Many factors, including opioid therapy, trauma and injuries can alter the brain’s perception of pain and set the stage for chronic pain. A number of alternative therapies have proven useful in resetting the brain’s perceptions and curbing chronic pain without the use of medication.
The brain is resilient and can adapt to changing circumstances. Trauma or injury can cause changes to the brain and pain pathways in the central nervous system through a process called neuroremodeling. These modifications can create unexpected and undesirable responses to pain.
“Trauma or prolonged pain can damage the nerve cells that transmit the sensation of pain to the brain, thus altering or changing transmission along the pain pathways,” explained Robert Goldberg, MD, FACOEM, an occupational medicine specialist and chief medical officer at workers’ compensation PBM Healthesystems. “This damage can cause a remodeling of the neurons and result in inappropriate or exaggerated sensations of pain which can delay a patient’s recovery and return to work.”
A number of alternative treatment options can reverse the changes brought on by neuroremodeling, keep pain from escalating and lessen chronic pain. They include opioid tapering and discontinuation, biofeedback and cognitive behavior therapy. The current issue of Healthesystems’ RxInformer clinical journal provides a detailed explanation of neuroremodeling and treatment options in the article “Understanding Pain: Neuroremodeling,” authored by industry-leading clinical pharmacists with expertise in pain management.
Abnormal Responses to Pain In some patients, opioid therapy administered to reduce pain has the opposite effect and the patient experiences an increased feeling of pain. This effect is called opioid-induced hyperalgesia (OIH). OIH is an example of neuroremodeling that occurs to the specialized receptors in the body that respond to opioids. The cause is unknown, but sometimes a normal perception of pain can be restored by discontinuing opioid therapy through a medically supervised program. The assistance of a comprehensive pain management center experienced in opioid tapering may be necessary.
Mind-Over-Matter Approaches. Chronic pain affects the total patient. Medications may target the physical part of pain but a complete treatment plan should include psychological therapy. Biofeedback and cognitive behavior therapy (CBT) are two examples of psychological therapies that may be helpful to alter the brain’s perception of pain and reverse the changes caused by neuroremodeling. One controls the physiologic changes that the body experiences when pain is present or anticipated; the other controls the thoughts that can drive the perception of pain.
When a patient is in moderate to severe pain, the breathing and heart rates may increase and the blood pressure may rise. This can also occur to patients who are anticipating pain, such as an injured worker who is about to have physical therapy.
These physical expressions can precede the escalation of pain. Biofeedback can teach a patient to recognize biological symptoms as they occur and gain control over them. Through relaxation, deep breathing, visualization and other non-pharmacological interventions, a patient can control and alter their perception of pain or keep it from escalating.
Cognitive behavior therapy (CBT) is a structured intervention that teaches patients to control their thoughts about pain and better cope with any pain they are experiencing. It is not unusual for injured workers to have feelings of defeat concerning their recovery, or serious concerns about their ability to regain function, return to day-to-day activities, participate in family life or return to full work duties. Ongoing negative feelings can actually intensify a patient’s perception of pain and make it difficult to cope with existing pain. This can interfere with recovery.
Through CBT, a patient can be taught to cope with existing pain using relaxation, distraction, imagery and self-hypnosis. He or she can also be taught to substitute positive thoughts for negative ones. For example, a patient who feels they cannot get through physical therapy without suffering significant pain can be trained to recall positive experiences in their mind during the therapy sessions and cope with any pain they may experience by thinking of how the progress they are making will positively affect their family, career and life. Sustained positive thoughts can actually reduce the perception of pain and allow a patient to participate in treatment, which can lead to the recovery they desire.
“These therapies are not yet widely utilized in workers’ compensation but are increasingly included in treatment guidelines,” noted Dr. Goldberg. “Inclusion of alternative therapies may improve patient care, decrease chronic pain and reduce costs associated with long-term claims.”
As opioid guidelines are revised, payers will need to give serious thought to including alternative therapies in pain management strategies. The costs of these therapies may initially appear high when compared to the cost of medications; however, the potential long-term benefits of reducing opioids and other medications and preventing chronic pain must be weighed.
About Dr. Robert Goldberg
Robert Goldberg, MD, FACOEM, is a board certified occupational medicine specialist and chief medical officer at Healthesystems, a leading PBM and ancillary medical benefits manager serving workers’ compensation payers. A past president of the American College of Occupational and Environmental Medicine, Dr. Goldberg is a nationally recognized authority on occupational medicine and musculoskeletal injuries.
Read the spring 2014 issue of the RxInformer clinical journal or download the app for iPad on the App Store to access a comprehensive guide to tapering opioid therapy. The Fall 2013 issue contains a comprehensive guide to the use of alternative therapies in pain management.
This is a sponsored post from WorkCompWire marketing partner Healthesystems.