Sometime during the recent NFL playoffs I saw another prescription drug advertisement. I’m 47, and anyone around my age will probably remember the genesis of prescription med ads and, if they were anything like me, thought, “What the hell is this?” I mean, I’m not a doctor (and I don’t play one on TV) so quite simply, I just don’t get it. The thought of drugs being marketed directly to the public just seems perverse. I can’t even come up with a metaphor because nothing is more precious than our health, and most of us don’t have the expertise to self-diagnose let alone self-prescribe prescription medications with often harmful side effects which may be worse than the disease they’re treating.
So, back to the ad I saw during the playoffs. This one was for a syndrome called Opiod Induced Constipation. Here we have a new syndrome perpetuated by an overprescribed class of drugs (opiates) to treat a side effect from these drugs. (basically, this is a medication to treat the side effects of another medication. Perhaps the pharmaceutical companies are more interested in making money than truly helping to improve our health). According to a New England Journal of Medicine study, the drug in question had laxative like benefits for 48% of its users as opposed to 15% of those using the placebo. About half of the people with opiod induced constipation benefited from the drug. Not bad, but not great.
But I believe that we need to look at the opiates being prescribed in the first place. The following is an excerpt from a letter from the Surgeon General sent to every doctor in the US in 2016. She writes, “Since 1999, opioid overdose deaths have quadrupled and opioid prescriptions have increased markedly – almost enough for every adult in America to have a bottle of pills. Yet the amount of pain reported by Americans has not changed. Now, nearly two million people in America have a prescription opioid use disorder, contributing to increased heroin use and the spread of HIV and hepatitis C.”
This is not an indictment of doctors and the job they face in treating people with chronic pain. Imagine patients coming to your office with pain wanting relief from the pain with the least path of resistance or better said, the quickest way out of pain. A summary of epidemiological data from the University of Washington showed that opiates, taken over a prolonged period, do not provide good efficacy or function. In short, the dose that may provide relief in the beginning must continually be increased to provide the same amount of pain relief. Eventually, the amount of medicine, due to drug tolerance, can’t keep up with the amount of pain.
The UW study also found that sustained opioid use delays return to work and impairs function leading to concerns of death, falls, and fractures. The odds of lost time in the workplace for patients on opiates are 11 to 14 times higher than those who were not treated with these medications. And, most stunning is the strong statistical suggestion that opioid use did not arrest the cycle of work loss and pain.
Opiates have their place as a short-term treatment for chronic pain conditions, but what is really at the root of people’s pain conditions? Is it obesity, poor lifestyle choices - i.e. little exercise, poor diet and sleep regimens - a lazy addiction to our need to be better with the swallowing of a little white pill? It’s probably all of these as one leads to the other.
So why am I, a Licensed Massage Therapist, seemingly far from qualified to write about such things, doing so? The answer is in my personal bouts with chronic pain as well as the clients I see suffering from chronic pain in my therapeutic massage practice. In my early 20’s, my back “went out” and my physician told me I had a herniated disc somewhere in the lumbar spine. He prescribed me a pain medication and told me to lay in bed until I felt better. This did not happen. After a week of bed rest, I had had enough. I forced myself out of bed and walked to Cobbs Hill Park in Rochester, NY where I forced myself to jog around the 1/4 mile pond as many times as I could. That would be exactly one time. I walked around it the next lap and forced myself to jog around one more time. You probably get the picture that I was not in great shape. I was pear-shaped from drinking too much and eating pizza every day for lunch and dinner. At least twice a week this was topped off with a trip to Nick’s for a garbage plate in the middle of the night after a drinking binge. Often times, the only way I knew I went to Nick’s the night before was because I could taste the onions in my burps upon awakening.
But something magical happened after forcing myself to get out of bed and walk and then run around that pond: I felt better. The pain in my back had substantially decreased. I was sick of lying in bed and the lessened pain pushed me forward to walk to the park the next day and repeat the process. Eventually, my quarter mile run turned into a three and a half mile run every other day regardless of the weather, which in my old neck of the woods was equally as brutal in cold as Columbia, SC is brutal in heat. I supplemented the running days with three sets of shoulder, chest, and arm weight workouts. This totaled about 20 minutes of lifting.
I still ate and drank as I pleased, but I was in my 20’s and could get away with it. The point is that my back pain went away - gone - and I was moving and feeling better than I ever had. I made a decision that I was going to get better, realizing that I was out of shape and that this probably had something to do with my pain. It did.
A regular client of mine recently came in with a migraine and said she almost didn’t come because she wanted to get home to take her medicine. I worked on her for an hour and a half and her headache was gone (those damn suboccipital muscles!). Another elderly client stopped seeing his physical therapist, instead choosing to have me work with him twice a month. The results were just better for him. He has gained flexibility, lost pain, and can do more. He is also seeing a personal trainer twice a month and modifying his diet.
We just don’t know enough about the immense complexities of the human body to say that alternative treatments don’t work as well as traditional ones. I don’t know if there’s a neurologist around who can explain why deeply massaging the scalenes in one client produces a pain in the knee in one person and a twitching toe in another and no response in the next. What we do know is that deep tissue massage therapy and soft tissue manipulation reduces blood pressure and stress, that it promotes lymphatic drainage, increases flexibility, and is a healthy way to manage and ease chronic pain. Then there’s the simple fact that humans crave touch emotionally and physically - it feels good.
Medications have saved countless lives and certainly have their place. The fact that we have eradicated diseases that once plagued us is a testament to that. But I would also argue that we wouldn’t need as much medication if we took a few preventative steps. In other words, treat yourself before you need to be treated.
So before you stop by your primary care physician asking for the latest miracle medication that you saw during the playoffs, consider doing something really good for yourself: take a walk, cut out as much added sugar from your diet as possible (known to cause systemic inflammation), stretch, find a yoga class to attend or a ten minute routine on YouTube, and maybe find yourself an educated and compassionate massage therapist who truly wants nothing more than to help you stop the chronic pain cycle.