Understanding Chronic Pain and The Opioid Crisis



Dr. Jeremy Roberts is Chief of Anesthesiology
at McLaren Lapeer Region Pain Clinic.
For more information, call (810) 667-5574.

Q:  What is the goal of a pain specialist?

A:  The entire goal of a pain specialists is treating and managing chronic pain without using opioids or using them in the smallest possible dose for the least amount of time possible.  The pain specialists follow the guidelines created by the Centers for Disease Control for use of opioids for chronic non-malignant pain.  It is in the best interest of patients to follow the guidelines due to possible side effects and risk for addiction.  The risk of opioids are also increased when used with alcohol, antihistamines such as diphenhydramine (Benadryl), certain muscle relaxants like carisoprodol (Soma), or benzodiazepine medications such as alprazolam (Xanax), clonazepam (Klonopin), or diazepam (Valium) for anxiety or sleep, as there is strong potential for patients to stop breathing suddenly with this combination of drugs.

Q:  How can chronic pain be treated? 

A:  Because chronic pain affects all aspects of one's life, it's important to treat chronic pain both medically and emotionally.  The honest, evidence-based truth is that the vast majority of the chronic pain in this country (particularly low back pain and neck pain) could easily be treated and vastly improved with one of several simple treatments: 1) weight loss; 2) regular exercise such as tai-chi, yoga, or swimming; 3) physical therapy including core muscle strengthening; 4) mindfulness exercises and/or regular counseling for pain-related depression and anxiety; and 5) massage therapy, acupuncture, and chiropractic manipulation.  Another simple treatment includes intermittent fasting for 16 to 24 hours, which studies have shown improves both weight loss and chronic pain by reducing inflammation and increasing neuroplasticity, which is the brain's ability to grow and form and reorganize connections in response to learning or following injury.  For those who have tried and failed these basic things, simple and sometimes very effective non-habit-forming pain therapies such as anti-inflammatory medications and certain kinds of antidepressants (yes, for pain!) are also available from a physician, as are interventional procedures.

Q:  What are some risk factors of chronic pain?

A:  Chronic pain is a huge problem in our society right now.   Despite decades of research, chronic pain remains poorly understood and notoriously hard to control.  It arises from numerous factors, including wear-and-tear and previous injuries, previous surgery, psychological traumas, and sometimes even depression.  Even factors like increased sugar, stress, medication, smoking and excess fat intake can lead to chronic inflammation and pain. The rate of "severe" obesity in rural areas has tripled in the last ten years; severe obesity itself is a chronic inflammatory condition, and has contributed substantially to the population in pain. Replacing food and drinks high in added sugar and refined carbohydrates such as high fructose corn syrup may help reduce inflammation. 

Q:  What procedures can be done to help chronic pain? 

A:  Some basic procedures include different types of joint injections, nerve ablations for neck and low back pain, and epidural injections for herniated discs to name a few.  There are several more advanced and invasive procedures that can be done, such as spinal cord stimulation or intra-spinal drug delivery; in which pain medications are given directly to the brain and spine via an implanted pump.