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OPIOIDS

Opioids are only one type of pain medications used to treat pain. They should be the last resort for the treatment of chronic non-acute, non-cancer pain and they should only be used after other non-opioid medications have failed to provide pain relief. This is an statement based on the most recent evidence-based medicine research available. Opioids belong to a family of medications commonly known as narcotics, from the latin word "narcosis": to produce sleep. They are potentially dangerous medications that if not taken as prescribed, may cause serious side effects and even death.

These medications are under federal regulation and are considered “controlled substances” meaning that they have to be monitored by the DEA (Drug Enforcement Agency). You and your doctor must follow and abide the regulations of monitoring at a Federal and State level. There are certain requirements, medical questionnaires and agreements that have to be fulfilled as well as normal regular discussions that have to take place if you are taking these medications. These are required conversations, questions, concerns that MUST take place with you doctor regardless of your past or current medical, psychological or social history. ALL patients are monitored for safety purposes. A urine drug screen must be obtained prior to starting the therapy and regular unannounced and random urine drug tests may be ordered as per your treatment and follow-ups require. These are highly addictive medications and it is important that you understand this before even considering taking these medications.

Beware of the Pain clinic, physician or provider that only offers you opioid prescriptions or offers you opioids as a first treatment therapy to treat your chronic pain. This is not a safe practice, this approach usually ignores all your other health conditions and psychosocial aspects that may influence strongly on your pain.

Discussions about opioids are difficult and complex and need to have many questions and answers from your side and from your doctor’s end, so expect to have these conversations and beware of any other provider that just signs a prescription for medications. You want to be offered the best and latest evidence-based medical alternatives and treatments for your pain.

Every pain experience is different, that is why research has tried to explain pain as a biopsychosocial phenomenon.

WHAT IS PAIN?

Pain itself is very complex, it is defined by the IASP (International Association for the Study of Pain) as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”.

Pain is a necessary and vital sensation or feeling. Pain is inevitable, but the suffer that it may bring is actually optional. Options as with everything in life, we all have options and that is why you are probably reading these lines. Now, you may want to ask yourself many questions about why you are having pain. You may want to start knowing if your pain is acute or chronic. Acute pain is pain that lasts less than 6 weeks and it’s usually related to an acute injury or postoperative pain. This is the primitive response of the body to alert it as to a need to heal itself or protect itself from further injury. Chronic pain is usually a pain that persists for more than 12 weeks or 3 months. This is the type of pain that becomes abnormal, pervasive and does not serve a preservation purpose. This is the type of pain that becomes a disease and again, the type of pain that may have brought you to read these lines.

DID YOU KNOW THAT YOU CAN HELP YOURSELF IN MANAGING YOUR PAIN?

It is normal to live with some sort of pain one way or another, specially if you are over 35 years old, if you have gained weight, if you are not doing any physical activity at all and your lifestyle is fairly sedentary, if you smoke and your diet is mostly “inflammatory” which is addressed on the diet section of this webpage. The difference is how each of one us copes with this chronic pain. Your goal, regardless of the options for treatment you have chosen is to learn how to cope best with your specific pain in a way that it does not interfere with your daily basic functions and allows you to enjoy life. Your role in the treatment of your pain is vital to enhance your outcomes. This is what we call self-care in the medical community and it’s not very complex. It includes adapting yourself to healthier lifestyle habits, using creams, rubs, ointments and patches for the treatment of pain on a regular basis, using heat or ice as tolerated and useful, staying active and avoiding bed rest as much as possible, taking care of your mental health and being kind to yourself. Remember, you must have an open mind to listen to what your doctor has to tell you about the most recent medical advise to help treat your condition. You must have realistic expectations, you may have lived with your chronic pain for many days, weeks, months and perhaps most likely years and in a pervasive way, it has become your best and worst friend. You must not expect that your doctor will magically take away all the pain and bring you back the same old self you were 20 years before. It is only normal and expected that you are kind to yourself and accept the reality of an aging body that needs to be reconditioned.

There is no magic bullet, there are options. You have to be patient, you have lived with your chronic pain for months, years, it may be challenging and frustrating, you must not expect your pain to be gone completely, at some point you must understand that it may not be 100% relieved and that you will have to change the way you react to it and live with it, getting to a balance of a good quality of life learning how to cope with pain. You must accept the reality of life.

Unfortunately, a fast and easy fix with medications that numb your whole body, emotions and mind is not the solution and these same medications created the catastrophe we are living today with the opioid epidemic.

WHAT IS A PAIN CLINIC?

A pain clinic is not an opioid clinic, if your primary care physician has referred you to a Pain Clinic, it doesn’t necessarily mean that you will be prescribed opioid medications. A Pain Management Specialist is usually a physician that has undergone extensive training, at least 5 years of a medical specialty and then at least a year in Pain management. As such, you should expect a broad variety of options that your doctor should provide you for options to treat your pain. Chronic pain is very complex and as such, treatment must be complex and diverse. Our bodies are a complex yet perfect anatomic machines. There is not a single thing that treats pain.

Pain and mental health

Daily normal or abnormal emotions also play a fundamental role in your chronic pain, specially anxiety, depression and stress. Diagnosed mental health problems tend to worsen your pain and make it chronic
Multimodal pain management strategy.
Overall aim for wellness
Have to find some motivation in one way or another

Pain and sleep

Sleep deprivation has been linked to chronic pain

Nightime mobility routine

If you’re living with pain and struggling with sleep then you’re not alone. It’s very common for people with persistent pain to have difficulties getting to sleep or staying asleep. Why can’t I sleep? It’s likely that there are a number of causes of your sleep difficulties. Here are six triggers often found by people living with pain:

Pain Psychology

"I am not crazy!" you may say to your Doctor. Don’t take it personally. Your doctor is offering you all the available evidence-based medicine to help you with the management of your chronic pain. You will have to identify in fact if mental health is playing a significant role in your chronic pain

Back to nature

Spending time outdoors can boost your mood, reduce stress and improve your well-being. Breathe it all in to find grace and wonder when you can. It's all around us! Make sure you notice the moments of joy! Slow down and reflect on how fortunate you are in so many ways.

Managing anxiety in the face of uncertainty

Be intentional
Make a personal game plan
Ask yourself: "How do I want to approach things?" even if you have no idea what will come your way
Make a list on paper of what's important to you, for example: family, financial security, self-growth, career and rank them.
Take care of yourself! In uncertain times feeling healthy in body and mind will give you strength
Continue your fitness routine, give yourself time to rest and seek social support even before you think you need it

Mindfulness and Meditation

When we are stressed and worried, we tend to brace our muscles and our breathing, which sends signals to your brain that something's wrong, that there's some sort of danger. That triggers more stressful, worried thoughts and creates this feedback loop. Practicing midnfulness interrupts that feedback loop, takes you out of that worry and stress and helps you find calm and become more grounded.

Self-care

When you first hear about self-care, you should feel hopeful and not helpless, suported and not abandoned. Our mission as Pain management physicians is to help you and guide you about what it actually means to take care of yourself. Your understanding of pain will improve your sense of self-efficacy. You need to learn how to live well with pain.

What is a multimodal pain management approach?

A multimodal approach is an interdisciplinary approach to pain management involving physical therapy referrals, chiropractors referrals, acupuncture, topical and oral analgesics, Pain psychology, self-care, injections and other interventions. You will get the best results, meaning less pain with the combination of these multiple varied treatments.

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