A few years ago, Renea Molden’s doctors told her they wanted to take her off hydrocodone pills.
“I was mad,” Molden says. “I’ll be honest. I was mad. I was frustrated.”
The 39-year-old woman from Kansas City struggles with pain caused by fibromyalgia, herniated spinal discs and degenerative disc disease. She says the three opioid pills a day that doctors wanted her to stop taking seemed to be the only way she could make it through work, go shopping or even fix dinner.
“It felt like they were taking a part of my life away from me,” Molden says.
Her doctors recognized that her pain was probably chronic, and they worried about a 39-year-old woman being on opioids for decades.
They wanted her to try non-opioid drugs. Or yoga. Or meditation.
“Meditation is something that I thought was not … I was like, ‘That’s crap. How is that going to help with anything?’” Molden says.
For Dr. Muhammad Farhan, medical director of the University of Missouri-Kansas City’s multidisciplinary pain management program, diplomatic conversations with patients like Molden are part of his daily routine. Farhan also is the medical director of the University Health Pain Management Clinic at Truman Medical Centers, which doesn’t prescribe opioids.
“We do have patients – one or two patients almost every day – who are upset that they are not getting their opioid pill,” Farhan says. “But the idea is to give them other options.”
Farhan’s clinic specializes in treating patients with chronic pain who want to avoid the side effects and potential dependence problems of opioids.
Adjusting expectations
The first step, Farhan explains, is getting them over the idea that they can eliminate pain entirely. He says this expectation can be especially dangerous for people who rely on increasing doses of opioids.
“Our idea of being completely pain-free can lead us to a place when they end up with more pain, no improvement in their quality of life after being on high doses of opioid medications, which can be harmful to the point that they may die,” Farhan says.
Farhan says opioids have their place – right after surgery or an injury, say, or for cancer pain. But for patients with issues like back pain or other long-term problems, he favors non-opioid drugs and treatments.
Many of these treatments by themselves don’t have the same pain-reducing effects as high-voltage opioids. So he pairs them with mind-body techniques like meditation, hypnosis, biofeedback and yoga to help patients control stress, which can make pain worse.
“When you’re under stress, you’re noticing the pain more or you’re focused on it more,” Farhan says. “Then if you are distracted, and if you have other coping skills, which you can use to relax or distract your mind, then you may not be feeling that much pain.”
Since peaking in 2010, opioid prescriptions nationwide have declined, according to the Centers for Disease Control and Prevention. But advocates for non-opioid pain management say alternatives to opioids still aren’t being used as much as they should be.
Training doctors
Dr. Bob Twillman, executive director of the Academy of Integrative Pain Management in Lenexa, Kansas, says there’s a reason for that.
“Doctors don’t know a whole lot about those things,” Twillman says.
About half of opioid prescriptions are written by primary care doctors, not pain specialists. A 2011 study showed that U.S. medical schools offer a median of just 9 hours of training on pain management – or less than 1 percent of curriculum hours.
“The content that we have in our medical schools is really very limited,” Twillman says. “And once people are in practice, they don’t have the opportunity to use those other interventions.”
Then there’s insurance payments. A recent large-scale research review published by the U.S. Department of Health and Human Services shows that nondrug treatments can help reduce pain. But lots of insurers still aren’t sold on paying for them.
“Reimbursement for procedures is generally very good. Reimbursement for medications is generally pretty good as well. Once you get beyond those two thing, reimbursement begins to tail off,” Twillman says.
Last year, the federal government released the National Pain Strategy, a large-scale plan created by doctors, researchers and other health experts that recommended a much bigger role for non-opioid pain management in the U.S. healthcare system, including changes to medical education and insurance.
Many health advocates liked the plan but have been disappointed that there hasn’t been much follow-up.
Twillman says he’s still hopeful.
“It’s just a very slow go,” Twillman says. “And some of it is going to require that some money be appropriated, so we also have to get the message to Congress that they’re going to have to step up to help us accomplish what’s in that strategy.”
But the hardest thing may not be convincing politicians, insurance companies or med schools so much as convincing patients like Renea Molden.
She no longer takes opioids, but neither does she dismiss their use for people who need them.
She now relies mostly on steroid injections to relieve her back pain but admits they don’t always make the pain disappear.
“There are moments that it just doesn’t seem like that’s enough,” Molden says. “Then I wish, ‘Oh, man, I really wish I had something else.’”
But Molden say she’s has learned to accept that pain will come and go. And she’s become a convert to tools like meditation and massage to help on the days when the injections aren’t enough.
“I know if I can just get through that day, there’s good days and there’s bad days, and you just kind of have to make it through the bad days.”
Even on the worst days, however, Molden takes comfort in the fact that she’s facing her pain without opioids.
KCUR is licensed to the University of Missouri Board of Curators and is an editorially independent community service of the University of Missouri-Kansas City.
Alex Smith is a health reporter for KCUR. You can reach him on Twitter @AlexSmithKCUR
