Opioids fail when it comes to long-term pain relief
Q: I’ve been taking opioid pain medication for five months to relieve the chronic pain of arthritis in my spine. It seemed to help at first, but now I swear the pain is worse and I am loath to increase my dose. How do I ease the pain and get off these scary drugs?
Janette F., Nashville, Tenn. A: This is a complicated issue. We cannot comment on what is the best therapy for your arthritis, not knowing its extent or if surgery is a smart option. But new insights into pain management may help you rethink your approach and give you some interesting points to bring up with your doctor.
Pain researchers from the University of Washington School of Medicine recently laid out their insights on why opioids are not a good remedy for pain. In a column published in the Annals of Family Medicine, they explained that chronic pain and emotional pain activate the same limbic brain center. That center contains the amygdala — the emotional hub of the brain; the cingulate gyrus, which induces an emotional reaction to pain; and the hippocampus, thalamus, hypothalamus and basal ganglia.
Ultimately, they say, taking opioids usurp and suppress the body’s natural emotional and physical pain-relief processes. Then it becomes difficult for the body to ease chronic pain or for you to feel rewards and enjoy interaction with others. That produces depression and makes it harder to do what’s needed emotionally and physically to control chronic pain. A vicious cycle of pain then makes you feel worse emotionally and physically. And it then seems that taking more opioids is necessary to ease the pain.
“Nope,” say the researchers. Instead, you want to ease off the opioids and encourage your natural pain-relief systems to improve your mood and quell your physical discomfort. So to truly manage chronic pain, ask your doctor about physical therapy, meditation, acupuncture, alternative medications and the potential for getting benefit from radiofrequency ablation or surgery.
Q: My doctor says I have frozen shoulder. All I know is that it hurts and my range of motion is restricted. What are the best ways to manage this and will it ever go away?
John J., New York
A: Frozen shoulder, aka adhesive capsulitis, is pretty common, but we don’t really know why thick bands of tissue, called adhesions, develop in the capsule that surrounds your shoulder joint, causing pain and limiting motion.
The American Academy of Orthopaedic Surgeons says frozen shoulder has three stages: freezing, frozen and thawing.
• Freezing is when it begins to seize up and can last from six weeks to nine months.
• Frozen means you have lost motion, and that can last up to six months, limiting everyday activity.
• Thawing is the slow return to normal functioning and can take two to three years.
It happens most often to folks 40 to 60 years old — more often women — and diabetes increases the risk of developing it, as do hyper- and hypothyroid disease, Parkinson’s disease and cardiac disease.
A new meta review of 65 studies, with 4,097 participants, published in JAMA Open Network, says that the best treatment is intra-articular corticosteroid injections given along with a prescribed exercise program or receiving electrotherapy or passive mobilizations. Also, ask your doctor about doing these at-home exercises:
External rotation: Stand in a doorway and bend your affected arm’s elbow to 90 degrees to reach the doorjamb. Keep your hand in place and rotate your body away from your arm. Hold for 30 seconds. Relax and repeat.
Forward flex: Lie on your back with your legs straight. Use your unaffected arm to lift your affected arm overhead until you feel a gentle stretch. Hold for 15 seconds and slowly lower; relax and repeat.
Crossover arm stretch: Gently pull the affected arm across your chest below your chin as far as possible without causing pain. Hold for 30 seconds. Relax and repeat.