Search for tag: "pain management"

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Interviewer: Dr. Higgins, so when it comes to opioid pain pills, I'm getting the point personally, and I want to see how you would react to this with the physician perspective, that opioid pain medications, they're just really bad news and we really shouldn't have them in our medicine cabinets anymore. We really should look for other ways to treat pain because you continue to hear about deaths and overdoses and addictions. Am I being a little overstated on that?

Dr. Higgins: Yes and no.

Interviewer: Okay.
Dr. Higgins: There are certainly indications and uses for opioid pain medicines, where appropriate. And the presence of them in your medicine cabinet, by themselves, is not harmful. It is the chronicity of use, using them over a longer period of time, and ramping up the doses, which is, and this is proven in the literature, this is where people get in trouble.

Interview: What should we do about what seems to be going on? It seems almost like a national health epidemic. And there again, I may be overstating this.

Dr. Higgins: It's absolutely not overstating it. It is a national health epidemic. If you set aside cancer and heart disease, the thing that was most likely to kill an American under 65 was their car with some sort of motor vehicle accident. It was that way for some time. In 2003, it was the first year in the state of Utah where a prescription opiate was more than likely to lead your demise than a motor vehicle wreck. That was kind of revolutionary at the time. Now, it's that way in greater than half the states.

Interviewer: Okay. So we were kind of ahead of the curve.

Dr. Higgins: Yeah, it's nothing to be proud of.

Interviewer: Yeah, in a bad way, yeah. So it is something that we need to address. As a patient, if my doctor says, "I'm going to prescribe you some pain medication that's opioid-based," should I say, "I'd rather look for a different solution?"

Dr. Higgins: If you want to do that, your doctor should definitely respond. The old teaching was that as long as you had discomfort, the opioids [Audio skips 00:02:12] likely to be taking someone else's medicines. The people in the 40 to 60 age group are more likely to be taking their own medicine and they were on it chronically and they were on higher doses. And there are people here doing some pretty fascinating research on what the susceptibilities are. We may all have genetic susceptibilities to flip that switch. So even if you don't think you have "an addictive personality," then you can certainly develop one rapidly even if you don't think it's in you.
The other thing is to not necessarily judge those people that have had problems. Plenty of very prominent people and people who we wouldn't necessarily expect have certainly run into problems and, in some cases, have been fatal.

Interviewer: So at the end of the day, a physician perspective, what do we do to solve the problem?

Dr. Higgins: I think it's critically important of late that the public becomes aware and this happens through the lay press. And then, from a physician standpoint, we have to educate the patient at the beginning, the initiation of treatment. Secondly, have an exit strategy. Thirdly, entertain other modalities we can be using besides these medicines to treat the pain.

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Dr. Miller: Medicine may not be the only nor the best treatment for low back pain. We're going to talk about that next on Scope Radio.

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Dr. Miller: Hi, I'm Tom Miller and I'm here with Dr. Rich Kendall. Rich is the Chair of the Physical and Rehabilitative Medicine Department at the University of Utah and we're going to talk about treatment of low back pain with non-medical modalities. Rich, tell us a little bit about physical therapy and how that relates to back pain and how exercise helps people improve their lower back pain. I think it's an area that's underutilized.

Dr. Kendall: Many people with back pain, just exercising on a daily basis will really reduce the intensity of their back pain quite a bit. Many studies have shown that back pain and exercise go well together. It can help with sleep, it can decrease back pain, lessen medication use, and even avoid surgery.

Dr. Miller: Rich, tell me a little about certain exercise modalities or maybe they're called stretching modalities, something like Pilates. I know that a lot of people say that Pilates is good, it improves core strength, but that may also translate into improved back strength and health.

Dr. Kendall: Well, Pilates is a very good exercise, but really there is no evidence that one form of exercise is any better than another form. Core-specific exercises, Pilates, Yoga

Dr. Miller: Yoga.

Dr. Kendall: A gym program where you lift weights. Really all of them can work in decreasing back pain. Now sometimes if an athlete is already doing a very rigorous program, they may need physical therapy with targeted exercises. But, in general, most people just sticking with a generalized exercise program and whatever they like. The key is doing something they like so you'll do it all the time.

Dr. Miller: One of the things that I struggled with is I didn't always have enough training in what physical therapists do. Do you find referring to a physical therapist to be helpful in cases where you're going to prescribe exercise therapy for people with back pain?

Dr. Kendall: I think for most people, starting with a physical therapist is a great idea. They're going to demonstrate the exercises. The therapist will watch that they can do the exercises correctly, that they have good form while doing the exercises, and also be able to look at other associated joints whether there's hip tightness or leg tightness, arm or neck tightness to try to work on some of those adjacent areas as well. But a lot of times, we'll start with a therapy and even then sometimes transfer over to a personal trainer.

Dr. Miller: Do you find that some patients are skeptical of exercises therapy? That they might seek medication instead? And how do you deal with that?

Dr. Kendall: A lot of people certainly are skeptical that exercise will do that. Nobody likes to exercise. Years ago, it was probably one of the hardest things to convince patients of. Now that everybody has to pay $35 or $50 a copay to go see a physical therapist, with two visits to a physical therapist you've paid two months of a gym membership. I can really convince people to exercise a little bit more. But many of the studies actually are showing people with degenerate discs, arthritis of the back, exercise is probably the best thing, even as well or better than surgery.

Dr. Miller: Rich, why is exercise beneficial in treating back pain compared to taking analgesics like Aspirin or Ibuprofen? How does exercise help in the long run?

Dr. Kendall: Well, there are a couple of reasons. First, you're strengthening your muscles. You really support the spine a lot better and with any arthritic joint, you strengthen the muscles around it, you load the joint a lot less and that triggers less pain from the joint. The second is you will get some change in the neuro firing patterns and how your brain perceives that pain. So overall your pain will be noticed less by your brain.

Dr. Miller: Could you explain why patients might be skeptical about utilizing exercise therapy or physical therapy to improve their condition?

Dr. Kendall: Well, one of the biggest things is that people already hurt doing very little activity and they think that doing more activity is going to hurt even more. So that is one thing that we have to overcome. The other is that they've probably been to therapy before or they've tried an exercise program and it may have helped them briefly, but then as soon as they stopped their pain came back. So they think it might be something more serious. Dr. Miller: So the key thing then is, number one, making sure they receive the proper instruction on the types of exercises that'll help strengthen the back and reduce the pain, but also encouraging them to keep up the exercise routine over time.

Dr. Kendall: That's true. Keeping it up is key and I always tell patients you can take a day here or a day there essentially Christmas and New Year's Day off, but every other day you should be doing some kind of activity. Whether it's five minutes or 10 minutes, that's great, but some kind of activity.

Dr. Miller: So, Rich, for patients that have mild to moderate back pain and who may not feel like they need to go in and see a physician, is there a website or a place they could go to find out what types of exercise might benefit them? Or do you even advise that?

Dr. Kendall: I think searching the web is a very difficult thing. If you type in low back exercises you get about 5 million websites to look at on Google. Knowing which one is correct, knowing which one is somebody just in their living room with no certification thinking that they're an exercise fitness guru is difficult. Really, I think that most people, unless you have an exercise background, seeing a therapist just one or two times, or even going and seeing a personal trainer at the gym it'd be a great place to start.

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