the program. Carilion wants to help patients understand how nutrition and supplementation can impact the amount of inflammation and pain in their bodies.
Troy Mueller, RD, a clinical dietitian at Carilion, has worked with physicians on the team to develop a nutrition education program that addresses inflammation, a key contributor to chronic pain. The program empowers patients to choose foods, beverages and supplements that can lower inflammation and pain over those that might be enhancing it.
Troy encourages patients to limit or avoid:
- Fast foods
- Processed meats such as bacon, deli meats and hot dogs
- MSG, or monosodium glutamate
- Artificial sweeteners
- Trans fats (hydrogenated oils)
- Refined sugar, including sugary sodas and sweet tea
- Corn syrup
- Refined carbohydrates like white bread and pasta
Instead, he recommends:
- Fruits
- Vegetables
- Fish and shellfish
- Healthy oils like extra-virgin olive oil
- Avocados
- Raw nuts
- Seeds
Under the program, a pain dietitian assesses a patient’s diet and develops an individualized nutrition plan, taking into account the person’s pain diagnosis, lifestyle and other factors.
The dietitian also helps the patient determine whether they would like to try anti-inflammatory supplements such as turmeric, Coenzyme Q10 or Omega-3 fatty acids.
Acupuncture
Acupuncture, which has been used for centuries in Asia, is now increasingly being used around the world to treat all types of pain as well as addiction.
By inserting thin needles into targeted acupuncture points on the body, doctors stimulate the central nervous system to release the body’s natural healing chemicals and hormones, resulting in pain relief.
At Carilion, Family Medicine physician Priscilla Tu, D.O., is trained in medical acupuncture and provides this service to patients. Dr. Tu trained at the Helm Medical Institute, best known for its work in battlefield acupuncture and research into post-traumatic stress disorder.
Pain Psychology and Psychiatry
“As we learn more about pain, we are finding a link between psychic and physical distress,” said Robert McNamara, Ph.D., a pain psychologist at Carilion. “Thus, the interdisciplinary pain team includes Psychiatry and Behavioral Medicine, primarily diagnosing and treating mental health disorders associated with pain.”
These disorders often include anxiety and depression. At Carilion, Dr. McNamara helps patients learn how to:
- Understand and change their responses to perceptions of pain
- Practice relaxation and mindfulness
- Understand the relationship between pain and psychological difficulties
- Gradually increase and pace their physical activity
- Get enough sleep and rest, and engage in pleasant activities
- Understand problematic behaviors and adopt coping strategies
- Better communicate with others about their pain and physical limitations
Death and Suicide
There is a concern that a new approach to pain management could actually prompt some suicides by people who can’t handle their pain?
It is a grim question, but an important one.
“Being in chronic pain is an identified risk factor associated with suicide," said Dr. McNamara, "but so is chronic opioid use.”
“It is important to understand that unintentional overdose deaths eclipse deaths by suicide year after year,” he added.
By offering patients a variety of therapies and engaging them more in their care, Carilion’s intent is to give patients more options and better put pills in their place.
Visit your primary care physician to find out more if you believe this program could benefit you or a loved one.
