Healthy Living: Non-Narcotic Pain Management
By- Dr. Joan Marie PellegriniHardly a week goes by that we do not read about some part of Maine’s narcotic problem. This is a really complex problem. As a surgeon, I prescribe narcotics frequently. The vast majority of patients use as little narcotic as possible. However, there are a few patients who require much longer pain management and may even live with chronic pain. I have noticed that most patients are rather uneducated about non-narcotic options for pain control.The goal of pain management is to reduce the pain enough to allow us to function properly. The goal is not necessarily to completely get rid of all pain. Also, if the pain is due to an acute injury or event, then we need to understand that our expectations should be different during the early course of healing versus the end of the healing phase. Narcotics are certainly quite effective for controlling pain. However, this effectiveness is not without consequences. Narcotics cause drowsiness, slowed motor control, decreased balance, potential for addiction, constipation, difficulty urinating, and respiratory depression. In short, narcotics are a very dangerous class of drugs.There are non-narcotic drugs such as acetaminophen, NSAIDs, tramadol, anti-depressants, anti-convulsants, etc. Acetaminophen is quite safe as long as one does not have liver disease and is careful not to exceed the maximum dose. NSAIDs are anti-inflammatories that are most useful for acute pain and inflammatory disorders. They also are useful as an adjunct to other therapies. They can be dangerous though in that they can cause bleeding, hypertension, kidney disease, fluid retention, stomach damage, and other potentially serious side effects.I have compiled a list of non-pharmacologic techniques for reducing pain. Many of these ideas came from an article that you can access on WebMD.â€¢Exercise: it is a catch-22. Pain makes us not want to move yet inactivity worsens pain. If you live with chronic pain, this becomes exceedingly important. It may not be anything more that gentle yoga excises or walking or swimming. The most important aspect is to move all the joints and muscles and maintain good balance. You may need to start with a physical therapist or personal trainer.â€¢Breathing and relaxation: get into a comfortable position and concentrate on slow, deep breaths. You may even use imagery or soothing tapes of various sounds (ocean, rain, music, etc). Focus on muscle relaxation and not on the pain or the day’s stresses.â€¢Avoid alcohol: alcohol can have a relaxing effect and makes us feel good. However, it will also interfere with sleep. Our sleep is less deep and we can wake up more frequently.â€¢Quit smoking: the chemicals in tobacco will slow healing and will reduce blood supply to an injured area.â€¢Eat healthy. Whole grains, fruit, and vegetables provide many disease fighting nutrients. Over time, our bodies will be able heal chronically injured areas.â€¢Journal: keep track of your level of pain, what activities you did during the day, foods you ate, and level/type of stress. Your doctor may be able to help you learn what some of the triggers are for your pain.â€¢Find a distraction: anything to take your mind off of the pain. Take a class, help a neighbor, find a project.â€¢Accupuncture: this is becoming more accepted and the good news is that because of this, there may be a specialist near you.â€¢Find a massage therapist who does myofascial release. I personally find this very helpful. Unfortunately, it can be painful when it is being done and it is a bit expensive (it is generally not covered by insurance).â€¢Find a sauna/ steam room/ hot tub that you may use. Whole body heat will loosen joints and muscles and make stretching more effective.â€¢Investigate if you have depression and treat it. Depression can cause pain and will certainly worsen any pre-existing pain.â€¢Try singing: this will also help with breathing exercises and relaxation. Along this same line is dancing which helps with movement and balance.â€¢Biofeedback: this is started with an instructor who measures a muscle’s level of tension. The patient then is taught various relaxation techniques and can see the results of the muscle relaxing.â€¢Invasive pain management: a pain specialist may inject certain ares. There are also stimulators that can be implanted. These specialists have many other techniques they may use.â€¢Get a pet: not just any pet. Studies show that petting a cat or dog will lower our blood pressure and our pain level. They also distract us.