Finding New Ways to Treat Pain

Maureen Robb's picture
By Maureen Robb on June 26, 2018

Did you know that more than 1,200 Virginians died from opioid overdoses last year?

Or that more than 10,000 people visited Virginia emergency departments for opioid and heroin overdoses?

Sadly, deaths from drug overdoses are now the main cause of unnatural deaths in the state, according to the Virginia Department of Health.

Some of them involve patients who were prescribed opioids to treat chronic pain.

A New Approach

How can we as a caring society meet the needs of patients in pain while also guarding against addiction to pain-killing drugs?

At Carilion Clinic, a team of physicians and advanced practice providers led by Shaheen Lakhan, M.D., Ph.D., chief of Pain Management, has been tackling this problem.

The result is a new Carilion Clinic Pain Management program that gives us more ways—besides medication—of treating chronic pain.

They include:

  • Acupuncture
  • Massage therapy
  • Reiki
  • Art therapy
  • Music therapy
  • Nutrition
  • Pain education
  • Yoga
  • Behavioral health services (psychology and psychiatry)
  • Aromatherapy

Because the focus of the new program is to restore function for a patient, Carilion is calling its approach “functional restoration.”

A Whole-Person Focus

The rising number of deaths from opioid overdoses and the sheer human toll of addiction shows the limits of our traditional pain management methods, according to Carilion physicians studying the problem.

Fortunately, there are also hopeful signs that patients can be helped to better cope with their pain.

A study published in Health Affairs showed that greater coordination of care and regulation of pain clinics reduced opioid prescriptions by eight percent and opioid overdose death rates by 12 percent.

“Under Carilion’s new program, chronic pain patients are offered coordinated care for the mind, body and soul using medicinal therapies, interventional procedures, psychology, psychiatry, nutrition, education and other tools,” said Dr. Lakhan.

The program also allows doctors like Elizabeth Stringer, M.D., and Yaohua Lu, M.D., to develop individualized pain intervention options for patients. And Don Bivins, M.D., applies holistic pain management approaches to care for hospital patients.

The Role of Nutrition

Nutrition therapy is one of the cornerstones of the program. Carilion wants to help patients understand how nutrition and supplementation can impact the amount of inflammation and pain in their bodies.

Troy Mueller, R.D., a clinical dietitian at Carilion, along with Dr. Lakhan, have jointly developed a nutrition pain management program that helps patients to better understand which foods and beverages might be enhancing inflammation and pain in their bodies and which foods, beverages and supplements can help decrease pain and inflammation.

Patients are encouraged to limit or avoid:

  • Fast foods
  • Processed meats (e.g., bologna, hot dogs, bacon, sausage)
  • MSG
  • Artificial sweeteners
  • Trans fats (hydrogenated oils)
  • Refined sugar (e.g., soda, sweet tea)
  • Corn syrup
  • Refined carbohydrates

They are encouraged to eat:

  • Fruits
  • Vegetables
  • Fish and shellfish
  • Healthy oils like extra-virgin olive oil
  • Avocados
  • Raw nuts (e.g., almonds, macadamia nuts)
  • Seeds

Under the new program, a pain dietitian assesses a patient’s diet and develops an individualized nutrition plan, taking into account a person’s pain diagnosis, lifestyle and other factors.

The dietitian also helps the patient determine whether they would like to try anti-inflammatory supplements such as turmeric, Coenzyme Q10 or Omega-3 fatty acids.

Acupuncture

Acupuncture, which has been used for centuries in Asia, is now increasingly being used around the world to treat all types of pain as well as addiction.

By inserting thin needles into targeted acupuncture points on the body, doctors stimulate the central nervous system to release the body’s natural healing chemicals and hormones, resulting in pain relief.

At Carilion, family medicine physician Priscilla Tu, D.O., is trained in medical acupuncture and provides this service to patients. Dr. Tu trained at the Helm Medical Institute, best known for its work in battlefield acupuncture and research into post-traumatic stress disorder.

Treatments again are individualized to the patient.

Pain Psychology and Psychiatry

“As we learn more about pain, we are finding a link between psychic and physical distress,” said Guyton Register, M.D., a pain psychiatrist at Carilion. “Thus, the pain psychiatrist is an integral part of the interdisciplinary pain team, primarily diagnosing and treating mental health disorders associated with pain—particularly anxiety and depressive problems.”

At Carilion, pain psychologist Robert McNamara, Ph.D., helps patients learn how to:

  • Understand and change their responses to perceptions of pain
  • Practice relaxation and mindfulness
  • Understand the relationship between pain and psychological difficulties
  • Gradually increase and pace their physical activity
  • Get enough sleep and rest, and engage in pleasant activities
  • Understand problematic behaviors and adopt coping strategies
  • Better communicate with others about their pain and physical limitations

Death and Suicide

Is there a concern that a new approach to pain management could actually prompt some suicides by people who can’t handle their pain?

“This is a somewhat grim, but important question,” said Dr. Register. “Being in chronic pain is an identified risk factor associated with suicide, but so is chronic opioid use.”

“It is important to understand that unintentional overdose deaths eclipse deaths by suicide year after year,” he added.

By offering patients a variety of therapies and engaging them more in their care, Carilion’s intent is to give patients more options and better put pills in their place.

Free group pain nutrition classes are offered twice a month on Thursdays at 10 and 11 a.m. at Carilion's Institute for Orthopaedics and Neurosciences in Roanoke. To register, call 540-224-5170.

Learn more about medical acupuncture.