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The nature of pain: Approach brings relief without opioids

“We’ve got to get you off of them”

For 22 years, Howard Winchel of Greenville, Mich., polished and buffed propellers for Michigan Wheel, putting his heart and his back into his work. The manual labor eventually took a toll.  

When his back first began to give him problems, Winchel was diagnosed with spinal stenosis. Surgery to correct it was soon followed by two more operations for ruptured discs.

The medication allowed him to push through the pain, dulling it enough for him to walk miles to go hunting, one of his favorite pastimes. But he soon built up a tolerance.

“I’ve been on hydrocodone ever since. I was on this stuff for 10 to 12 years,” he says. “I was on two of them every eight hours … I guess that’s a pretty high dose of it. But it’s like anything else, once you get used to it, then all of a sudden the effect can wear off and then you want something stronger.”

Winchel tried Oxycontin for a year but didn’t like how it made him irritable. His wife, Kim, noted how the opioids changed him.

“He was tired all the time, he was run down,” she says. “He never had any energy and anything he wanted to do was a chore. When he was on the opioids, he would get very moody. I always felt like I was on pins and needles to make sure I didn’t say something wrong to get snapped at.”

After a decade of using opioids, Winchel knew he couldn’t just stop cold turkey.

“Until you start to go off it, you don’t realize how addicted you really are,” he says.

Sensing a problem and worried by the news reports about the ongoing opioid crisis, Winchel sought help from Dr. Philip Baty.

“Phil told me, ‘We’ve got to get you off of them,’” he says.
 

Learning about pain

Winchel and doctor

Howard Winchel (left) and Dr. Philip Baty discuss Winchel’s X-ray. (Image: Eric Bronson, Michigan Photography.)

Like many other clinicians across the country, Baty, who is with Mercy Health Physician Partners in Rockford, was struggling with an epidemic of chronic pain and opioid abuse in his community. To help his patients, he knew he needed a better understanding of the nature of pain and treatment for pain.

“Those of us who were trained years ago were under the impression that if the X-ray says it looks bad, the pain is bad,” he says.

His mindset began to change after attending a seminar put on by Dan Clauw, director of U-M’s Chronic Pain & Fatigue Research Center.

“Dr. Clauw always starts his talks out with this bad looking X-ray and a good looking X-ray, and he points out that both people have pain,” Baty says. “So when [you see that] people have bone on bone —oh my God, they must be in a lot of pain.

“When in reality, what I’ve observed is that’s not true. I’ve seen people with huge knees who have minimal pain. They’re walking four miles a day and I see people who have normal X-rays and they are in a lot of pain.”

One of Baty’s main takeaways from the seminar was the fact that the experience of pain lies in the brain and not necessarily in the injured body part. And while pain is, in a sense, in the mind, it can still be debilitating.

“When you look at physical function, chronic pain is as disabling as having metastatic cancer,” Clauw says. “Yet pain patients are not necessarily treated like that by their family members, friends, or co-workers. It’s very frustrating for people to have chronic pain because it really impacts negatively on every aspect of their lives.”

Options

Clinicians learn about pain

Dan Clauw, director of U-M’s Chronic Pain & Fatigue Research Center, where doctors are teaching clinicians a new way of thinking about pain. (Image: Eric Bronson, Michigan Photography.)

Clauw has spent the past 15 years educating patients, their families, and clinicians to change how people think about pain and encourage them to consider treatment options beyond drugs.

As a medical director for the Michigan Center for Clinical Systems Improvement, Baty saw an opportunity to help doctors throughout the state. U-M has partnered with the center to hold educational programs in seven cities so far, from Grand Rapids to Traverse City.

During these sessions, clinicians learn more about different types of pain as well as nonpharmacological approaches to pain relief, including acupuncture and yoga, that are nonaddictive and more effective than opioids. The series has helped hundreds of doctors and patients.

“I find that most providers really, really would like to understand how to diagnose and treat pain better, which is why I think these statewide conferences that we’ve had have been very well received,” Clauw says. “People will say, you know, now I think I can go into an exam room and diagnose and treat pain — I feel more comfortable, I feel more confident. I think patients around the state benefit from that.”

