On a drizzly day last fall, with colorful leaves dotting the wet sidewalk, I stood silently still as name after name was read. It was late last year, at a somber vigil to bring awareness to overdose deaths in my small, idyllic town, which like many others, has not escaped the opioid crisis.
As I listened to that tragically long list of victims, I heard the names of three of my friends’ sons -- friends who had their babies around the same time I had mine. These were the same families who went on vacations together, sat through endless soccer games, and helped edit their teenagers’ college essays. Now, a scant 25 years later, their young men were gone – victims of the opioid overdose epidemic.
There are many routes to opioid addiction. One route of grave concern is the misuse of prescription opioid medication, often prescribed for the treatment of chronic pain. The advances put forth by the Massachusetts Medical Society are part of an essential and national effort to shift prescribing habits, which over time will help enormously to stem this epidemic. The MMS recommendations adopted by the Board of Registration in Medicine offer clear guidelines on prescribing issues and practices.
The number of Americans suffering with chronic pain exceeds that of diabetes, heart disease and cancer combined. Addiction and overdose from prescription pain relievers continues to grow at galloping rates [i]. Licensed naturopathic doctors (NDs), trained in non-pharmacologic, integrative approaches to the treatment of pain, fill an important gap in the medical treatment of chronic pain.
Licensed NDs are educated at four-year, post-graduate, full-time naturopathic medical schools recognized by the Federal department of Education. Governor Charlie Baker earlier this year, signed a bill into law, which licenses naturopathic doctors in Massachusetts. Trained to use a variety of natural medicine approaches for the treatment of chronic pain and also to understand the essential role of pharmaceuticals, NDs take into account lifestyle, nutrition, work and leisure activities, current and past stressors, and relevant previous injuries. Like medical physicians, NDs aim to inspect the pain you have and understand all its manifestations.
In one trial, naturopathic therapies were estimated to save close to $1,000 per patient with low back pain. Importantly, missed work due to illness diminished by 6.7 days, leading to return on investment of 7.9 percent. [ii]
In another study on chronic pain related to rotator cuff tendinitis in postal workers, naturopathic therapies decreased pain by over 54 percent, significantly better than other approaches used in the trial. The naturopathic approaches also diminished disabilities. [iii]
Licensed naturopathic doctors create individualized plans for patients. Utilizing nutrition through dietary recommendations and nutritional supplements along with botanical medicines, naturopathic doctors target inflammatory pathways in order to help reduce inflammation and its ensuing pain. Naturopathic doctors work with physical medicines approaches and offer exercise recommendations. We recommend body-mind approaches that are known to reduce perception of pain. We work to engage inherent healing capacities of the human body.
Communication with other medical providers to encourage understanding across disciplines for the benefit of the patient is typical. We understand the value of pharmaceuticals as well. Naturopathic doctors are prepared to make appropriate referrals for further diagnostic work-up, for treatment support or for surgical intervention as indicated. We also receive referrals from medical colleagues looking for a fresh perspective for oftentimes difficult to treat chronic pain patients.
Increasingly, pain clinics include ND providers and integrative medicine approaches for the treatment of pain. In Oregon, a state that has long licensed naturopathic doctors, Bill Walter, ND practices at a Federally Qualified Health Center in Eugene as part of the Department of Health and Human Services. As part of his job, he describes “strategizing with the clinical care team about how to think about pain management, to help patients learn to change habits and patterns that worsen pain, while at the same time helping patients improve functioning. We offer novel perspectives on pain management and are leaders in changing the paradigm away from first-line opioid usage.” In another example of an integrative medicine pain clinic, The Southwest College of Naturopathic Medicine Pain Relief Center, a model for such clinics, has on staff naturopathic doctors, medical doctors, physical therapists, acupuncturists and more.
Licensed naturopathic doctors collaborate with other professional organizations to modify national prescribing habits in order to limit opioid prescriptions. Members of the naturopathic community were leaders in the seminal work, “Never Only Opioids” Policy Brief: The Imperative for Early Use of Non-Pharmacological Approaches and Practitioners in Pain Care[iv].
The goal is to insure that non-drug approaches are moved to the beginning of the treatment of pain and that opioid medication is prescribed only as a last resort. Former U.S. Army Surgeon General Eric Schoomaker, MD, PhD, characterized the military’s engagement of complementary and integrative medicine as imperative. [v]
I write this piece in loving tribute to the three young men I knew who lost their lives to this epidemic. May we work together to reverse this trend and pool our resources and expertise to help patients suffering with chronic pain.
If you or someone you love is struggling with chronic pain, or working to decrease dependence on opioid medication, consider adding a a naturopathic doctor to the health care team.
To find a licensed ND near you see here.
To read about naturopathic medical education, see here.
An abbreviated version of this post appeared in the Boston Globe Online 4/20/17.
[i] http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf, retrieved 12/30/16
[ii] Herman PM, Szczurko O, Cooley K, Mills EJ. Cost-effectiveness of naturopathic care for chronic low back pain. (2008) Altern Ther Health Med Mar-Apr 14 (2):32-39)
[iii] (Szczurko O, Cooley K, Mills EJ, Zhou Q, Perri D. Naturopathic treatment of rotator cuff tendinitis among Canadian postal workers: a randomized controlled trial. (2009) Arthritis Rheum 61: 1037-1045)
[iv] http://www.painsproject.org/wp/wp-content/uploads/2014/09/pain-policy-issue-5.pdf, retrieved 12/28/16
[v](Schoomaker E. The Imperative for Integrative Medicine in the Military: A Personal and System Perspective. May 15, 2014, International Research Congress on Integrative Medicine and Health, Miami, Florida. http://webcast.ircimh.org/, retrieved 1/17/17