Susan Lord, M.D. and Nancy Fernandez Mills: Integrative approach to treating pain without opioids
GREAT BARRINGTON — The current epidemic of heroin addiction, frequent overdoses of prescription painkillers and huge increases in the number of opioid-related hospital visits are causing alarm in Berkshire County, as they are nationally. As a result, health care administrators and government officials are beginning to search for alternatives to the conventional medical approach of relying on opioid medication to help people in chronic pain.
Volunteers in Medicine Berkshires (VIM) is providing a promising alternative model of care. The privately funded, free clinic in Great Barrington has pioneered an integrative approach to treating pain without resorting to opioids.
Because of VIM's innovative program and excellent track record, the clinic was chosen as one of three sites in Berkshire County to offer a new approach to pain management as part of a study funded by a grant from the Massachusetts Department of Public Health. About 115 patients participated countywide in this pilot program, which was administered by Berkshire Health Systems.
The pilot ran for three months, offering nutritional counseling, acupuncture and gentle exercise called Integrative Movement Therapy. Mind-body skills groups taught patients techniques to handle stress, which is known to exacerbate pain.
Preliminary results are encouraging. Twenty-eight VIM pain patients attended 389 healing sessions over three months. They reported their long-term, often disabling pain levels were reduced by an average of 39 percent on a recognized pain assessment tool. Chronic low back pain was reduced by 42 percent, severe headache by 47 percent.
Individual stories were often stunning. "Sophie," a self-employed worker and a caregiver for her elderly mother, was having trouble walking and was terrified of being disabled by pain. After being treated with acupuncture, attending movement therapy classes and changing her diet, she felt better, lost weight and was able to return to full-time work.
"Katherine" suffered from migraines for 20 years, sometimes two or three times a week. She has now gone three months without a migraine, but without the free pilot program, she will not be able to pay for the acupuncture treatments that helped her heal.
"Julia" was a self-described "mess, crying at the drop of a hat" when she started the program, suffering from severe low back and abdominal pain. Now she has only occasional mild pain that she has learned to handle, preventing frequent trips to the hospital emergency room.
As the epidemic of addiction has grown and physicians have faced new restrictions on how many opioids they can prescribe, caregivers must be able to offer meaningful alternatives to pain patients. Pain is complex and very personal. By addressing the needs of the whole human being, we increase our chances of restoring balance in the body and reducing pain.
Opioids as the sole treatment for pain takes a hammer to delicate mind/body systems, often wreaking havoc on every level when used for an extended period of time. A more personalized and holistic approach to care honors the delicate and subtle ways we respond to our environment with equally subtle yet powerful treatments.
Public health officials should continue to gather data to verify the efficacy of a more integrated approach. In the meantime, health insurers should begin to pay for well-run integrated treatment programs — including acupuncture, nutrition counseling, mental health counseling, stress management training and therapeutic movement classes — for chronic pain patients.
Susan Lord, M.D., is a mind/body medicine specialist and Nancy Fernandez Mills is a certified nutrition counselor for Volunteers in Medicine Berkshires.