Despite concerns about addiction and overprescription of opioids, the drugs are still considered an effective choice for acute or short-term pain. But the brain also can produce results just as effective.
Dr. Timothy Clark, a neuro-psychologist with Baylor Pain Management Center, doesn鈥檛 see an end anytime soon to doctors using opioids for pain control.
Clark says they will likely remain a 鈥渇irst-line choice鈥� for control of acute or short-term pain 鈥� and probably for post-surgical pain.
鈥淎lthough hospitals are looking at that differently now,鈥� he says. 鈥淚 think the problem has come is once people get post-acute or post-surgical pain, there are probably better things to do than opioids at that time."
Interview Highlights
On alternatives to narcotics for pain: If you take something like low-back pain, what we find is that patients at that point will do far better if you don鈥檛 start them on narcotics. What you would do is get them involved in physical activation through some kind of physical therapy and teach them some behavioral tactics for pain control.
Behavioral tactics? It's the basic concept that what our pain level is is not a direct response to the injury. Injury is part of it, but what happens is how I understand my pain 鈥� the emotions I have with it, where my attention goes 鈥� almost works like an amplifier for the pain signal. If I can teach people to begin to respond to pain differently, we could substantially reduce that pain, and that works as well as narcotics.
On our expectations about pain: It is a Western phenomenon to think that I should be able to get rid of pain. Pain is part of the life experience. We use so many more narcotics than any other country in the world because we have this expectation of 鈥淚 want something to take it away.鈥� The more you fight pain, it actually makes it worse. There鈥檚 a good amount of literature that says if I have some pain, but then work around that, the pain actually becomes much less, and it's much less disabling at that point.
Centralization of pain: As the pain becomes more chronic, the brain actually begins to change in response. And that becomes a big problem because pain begins to spread in locations, so people have multiple sites 鈥� not because there are other areas injured, but because the brain is over-representing that.
We know that people will often become more depressed. It upsets their sleep. They lose energy and focus. And these are just results of centralization of pain. If you put the right conditions in place, no matter what the cause of the pain is, you can substantially reduce pain, get people a lot more control back in their lives, and change their level of functioning.
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This interview has been edited for brevity and clarity.
