Health Check: Treating chronic pain without opioids
At the Comprehensive Spine Center at Rhode Island Hospital, treating chronic pain without opioids has become a concerted team effort.
"In the majority of cases we see here, and nationally, I think patients have been put on these medications,” said Dr. Alexios Carayannopoulos, medical director of the Comprehensive Spine Center at Rhode Island Hospital.
"They've escalated doses, which means that they're not necessarily increasing their pain control. They're just having more side effects and more problems from the opioids themselves," Carayannopoulos said.
Ronald Ranes, of Maine, is one of those patients.
"I've been on methadone about 10 years plus or minus," Ranes said.
It was prescribed for chronic pain. He continues to make the four-hour drive to see Carayannopoulos at Rhode Island Hospital because of what he and the center have done for him.
"In the course of those appointments Dr. Carayannopoulos suggested I get off of methadone," Raines said.
"We teach him about a phenomenon called opioid-induced hyperalgesia syndrome, which, in short, makes pain worse in some patients who are on chronic opioids," said Carayannopoulos, "We always try to use all the tools in our tool chest. So procedurally, this patient has several levels of narrowing in his spine."
He had two vertebrae fused, or welded together.
"And he had neck and arm pain despite the cervical fusion," said Carayannopoulos.
That led to his chronic use of opioids. He is now off those medications.
"It was about a seven-month withdrawal program and it largely went well,” said Ranes.
He's also had several procedures here with temporary success, and another one planned. But it's a team effort.
Patients, like Ranes, are prescribed exercise and behavioral sessions.
"So, we do a lot of mindfulness based strategies,” said Dr. Lucy Rathier, director of Behavioral Medicine. “We do relaxation strategies as well and we also teach patients cognitive coping skills about how to restructure their thoughts so they're more helpful and help them cope better."
The combination is making a difference.
"I have better cognition. I have more personality, better humor, and I'm delighted to be off the drug," said Ranes.