UW doctors pioneering advanced opioid-free pain treatments

Nov 29, 2016, 8:21 AM
Since the dawn of medicine, medical providers used opioid drugs to treat the most extreme pain from injury and debilitating illnesses such as cancer. And many doctors figured if it works for one pain, it can work for all pain. (AP)

As the opioid epidemic continues to ravage our communities, the medical world is working hard to find better ways to treat pain without opioids. And doctors at the University of Washington Medical Center are leading the way.

“It’s hard to estimate, but almost certainly more than 100 million people in the country have some kind of ongoing pain, and in terms of disabilities, it’s tens of millions who are not able to function fully in society because of their ongoing pain,” said Dr. Brett Stacey, medical director at the Center for Pain Relief at the UWMC.

Treating pain is no easy feat. Unlike a broken bone or some other relatively simple diagnosed and repaired condition, pain is completely subjective.

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“Some people can have an MRI that looks horrible and not really have much pain and other people have an MRI that doesn’t look that bad and have horrible pain,” Stacey said. “So the medical diagnosis is one part, but the way that medical diagnosis manifests in each person … is completely individual and is only partially related to the underlying diagnosis.”

What’s really fascinating is how much our experience, emotions, and other factors contribute to our experience of pain or sensation in general.

For example, while a loved one can pat our leg in a movie theater and generate feelings of warmth or affection, if a stranger were to do the same thing, our feeling would be completely different — even though the physical contact is exactly the same.

That’s why there’s no single way to treat pain, according to Stacey. But for too many years, uninformed doctors tried.

Since the dawn of medicine, medical providers used opioid drugs to treat the most extreme pain from injury and debilitating illnesses such as cancer. And many doctors figured if it works for one pain, it can work for all pain.

“And so what happened was we took that experience and said pain is pain, let’s just transpose this to chronic pain,” Stacey said.

Add that to the huge push from profit-driven drug companies to get doctors to prescribe opiates such as Oxycontin, and an epidemic was born.

With an increased emphasis on mitigating pain in hospitals, the medical dramatically expanded the use of opioid treatment, with little foresight or regard for what could or would follow.

But Stacey was among a number of pain professionals seeking to minimize their use.

He says opiates do have a place, but only when they’re medically appropriate at what he calls the correct stage and the lowest dose possible, with clear goals for ending their use.

So how do you treat chronic pain without opiates? There are a number of physical procedures.

“Sometimes those procedures are simple injections. Sometimes it involves altering the function of a nerve with freezing or burning it. Sometimes it involves stimulating the nervous system to change pain signals with implanted devices,” Stacey said.

And doctors are having increasing success with naturopathic treatments including yoga, acupuncture, hypnosis and meditation, as alternatives to opioid treatment.

It’s an art that keeps evolving. And there’s one important component far too many people don’t want to hear – we all have to be engaged in the process of healing.

“It takes more work to do something besides just write a prescription,” Stacey said. It doesn’t work to manage someone’s pain if their expectation is I’m going to do everything for them. If you’re not active in your healthcare, you’re not going to have a good outcome.”

But the good news is you don’t have to live with pain. So what do you do? Stacey says to start with your primary care doctor. Make an appointment to talk specifically about pain, not just a bunch of stuff as you would in a physical. Then, get a referral to a specialist if your doctor can’t help.

And remember, you have far more options than you or your doctor might know.

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UW doctors pioneering advanced opioid-free pain treatments