Drug-free Pain Relief: A Sardonic Review
As you probably know by now, the Centers for Disease Control and Prevention are preparing to release new guidelines to physicians on prescribing opioid analgesics. The gist: prescribe them a lot less, and in lower doses, because opioid pain relievers are addicting and killing patients.
Whether you agree with the CDC or not, the media has taken the “evil opioids” ball and run with it. Everyone from your grandma to this year’s presidential candidates are convinced that we must crack down on this dire menace to society. That we’re leaving legitimate chronic pain patients, who have never abused their opioid pain relievers and never will, to suffer debilitating pain and a much lowered quality of life doesn’t seem to matter much.
Instead of opioid analgesics that relieve pain quickly and easily, the CDC recommends that chronic pain patients should try non-drug pain relief options, such as cognitive behavior therapy, acupuncture, etc.
Of course, not one of these options (or “modalities,” as they’re known) will relieve the pain you’re suffering right now, at this moment. Not to worry. That doesn’t mean they won’t work at all.
In fact, many of these alternative pain relief methods can and do lessen pain to some degree. The big hitch: they take time, dedication, and lots of effort. But for your reading pleasure, and so the Powers That Be know we’re doing all we can to be good, aware, compliant chronic pain patients, I’m going to give you the run-down on these oft-referred-to alternatives to that small, white opioid pill. You know, the one that usually provides some measure of pain relief within minutes.
So you can get on with your life. Or sleep tonight. Or avoid suicide.
Cognitive Behavioral Therapy
This one is close to mine own heart, being the generally optimistic, positive idiot that I am. The Mayo Clinic states that CBT is a form of psychotherapy that “helps you become aware of inaccurate or negative thinking, so you can view challenging situations more clearly and respond to them in a more effective way.”
Simply put, it’s paying attention to your inner dialogue and re-vamping it toward the positive and away from the negative. Doing this can help you find the tools you need to cope with your fatigue and pain from rheumatoid disease. How? According to the American Chronic Pain Association, unhelpful thoughts and behaviors regarding your pain can lead to negative feelings, which in turn may increase your sensitivity to your pain. It’s a sort of vicious circle. CBT, they state, “includes a range of strategies aimed at enhancing coping skills, increasing confidence and self-efficacy for managing pain, and changing how individuals behave in response to pain.”
I know, it sounds, well, ridiculous. But for many people, it does actually work. It’s possible your insurance will cover the 10-20 sessions you’ll need to attend with a therapist.
A 3,000-year-old technique of traditional Chinese medicine, acupuncture involves ultra-thin, metal needles tapped painlessly into the skin at various parts of the body. The intent is to direct an individual’s wayward chi,or life force, so that it runs as it should, thereby relieving pain.
Yes, it sound woo-woo (and it is), but often, amazingly, it works. I’ve tried it myself. The first time, it dramatically reduced the pain of a flare in my hands and feet for about 48 hours. The practitioner explained that while it wouldn’t cure my RD, periodic sessions would help to control the pain. Unfortunately, my health insurance wouldn’t cover it--and I couldn’t afford it on a small-town journalist’s salary--so I didn’t pursue acupuncture as a regular therapy. When I tried it again many years later, it had no effect at all on my pain, though I’ve no idea why not. Again, this therapy won’t have much effect on your immediate pain. But I’m a believer--it can work. It’s worth a try. And really, it is painless.
Your medical insurance might pay for it.
This is where you’re forced to visit an intimidatingly fit, enthusiastic, depressingly athletic person wearing fashionable workout clothes. This person puts you through a tortuous routine of painful exercises a couple of times a week for a month or two, but only after your insurance company has refused to pay for it twice and forced you to appeal and wait for weeks before finally giving in and approving it. Never mind what the doctor wanted for you, or how much pain you were in when it was prescribed, or that you’ve had to live daily with your pain, untreated, in the interim. Also, there’s Homework.
All together now: We Hate Physical Therapy.
However, once it’s approved and you live through the first three or four appointments--and you do the Homework--it can reduce and relieve some degree of your pain, depending on what’s causing it. Good luck.
There’s no doubt that eating a nutritious, healthful diet can help you cope with your RD, particularly if doing so helps you lose any excess weight you’re carrying around. Lightening the load on your weight-bearing joints may well decrease your pain (though it won’t happen fast).
Good nutrition is also important for heart health, cognitive function (your brain power) and your overall well-being. It can help prevent type 2 diabetes, improve bowel and kidney function, and lower your cholesterol levels and blood pressure. Really, what’s not to like, except you can’t have donuts?
Some people find that eliminating vegetables from the nightshade family--potatoes, tomatoes, and eggplants--helps their RD. Others swear that eliminating gluten helps relieve their pain. It’s worth a try, anyway.
The good news: You don’t need health insurance to eat a healthy, small portions of lean meat, tons of veggies, whole grains, beans, fruit, plant-based fats like olive and canola oil, and a little dairy here and there if you really must have it. The bad news: changing your diet won’t relieve your pain quickly or completely.
You know the words: motion is lotion. They’re true, and I wish I could say that exercise was easy. It’s not, but moving your body in a fairly strenuous and sustained way really is good for rheumatoid disease and other types of arthritis. Like the other alternative pain relief options mentioned above, however, it will do nothing for your pain today. You’ll just have to live with it.
Still, if you exercise hard enough, your brain will release happiness chemicals called endorphins, similar to those it releases when you take that little white opioid pill, but a whole lot less of them. So pay attention, you might miss the good feelings while you’re struggling to catch your breath.
I’m being sarcastic. Forgive me? Exercise really is one of the best things you can do for yourself, even if it doesn’t relieve your pain today (or tomorrow, let’s face it). What it does do is strengthen the muscles that support your joints, helping you move more easily, with more confidence, and more safely. Weight-bearing exercises like walking also help build up weakened bones and prevent bone loss, two problems that are all too common among people with RD.
And of course, exercise does you a lot of good in other ways, as well, promoting heart health, increasing stamina and lung capacity, lowering cholesterol, burning off excess blood sugar and fat, and lightening up your mood. It doesn’t have to be hard, like Marine Corps calisthenics or killer spin classes at the gym. You don’t have to jog. Just take a fairly brisk walk for 30 minutes, five times a week. (Break your walk into two, 15-minute sessions, if you like. Works just as well.) Or ride a bike. Or swim. Maybe take tai chi or yoga classes. You can modify any of these activities to fit how your joints feel today, this minute. Hey, I swear, in time you’ll notice a difference--and it will be positive.
I want to be glad that the CDC is so concerned about my health. I want to be happy they don’t want me to become addicted to opioid pain medications and accidentally overdose myself and die. But since I’ve been taking these drugs off and on for nearly 30 years without harm, and since I’d never dream of abusing them or selling them on the streets, I wish they’d leave me--and other legitimate, responsible chronic pain patients--alone.
They won’t, though, so using my best CBT techniques, I’m going to be positive about how I’ll handle the RD flares that may be waiting in my future, without the helpful drugs that relieve my pain.
After the past 2+ years, how do you feel about telehealth appointments to manage your RA?