Armed with a new understanding of pain, Baty has passed that knowledge on to Winchel, helping him slowly taper off of opioids through lifestyle changes, including weight loss, self-help coping techniques, and an antidepressant to alleviate the anxiety of being without the powerful drugs.

“Dr. Baty is the one that gave me the confidence to give the opioids up as well as the health risks. And I trusted him with the plan we had,” Winchel says. “It felt good to be off of them, it really did.”
 
(Top image: Eric Bronson, Michigan Photography.)

Comments

  1. George Saunders - 1967

    I’ve been on Norco for the past ten years for Post Polio Syndrome. As my Rx seemed less helpful I began thinking about getting off them. Nothing worked until my wife stepped in and offered to help. I’m not off Norco yet but my wife’s help is essential to my cessation of this drug. She has taught me that quitting takes time, has ups and downs, as well as we jointly tackle bad days together. We now live in California and miss Ann Arbor.

    Reply

  2. Fred Dery - 2000

    I’m a board certified pain management specialist in Iowa. I’ve been in practice for 10 years and have built a thriving and successful (meaning patients seek me out because they want to get better) practice WITHOUT the use of opioids. Period. No one comes to my clinic with acute or chronic pain and gets opioids, including such “weak” drugs as tramadol or Tylenol #3. They simply aren’t needed in today’s world. There’s plenty of other options that are more efficacious, better tolerated, and safer. I would encourage anyone reading this article- doctor, other medical provider, patient, researcher, etc- to read up on non-opioid treatment options such as exercise, PT/OT including modality options, yoga, tai chi, psychological interventions, CAM therapies, acupuncture, anti-depressants, anti-convulsants, spiritual options, injection procedures, implantable devices, topical and transdermal options, dietary interventions, weight loss options, etc.

    While opioids have legitimate, albeit limited use (post-surgical, acute trauma, end of life, etc) in my opinion, there are plenty of other better options out there for long-term pain management. The known potential risks of short-term and long-term use of opioids (medical, societal, etc) simply don’t justify regular use any more.

    That’s my 2 cents. I’d be interested in seeing other’s opinions. Thanks for printing this article!

    Reply

    • Joe Blow - 1988

      Great comments. I have stenosis, arthritis, a bulged disc, and my L4 vertebrae is 9 mm out of alignment from an auto accident when I was young. The Dr wants to place a pin in my back, ESIs, pain meds, etc.

      I told him I will first lose weight and strengthen my core, one year later I have lost over 50 lbs. and my core is much stronger. I feel much better, and my blood pressure, cholesterol, glucose levels, etc look great.

      It is about time that that medical community tells their whining, weak patients, to take responsibility of their health and become healthier through diet and activity. People need to be responsible for their health and take some pride in their wellness.

      Reply

  3. Cailin W

    Physical Therapy plays a vital role in the multidisciplinary approach to pain management and fighting the opioid epidemic. There is plenty of research available to support the use of physical therapy and physical activity to lower pain levels and healthcare utilization/costs!

    http://www.apta.org/uploadedFiles/APTAorg/Advocacy/Federal/Legislative_Issues/Opioid/SafeAlternativeToOpioids.pdf

    Reply

  4. Patrick CARDIFF - 1990

    At 60, my body’s worn out, I played college ball (Bucknell ’82 Go Bison!), now I have arthritis, but I’m still working out because I need the stress relief. My pain is about average to intense. Physical therapy works best for me, low-impact exercise with stretching also, before an intense workout it’s lidocaine rub, afterwords it’s epsom salts or icebath. Sometimes the next day after sport (Ultimate) it takes a minute or so to unstiffen. But I would never use prescription drugs for pain. Aleve is nauseous. I’ve tried marijuana and it works for pain-killing and overall relaxation. None of this is advice for anyone because we are all different, but you can *prepare* for pain so your muscles will be looser going into the work.

    Reply

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