Medication (Living Beyond Pain Podcast)

Medication (Living Beyond Pain Podcast)


[Narrator] Stay tuned for Army Capt. Tracy Beegen, of
the “Living Beyond Pain” podcast, produced by the Defense Health Agency. [music] [Army Capt. Beegen] Welcome back to the “Living Beyond
Pain” podcast. Today’s episode is going to focus on medication
and the impact that it can have on managing chronic pain. And we’re really excited to have Dr. Jennifer
Potter who’s a family physician at Madigan Army Medical Center and she’s also a veteran
and has served on active duty. Welcome to the show Dr. Potter, and thank
you for sharing your expertise with us. [Dr. Jennifer Potter] Thank you. Glad to be here. [Beegen] Dr. Potter, can you tell us a little
bit about the shift that’s happening right now with prescribing medication for chronic
pain? [Potter] Absolutely. I would say in the past, maybe 15 years ago,
that it was very common for pain– that we were taught to just keep using opioids and
increase as we needed to to help people’s pain and really focus on taking all of that
pain away. Now though, we’ve learned different and are
really concerned for safety of our patients. And that using the opioids the way we had
been taught is actually concerning and can lead to catastrophic consequences for our
patients. And so we’re steering away from that method
of treatment and looking at other safer options. [Beegen] So if I’m understanding you right,
opioids are effective for treating acute pain and short term pain but the effects that long
term use of opioids can have some pretty negative outcomes for patients. [Potter] Absolutely. So there’s definitely a role for using medications
in managing pain but identifying what the pain is about and what type of pain it is
is really important. So there is a difference with acute pain versus
chronic pain and therefore the treatments are really different as well. [Beegen] And can you remind our listeners
what the difference between acute pain and chronic pain is? [Potter] So acute pain, the best way I think
about it is it happens because there’s a purpose. In other words, it’s a cue your body is telling
you to do something or it feels pain because of some acute event. So there’s a hot stove that you’re burned
on and you pull your finger away from it or you’re having shin splints from running so
much and your body says, “Hey. Slow down. This hurts. I got to back off so I can start to feel better.” And that’s acute pain. It tends to last a shorter time. Maximum three months maybe up to six months. It’s directly related to some type of soft
tissue damage like a sprained ankle or a paper cut. But then it goes away when there is no longer
an underlying cause for that pain. It heals and the pain resolves. So medications for acute pain are effective
when they’re treating that acute cause of the pain. The goal is you take it a short time, the
pain reason is resolved, and then the pain goes away. Now chronic pain is different. It typically lasts greater than three months. It’s past that time of your normal tissue
healing in your body and it can be a result of many things. It can be a result from a chronic medical
disease, injury, different medical treatments. This inflammation that didn’t heal or just
an unknown cause we don’t know why. But the bottom line is the pain is real. The pain has three components. There’s a sensory component – you’re feeling
that pain. There’s a cognitive component – so like, “Hey. How do I understand this pain and what to
do about it?” And emotional – how you feel about it. [Beegen] And that’s really a change that we’re
seeing in how we treat chronic pain. That it’s really looking at a multidisciplinary. So using like you said, really going at it
from the sensory, the emotional, and the cognitive. So how we think about pain, how we experience
our pain, and the emotions tied to it, and the physical sensations of pain. I know for myself, when I’m in pain, I think
I need to go see the doctor. And I really focus on that physical sensation. But we’re really looking to treat the pain
from all of those different angles. And so that’s challenging when we as patients
are used to being treated in a certain way and going to a certain professional and you
know the expert, right, the doctors are the expert. So making that shift to say, well, there’s
some other tools in some other areas that we really can utilize to treat chronic pain. So with that, what are some challenges that
you commonly see in the primary care or the family care clinic with patients experiencing
chronic pain? [Potter] Great question. It’s interesting, and I think part of it is
what we were taught as providers and what we told our patients for years and now what
we do know differently. So for years, the thought process was, if
you’re in pain let’s give you a pain medicine. Let’s titrate up on your opioids to take care
of that pain. And we were really taught there was little
risk for bad outcomes or adverse effects. And this is what the providers knew. This is what our patients know for use on
pain management. And so when we’re used to being on a certain
amount of opioids and then we’re told to reduce them, it’s kind of scary like, “Hey. My pain’s not going to be managed as well
now if you cut out what I was taking for it.” So I definitely see that reluctance and trying
to titrate down into a safer range that helps prevent the opioid overdoses that we’re seeing. The second, I would say our treatment as we
discuss for chronic pain is really what I try to do as a holistic approach where you’re
really treating the whole person and looking at how you feel about the pain, how you’re
