Pain Management: How About Holistic?

I recently received the letter and instruction card for prescribing narcotic analgesics from US Surgeon General Vice Admiral Vivek H. Murthy, MD, MBA. While I agree in principle with the movement to improve pain management, I feel there is a lot being overlooked in this crusade and would like to suggest alternative evidence-based methods that don’t involve prescription narcotics.

I have extensive training in energy therapy, guided imagery, and ozonotherapy. Healing touch is one well-researched energy therapy that has been shown to reduce pain. I have performed and published research demonstrating its effic­acy (see http://healingbeyondborders.org/index.php/research-integrative-health/research); patients’ functional abilities improve, and they are able to decrease or eliminate use of pain medication. Providers from many disciplines, including MDs, DOs, NPs, and DCs, practice healing touch. Training for healing touch is available worldwide. The certification process is similar to masters-level education, including both classroom and hands-on clinical practice experience. My practice uses healing touch for patients, and I teach classes using the international curriculum.

In addition to the research published on the efficacy of guided imagery (another method of pain relief therapy), I have personally witnessed and been part of several successful examples in my clinical practice. In the burn unit, Dr. Jean Achterberg Lawlis and I used guided imagery to relieve pain in patients with third- and fourth-degree burns over 70% or more of their body. We performed tanking and dressing changes without narcotic pain medications; patients were comfortable during treatment and slept peacefully after. In another instance, a 23-year-old man presented with major chest and spine injuries after a motorcycle accident. Morphine (100 mg IV) did nothing to relieve his pain. But guided imagery of racing his stock car around a racetrack eliminated any need for narcotics during dressing changes. I’ve also worked with women prenatally, teaching guided imagery for smooth, successful deliveries without pain medications or epidural.

Ozonotherapy has an extensive international evidence base, and many studies show that it relieves pain without the need for narcotics (see http://aaot.us/?page=Literature). I have seen many cases of chronic pain relieved by major autohemolytic therapy and prolozone injection therapies. Here, too, patients are able to decrease and eventually stop their narcotic medications. Some patients are able to avoid joint replacement surgery, achieving improved function and comfort without the adverse effects of steroids.

An effective way to release muscle tension and relieve pain from injury (eg, low back pain, plantar fasciitis, whiplash, carpal tunnel) is through massage therapy. Providers who refer patients to massage practitioners can avoid narcotic medication prescriptions by addressing the problem that is causing the pain. Chiropractic care is a standard care for low back pain; it can also resolve problems that cause migraines, trigeminal neuralgia, and Bell’s palsy without narcotics, steroids, or the sedating muscle relaxants and seizure medications. Yet several veterans in my community were denied chiropractic care until they had tried narcotics and physical therapy (which involved a four-hour roundtrip car ride, no less). Oh, and in the meantime, they were prescribed an additional narcotic!

By focusing only on narcotics, we miss out on other options to treat pain. If we overlook the full range of evidence, then the “evidence-based” mantra isn’t truthful, nor is it useful. To follow the pledge to “do no harm,” we must treat the causes of pain. Of the Surgeon General, I request: Please don’t just send us a teaching card on how to prescribe narcotics. Get providers involved in seeking continuing education credits in therapies that help us avoid prescribing them in the first place.

Susan Peck, PhD, GNP-BC, APNP, FAAO, APT, CHTP/I

Eau Claire, WI