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patients should stick with physical therapy or try less traditional treatments, such as yoga, meditation and even acupuncture.
But doctors say it can be difficult to get patients to adhere to alternative treatments that may require repeated visits to a practitioner’s office. These therapies can also be physically uncomfortable and tedious; taking a pill is easier. Some insurance companies also don’t cover some alternative treatments such as acupuncture or treatments that are still in medical trials and have not yet been approved by the federal government.
“We are a society of instant gratification,” said Dr. Bahador Momeni, regional director of the University of Maryland Community Medical Group. “Take a tablet and feel better. Insurance won’t cover something like aqua therapy, but they cover prescriptions. As a society, we need to change our approach if we want to solve this problem.”
Momeni and other doctors said opioids have a place in pain management, mostly for short-term recoveries, especially after a major surgery or medical procedure. But they say it is better to try other treatments for chronic conditions.
For example, Momeni recommends his patients get water therapy — exercising or doing physical therapy in a pool — to treat pain. He believes many of these problems are linked to weight and other lifestyle issues and water therapy can help people lose weight and also be therapeutic to muscles. Restorative exercises are also easier to practice in the water.
Howard General Hospital endeavors to offer patients a wide range of pain treatment options and will combine some treatments, said Dr. Steven Levin, the hospital’s medical director for patient medicine.
“Pain specialists have long had the feeling that comprehensive care is the best care,” Levin said. “The more you can offer the patient to treat their pain, the less likely the patient will become addicted to opioids.”
Dr. Steven P. Cohen, chief of pain medicine and director of clinical operations at Johns Hopkins Medicine, is studying whether alternative pain treatments can reduce opioid use in patients already using the drug. So far he has found that it does not. The results will be published in the journal Anesthesia & Analgesia.
“Opioids work very well when you first take them, but then they lose their effectiveness,” said Cohen, who is also director of pain research at Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences. “You don’t really see a lot of evidence that supports ongoing effectiveness for more than three months.”
Daisy Harris, 79, of Laurel was using low doses of the opioids oxycotin and fentanyl to treat pain after a knee and hip replacement and back pain. She decided to stop using them a couple of years ago because what she heard about people getting addicted started to spook her. She threw out a bottle of 60 oxycontin pills and began looking for alternatives.
As the former head of a health clinic, Harris saw firsthand how addiction gripped some of the patients. “I just don’t want to become overly dependent on them,” she said.
“I don’t want to overtake them.” She worked with Dr. Levin at Howard General to come up with an alternative pain management plan. She now uses occasional steroid injections, physical therapy and anti-inflammatory drugs to treat her pain,
She hasn’t ruled out using opioids again if her pain is excessive, but she hasn’t needed to since she started using alternative treatments.
“I have no problem with opioids,” she said, “but let’s try to manage the pain first.”