understanding the pain, and how we can manage it in your everyday life. That can be in our busy everyday life really
hard to do. It can sound cumbersome on too much work to
look at other options other than taking a pill and thinking that we could realistically
get that done and help our pain just sometimes sound like too much. [Beegen] Well, and like you said, the fear
of, “If they take my medication away, I’m already in pain. So now my medication is gonna be taken away. And then I’m also going to have those withdrawal
symptoms.” What advice would you give to someone who
may be their primary care provider has talked to them about titrating down or reducing the
amount of medication, pain medication that they receive another? [Potter] Another great question. And this comes up all the time. The biggest thing that I have found to be
successful is doing a gentle taper of the opioids to avoid withdrawal symptoms. And work with your patient on what helps them
titrate down but not experience the feelings of withdrawal. And it’s a little bit different for everybody,
but definitely, if opioids are tapered too rapidly it is a real feeling of withdrawal. And that does not feel good. So we want to prevent that. The Center of Disease Control who helps teach
us on the best way to manage that gives the recommendation to gently decrease opioids
by somewhere about 5 to 20 percent of the total amount you’re taking each month. And I personally have found that if we keep
the taper at about 10% that there are no withdrawal symptoms or very minimal and that it’s very
tolerable to do. [Beegen] And we want to remind our listeners
to make sure they are working with their providers to reduce their medication and not doing it
on their own. [Potter] Absolutely. It’s a great team approach. The provider work very closely with our patient
and it’s really a team effort to get this accomplished and helping the patients safely. [Beegen] So you’ve shared with us about some
of the different approaches and the different aspects that impact how we experience chronic
pain. Can you tell us about some of the complementary
treatments for chronic pain that you might recommend for our listeners? [Potter] Yes. The active treatments, they can include yoga,
Pilates, something called Tai-chi. They’re multi-modal in treatment. Meaning that they are an exercise but it’s
not just saying go do exercise to feel better. They work in a couple of different manners
but they’re helping to stretch and strengthen your muscles. But again, it also works on that behavioral
part of being able to slow your breathing down and put you in a better mindset to help
manage your pain. I think first off that is first and foremost
is physical therapy or regular exercise to help with movement is often very helpful in
reducing pain. Also, what’s called cognitive behavioral therapy,
which is a big fancy word but it’s really been shown through evidence that teaching
how to kind of regulate how you’re feeling about the pain and slow your body down and
be more relaxed is really helpful in reducing your feeling of pain. [Beegen] I know when I was working in the
primary care setting and I would have a patient referred to me as a psychologist. They expressed some frustration. They would say my primary care provider thinks
I’m crazy. That’s why they sent me here. They think the pain’s all in my head. And so when you make a referral to a behavioral
health specialist, it’s really not that you’re being dismissive. It’s that you are trying to help give them
more tools to manage their chronic pain. [Potter] Right. I totally hear you. The best way I look at it is, I sit down with
my patient and we go over all the different treatment options for pain. And medication is one of many options. And really, as we find, is not even the most
important as we move forward with these different therapies. But it’s tailored to the patient. It’s tailored to what works for them. So for one person, it may be Tai-chi. Another, it may be physical therapy. Another maybe even acupuncture or chiropractic. That there’s different options and really
creating an individual-tailored-therapy gives the best result and hopefully really improve
the quality of life for that person. [Beegen] Well, thank you so much, Dr. Potter,
for just sharing your time and your talents and experience with our listeners. [Potter] I’m just very glad to be able to
help people. I understand having pain is painful. I get that. And working with the patient together forming
a team so we can try to improve their function and quality of their life is really our overall
goal. [Beegen] And that’s really what this resource
is all about. Giving patients and our listeners a resource
where they can really live beyond their pain and giving them more control over their life
rather than their pain having control over their life. So thank you again for being with us on the
show. For our listeners, please check out some of
the resources we have listed in our show notes. Some really great apps that can help you with
incorporating some of the resources that Dr. Potter discussed on our show today. And we really want to encourage our listeners
to reach out to your community resources and see what resources are available within your
community. If you have a resource to share we’d love
to hear about it and maybe it could impact some of our other listeners in your local
area. We appreciate all your feedback and please
let us know if there’s topics you’d like us to discuss and tell the next time. Be well. [music]

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