We CAN treat chronic pain without opioids
Naturopathic doctors are on the front lines of the battle against opioid addiction, explains AMY ROTHENBERG, N.D.
On a drizzly fall day with colorful leaves dotting the wet sidewalk, I stood silently as name after name was read. It was late last year at a somber vigil to bring awareness to overdose deaths in my small, idyllic town, which like many in Pennsylvania, has not escaped the opioid crisis. As I listened to that tragically long list of victims, I heard the names of three of my friends’ sons; friends who had their babies around the same time I had mine. These families who together went on vacations, sat through endless soccer games and helped edit their teenagers’ college essays. Now, a scant 25 years later, their young men were gone — victims of the opioid overdose epidemic.
There are many routes to opioid addiction. One route of grave concern is the misuse of prescription opioid medication, often prescribed for the treatment of chronic pain. The educational advances put forth by the Pennsylvania Medical Society are part of an essential and national effort to shift prescribing habits and will
help enormously to stem this epidemic.
The number of Americans suffering with chronic pain exceeds that of diabetes, heart disease and cancer combined. Addiction and overdose from prescription pain relievers continues to grow at galloping rates. Licensed naturopathic doctors (N.D.s), trained in nondrug approaches to the treatment of pain, fill an important gap in the medical treatment of pain.
Licensed N.D.s complete doctoral-level education at four-year, post-graduate, fulltime naturopathic medical schools recognized by the Council for Naturopathic Education. The U.S. secretary of education recognizes the council as the national accrediting agency for programs leading to the N.D. degree. Gov. Tom Wolf in 2016 signed a bill into law that regulates naturopathic doctors in Pennsylvania. Trained to use a variety of natural medicine approaches for the treatment of chronic pain, N.D.s take into account lifestyle, nutrition, work and leisure activities, current and past stressors, and relevant previous injuries. Like medical physicians, N.D.s aim to ensure that pain patients have and understand all its manifestations.
In one trial, naturopathic therapies were estimated to save close to $1,000 per patient with low back pain. Missed work due to illness diminished by 6.7 days, leading to return on investment of 7.9 percent.
In another study on chronic pain related to rotator-cuff tendinitis in postal workers, naturopathic therapies decreased pain by over 54 percent, significantly better than other approaches used in the trial. The naturopathic approaches also diminished disabilities.
Licensed N.D.s create individualized plans for patients, utilizing nutrition through dietary recommendations. We work with nutritional supplements and botanical medicines to help reduce inflammation and pain. We recommend bodymind approaches to address stress. Naturopathic doctors offer exercise recommendations and work with physical medicine approaches. We work to engage inherent healing capacities of the human body. Some naturopathic doctors, with additional education and training, are duel-licensed as acupuncturists, bringing that wealth of knowledge to the treatment of chronic pain.
Communication with other medical providers to encourage understanding across disciplines for the benefit of the patient is typical. Appropriate referrals for both further diagnostic work-up, for treatment support or for surgical intervention are made as indicated. We also receive referrals from medical colleagues who are looking for a fresh perspective or new ideas for difficult-to-treat patients.
Increasingly, pain clinics include N.D. providers and integrative-medicine approaches for the treatment of pain. One example is the Southwest College of Naturopathic Medicine Pain Relief Center, which has on staff N.D.s, M.D.s, P.T.s, acupuncturists and more. In Oregon, Bill Walter, N.D., practices at a Federally Qualified Health Center in Eugene as part of the Department of Health and Human Services. He describes “strategizing with the clinical-care team about how to think about pain management, to help patients learn to change habits and patterns that worsen pain while at the same time helping patients improve function. Naturopathic doctors offer novel perspectives on pain management and are leaders in changing the paradigm away from firstline opioid usage.”
Licensed N.D.s collaborate with other professional organizations to modify national prescribing habits in order to limit opioid prescriptions. N.D.s weighed in on the seminal policy brief “Never Only Opioids: The Imperative for Early Use of Non-Pharmacological Approaches and Practitioners in Pain Care.” The goal is to ensure that non-drug approaches are moved to the beginning of pain treatment and that opioid medication is prescribed only as a last resort.
If you or someone you love is struggling with chronic pain or working to decrease dependence on opioid medication, consider adding an N.D. to your health care team. To find a licensed naturopathic doctor in the United States or Canada, visit naturopathic.org and, in Pennsylvania, panaturopathic.org.
I write this piece in loving tribute to the three young men I knew who lost their lives to this epidemic. May we work together to reverse this trend and pool our resources and expertise to help patients suffering with chronic pain.
Amy Rothenberg is a licensed naturopathic doctor and was named 2017 Physician of the Year by the American Association of Neuropathic Physicians (amy@nesh.com). She lives in Amherst, Mass., and practices in Enfield, Conn.