Transcription:
Opioid Alternatives: Find a Better Way to Manage Your Pain

Melanie Cole, MS (Host): The use of opioids has skyrocketed in recent years. As a result, addiction to them has increased as well. More and more, people are looking for alternatives to the use of opioids for acute and chronic pain management. My guest today is Dr. Kelly Zach. He’s an anesthesiologist with Innovative Pain and Spine Specialists. Dr. Zach, what are the basic types of pain? Let’s just kind of start with a working definition. What is chronic pain and what is acute pain? And since they're somewhat subjective, how do you measure them?

Kelly Zach, MD (Guest): Right, right. So, I want to take it back a step. First of all, the definition of pain itself is really an unpleasant physical and emotional response to some stimulus. So, when we talk about pain, there’s really two types. There’s acute pain and there’s chronic pain. So acute pain is that pain that we get in the setting of some noxious stimulus. So, it may be an injury, it may be surgery, it may be a disease process, it may be a trauma. There’s really some stimulus that starts it. Then chronic pain, by definition, is pain that lasts longer than three months. Often times chronic pain starts out as acute pain with some injury, but then it persists. Chronic pain has really become an epidemic in this country. And actually, there’s more people that suffer from chronic pain that diabetes, heart disease, and cancer combined. So, it’s really a bid problem.

Host: Wow. So, you're an anesthesiologist. How do you work with patients? Tell us a little bit about a multifaceted approach to painful disorders. What are the first things you do when someone comes to you in pain?

Dr. Zach: Right. So, the first thing we do is we want to get a sense of the person, right? So, we take a good history. We do a physical exam. We review any records that they may have. Often times we’re seeking out imaging that they may have had on their back or their spine or other parts of their body. So, we’re really looking at the person as an individual and getting a sense of their overall health. Then what we do from there is we kind of get a sense of what exactly is the nature of their pain. What’s causing their pain? And what are the options for going forward and managing that?

Host: So, then what? Before we get into some of those alternatives, what had been the way that doctors prescribed opioids? What is different now? We hear about opioid stewardship? What does that mean now?

Dr. Zach: Alright. Well it started essentially several years ago when really the main goal was for patients to be completely pain free. Pain was actually identified as a fifth vital sign. So, the goal was that every patient that came to the hospital or every patient that came to a primary care doctor’s office or to the pain specialist’s office, the goal was for them to be completely out of their pain. So that created an issue down the road. Essentially, we started prescribing opioids. See, opioids have always been the best pain medication available. However, over time, what happens is your body builds a tolerance to them. So, it requires more and more for the medication itself to do what it once did.

So, what happened was we continued to prescribe more and more of these pain medications. Then we opened up a bigger problem, which is the opioid epidemic where patients started to be on large doses of opioids. They became dependent or addicted to them. They started to develop side effects from them. That created the epidemic that we’re in today.

Host: So, when we’re looking for alternative, I mean there are so many now. Tools in your tool box, Dr. Zach, that can help people. Whether it’s acupuncture or nerve blocks or injection procedures or other medications. Speak about some of these alternatives that you might try, and why listeners should look to those before they consider going on an opioid.

Dr. Zach: Right. So, what I try to strive to treat a patient with is really a multimodal approach. So, what that means is we’re using non-opioid pharmacologic medicines. We’re using non-medicine types of treatment. So, things like physical therapy, chiropractic treatments, acupuncture. There’s various nerve blocks that we can do. There’s various injections like epidural and steroid injections. We can put steroids into people’s joints. There’s also newer treatments like radio frequency ablation, which is a treatment for arthritis of the spine. As well as a treatment called spinal cords stimulation, which is essentially a treatment where we target the nerve impulses in our back or in our legs with a little device that we can actually implant into patient’s body. So, there’s really emerging kind of treatments that have been developed over the last several years that we’re utilizing more and more to try and accomplish what really is the effective way of treating pain.

Host: Where do complimentary or adjuvant therapies come into play in this doctor, like meditation, relaxation techniques, psychotherapy, biofeedback. Any of these kinds of things, do they fit into that picture?

Dr. Zach: Absolutely. So, going back to the definition of pain. It’s really an unpleasant physical and emotional response to some stimulus. So, there’s a huge emotional component to pain. What that means is that people that have maybe some anxiety or depression, their pain tends to be more difficult to control. So, there’s various things that we can do from a psychological standpoint to help our patients kind of cope with pain or distract themselves from pain. So, things like cognitive behavioral therapy, biofeedback, meditation and mindfulness. There’s breathing exercises. There’s yoga. There’s tai-chi. Those types of things that really are kind of holistic and natural ways of coping with pain that can be quite helpful.

Host: Now, as I’m an exercised physiologist Dr. Zach, I have to ask you about exercise because that can be a limiting factor when somebody is in pain and they feel like they can't exercise. And yet, we know that moderate exercise can benefit people that are suffering from chronic pain. So, speak about that.

Dr. Zach: Right. So, again, this goes back to the old adage that essentially when you are in pain, we’re taught to sit around and put ice on it and try to be as stationary as we could be. But what we found is that this is actually counterproductive. So, when we exercise, our body releases its own endogenous internal opioids actually that are kind of the feel-good hormones that can actually provide analgesia or pain relief. Not only that, but it’s good for our cardiovascular, our lung health, and just our overall wellbeing.

Host: Tell us a little bit about the Bryan Pain Manage and Opioid Stewardship program and how this might affect someone who’s coming to the hospital for treatment.

Dr. Zach: Right. So, this is an initiative started this fall. It was requested by the senior leadership team at Bryan really as a response to the opioid crisis. I've been honored to be able to serve as the medical director for this product. I'm working with 25 other leaders from various departments at Bryan, including pharmacists and nurses and physical therapists. There’s people from the behavioral health department. There’s addiction specialists. I have folks from the IT department as well as quality specialists, and, of course, many physicians as well. What we’re essentially trying to do is we’re trying to identify areas of potential improvement in terms of pain management within the hospital setting and also as we transition patients out of the hospital.

So, what we’re doing is we’re looking at things that we can improve upon and really trying to offer a personalized, safe, and appropriate personalized pain management approach for the patients that come into the hospital.

Host: Wrap it up for us because it’s such a huge topic and we’re hearing so much in the media about it. Give us your best advice as an anesthesiologist and the director of this opioid stewardship program at Bryan. What do you want listeners to take away from this when they are asking their doctors about their pain issues and trying to decide which of these different avenues to go down to help manage their pain?

Dr. Zach: Sure. I think it starts with the patient/doctor relationship. It takes time, but I think that’s the most important thing. We have to sit down with our patients and we have to identify exactly what it is that’s causing their pain. We have to offer a multimodal therapy approach. We have to make sure the patients understand the risks and the benefits of everything that we do, including opioids. Then we want to try to treat that patient from a personalized, individualized, and really compassionate approach. That, I guess, is kind of our goal with this pain management stewardship program, and also my goal every day when I see my patients.

Host: That’s wonderful information and so timely and so important. Dr. Zach, thank you so much for being on with us today. You can speak with your physician about how best to manage your pain. If you do not have a physician, you can go to bryanhealth.org/doctors. To hear more podcasts in this series, you can go to bryanhealth.org. This is Melanie Cole. Thanks so much for listening.