Local integrative pain practice helps many older patients wean off opioids
EDITOR’S NOTE: This is the third installment of a 5-week series covering opioid use and treatment which will run each Thursday through Oct. 4.
BULLHEAD CITY — Conversation is said to play a significant role in helping people navigate the often daunting and embarrassing journey of treating chronic pain, according to doctors.
The majority of Dr. Christina Goldstein-Charbonneau’s patients are seniors and military veterans. Many of them suffer from pain or neuropathy and are looking to relieve their ills using opioid alternatives, she said.
Communication between people who seek medical service and those who provide it is crucial, Goldstein-Charbonneau said.
“Sometimes when you see their lists of medications you’re just in awe,” she said.
According to Goldstein-Charbonneau, emphasis on opioids and other pain medications is sorely needed but the stigma against patients who deal with chronic pain and other health problems through the use of opioids and other narcotics isn’t fair to them, she said.
“Patients don’t realize they’ve built up a tolerance to these prescriptions and that they now have a problem because they were told to take them,” Goldstein-Charbonneau said. “None of these people meant to be addicted. (Doctors) were all trained to give pain medication but before we knew it, things went out of control.”
She said she has been dismayed to find that many patients — especially seniors — have been prescribed multiple prescriptions with overlapping side effects, a combination that can pose serious health dangers, including death.
People who need to quell chronic pain often end up on a regimen dubbed in some medical circles as “The Holy Trinity,” said Goldstein-Charbonneau.
The Pharmacy Times described the combination as containing at least one opioid, a benzodiazepine (a psychoactive drug used for various reasons including anxiety and panic) and a muscle relaxant. All three together can cause drowsiness, confusion, tremors, seizures, respiratory depression and death, Goldstein-Charbonneau said.
All Wellness Medical Center has been expanding its focus on integrative care in recent years and said conversation between physician and patients often reveals that patients want to wean themselves from opioids, other narcotics and drugs that seem to have stopped working.
Opioids have a place in medicine, but that place isn’t as a permanent solution for chronic pain, she reiterated.
Her goal is to slowly wean patients off opioids and other strong, but now ineffective drugs as they try to alleviate pain in other ways, Goldstein-Charbonneau said.
People can try one or more alternative solutions, including changes in diet or the addition of dietary supplements, as well as one or more alternative treatments, such as acupuncture or massage therapy.
Anxiety and stress can intensify one’s physical pain but relaxation through targeted breathing and the practice of mindfulness often can help, Goldstein-Charbonneau said.
“Less pain and less stress can result in the need for less medication,” she said.
Myofascial release, the use of gentle and sustained pressure on connective tissue, might help with trauma, inflammatory responses and surgeries that created pain and limit one’s range of motion but these are only a few potential solutions, Goldstein-Charbonneau said.
Communication is crucial as a process of trial and, sometimes, error occurs while people try to find a combination of solutions that allows them at least to reduce dosages of medicines if the need for some prescriptions doesn’t fully fade over time, she said.
According to the doctor, human interaction itself buoys people psychologically and spiritually, and provides them with stimulation and an improved overall sense of wellbeing.
Older patients living solitary lives because they’ve lost their partner and don’t have a great deal of fulfilling contact with others can feel renewed through contact with others, Goldstein-Charbonneau said.
Depression can make it difficult to cope with serious medical problems so finding ways to help patients feel better psychologically is explored, she said.
“Something that allows them to be social,” Goldstein-Charbonneau said. “Something that allows them to get out of the house.”
That could mean considering having a pet or taking up a hobby.
“It’s a way to get them to care for something else,” said Goldstein-Charbonneau. “Thinking 24/7 about their pain without diversions only makes things worse.”
Others with problems that make going outside their home difficult might fare better with home visits by a healthcare worker, a professional who would “come to the home and evaluate how desperately the person needs human contact,” Goldstein-Charbonneau said.
Integrative medicine for pain and other problems is where the medical profession is headed, she added.
The number of patients looking for what The University of Arizona’s Center for Integrative Medicine describes as a style of care that “takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies,” is on the rise.
Goldstein-Charbonneau recently completed a fellowship with Dr. Andrew Weil, director of U of A’s integrative medicine program and a professor of Medicine and Public Health, widely known as an author, a newspaper columnist and as a frequent guest on PBS.
U of A stressed that in integrated medicine “patient and practitioner are partners in the healing process. “