To Curb Pain Without Opioids, Oregon Looks To Alternative Treatments
When Portland resident Doris Keene raised her four children, she walked everywhere and stayed active. But when she turned 59, she says, everything fell apart.
"My leg started bothering me. First it was my knees." She ignored the pain, and thinks now it was her sciatic nerve acting up, all along. "I just tried to deal with it," Keene says.
Eventually she went to a doctor, who prescribed Vicodin and muscle relaxants. In 2012, about 1 in 4 Oregonians received an opioid prescription — more than 900,000 people.
The state also currently leads the nation in nonmedical use of opioids, and about a third of the hospitalizations related to drug abuse in Oregon are because of opioids.
Keene says the drugs helped her, but only to a limited degree.
"My body was saying, 'Well, if I take another one, maybe it'll work.' So, I mean, that's just human nature. Especially when you're in the kind of pain I was in. You get to the point after months and months of pain where you're begging for anything — anything — to relieve the pain," she says.
In the end, Keene became addicted. Her doctor ended up cutting off her supply of pills.
"I got very upset," Keene recalls. "I said, 'What do you mean? You gave them to me. Why'd you give them to me and then tell me that I couldn't have them?' I was begging."
Then Keene went to the Quest Center for Integrative Health, a pain management center in Portland.
Lying on a foldout chair in a darkened room, Keene has about a dozen acupuncture needles in place — all part of her treatment.
"I came in here wearing back braces, and knee braces and a crutch, and Dr. Dave told me, 'Get rid of them! They're just weakening your muscles,' " Keene says. "And when I could walk out of here after the first acupuncture [treatment], I wanted to grab him and kiss him."
David Eisen, executive director of the Quest Center, is Keene's "Dr. Dave." He is board-certified in traditional Chinese medicine and acupuncture, and he says doctors need to stop thinking of opioids as a first-line defense against pain.
"There should be an array of things for people to choose from," Eisen says, "whether it be chiropractic care, or naturopathic care, or acupuncture, nutrition, massage. Try those things — and if they don't work, you use opioids as a last resort."
Oregon wants more patients to try this approach. Denise Taray, coordinator of the Oregon Pain Management Commission, says Medicaid's traditional way of dealing with back pain involved bed rest and prescription painkillers.
"The only thing that might have been covered in the past was narcotics," Taray says. "But treatments such as acupuncture, chiropractic, massage therapy, physical therapy and rehab would never have been covered."
Starting in January 2016, the state will fund many of these alternative treatments for patients who get their health care via Oregon's version of Medicaid — the Oregon Health Plan. While the treatments may cost more than a course of pain pills, the hope is to save money by reducing the number of people who become addicted to opioids or abuse them.
Plus, pain pills aren't always as effective as some people assume.
"Research is out there that suggests that with back conditions we're spending a lot of money on health care treatments and services that aren't improving outcomes," Taray says.
Oregon has not found overwhelming evidence that acupuncture, yoga or spinal manipulation work better than other options. But, as Taray points out, these alternatives don't involve drugs.
This story is part of NPR's reporting partnership with Oregon Public Broadcasting and Kaiser Health News.
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Transcript
DAVID GREENE, HOST:
Often drug addictions begin with prescription painkillers. Now, when it comes to these kinds of narcotics or opioids, the U.S. is in the midst of an epidemic. Well, now a new approach in Oregon - that state is helping patients switch from pills to alternative remedies like acupuncture and massage. Kristian Foden-Vencil of Oregon Public Broadcasting reports.
KRISTIAN FODEN-VENCIL, BYLINE: Oregon has a serious opioid problem. In 2012, about 1 out of every 4 Oregonians received some form of opioid prescription. Doris Keene was one of them. She says she walked her four kids everywhere and stayed active, but when she turned 59, everything fell apart.
DORIS KEENE: My legs started bothering me. First it was my knees, and then all along I think it was my sciatica, but I just ignored it.
FODEN-VENCIL: Eventually, she went to a doctor who prescribed Vicodin and muscle relaxants. She says it wasn't long before she was addicted.
KEENE: My body was saying well, if I take another one maybe it'll work. Especially when you're in that kind of pain that I was in, you get to the point after months and months of pain where you're begging for anything - anything - to relieve the pain.
FODEN-VENCIL: Keene was very upset her doctor cut her off.
KEENE: I said what do you mean? You gave them to me. Why'd you give them to me and then tell me I couldn't have them?
FODEN-VENCIL: Eventually Keene went to the Quest Center for Integrative Health. It's a pain management center in Portland. Lying on a foldout chair in a darkened room with about a half-dozen other people, she was speckled with acupuncture needles.
KEENE: I mean, I come in here wearing back braces and knee braces and a crutch. And Dr. Dave told me get rid of them. They're just weakening your muscles. And when I could walk out of here after the first acupuncture, I mean, I wanted to grab him and kiss him.
FODEN-VENCIL: The Dr. Dave she's talking about is Dave Eisen, the executive director of the Quest Center. He says doctors need to stop thinking of opioids as a first line of defense against pain.
DAVE EISEN: There should be an array of things for people to choose from, whether it be chiropractic care or naturopathic care or acupuncture, nutrition, massage - to try those things, and if they don't work, you use opioids as a last resort.
FODEN-VENCIL: Medicaid officials actually agree with Eisen. And that's a big deal because about a million people are on Medicaid in Oregon. Denise Taray advises Medicaid officials on ways to treat back pain, and she says things are changing.
DENISE TARAY: The only thing that might have been covered in the past was narcotics. But treatments such as acupuncture, chiropractor, massage therapy, physical therapy and rehab would never have been covered.
FODEN-VENCIL: But starting January, Medicaid in Oregon will cover those treatments for back pain. While the alternative treatments may cost more than the cost of pain pills, the hope is money will be saved by reducing the number of people who become addicted to opioids or who abuse them. And pills aren't the silver bullet people think they are.
TARAY: Research is out there that suggests that with back conditions we're spending a lot of money on healthcare treatments and services that aren't improving outcomes.
FODEN-VENCIL: Oregon has not found overwhelming evidence that acupuncture, yoga or spinal manipulation work better than other options, but, Taray says, alternative therapies have proven benefits and are a way of dealing with lower back pain that doesn't involve drugs. For NPR News, I'm Kristian Foden-Vencil in Portland. Transcript provided by NPR, Copyright NPR.
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