Mind Over Pain Meds: To Solve the Opioid Crisis, We Need a New Approach to Pain
Created January 25, 2018 by John Stracks, MD
The other day I drove through a neighborhood in Chicago I once lived in and happened to drive by the National Opioid Overdose Memorial. It consists of 22,000 pills, each one engraved with the face of someone who has died of an opioid overdose. On average, another person dies of an opioid overdose in the United States every 15 minutes. That’s astounding.
Because of the nature of the work I do as an integrative medicine specialist who commonly sees patients for chronic pain, I spend a lot of time thinking about the opioid crisis. As the crisis has worsened though, I’ve felt increasing urgency to tell more people what I know about treating pain, because I’ve seen hundreds of patients dramatically decrease or even eliminate their pain without medications, without opioids, without surgeries, and without procedures. As the pace of overdose deaths accelerates, it has become increasingly important to let patients and other physicians know both that the most common ways of understanding and treating pain are outdated and that effective, non-medicinal, non-interventional treatments are currently available.
Let me give you a little personal background for perspective. In 1999, when the Student Doctor Network (SDN) was new and I was posting questions about my post-bacc program and which med schools to apply to, I fell down a flight of stairs in downtown Chicago. That accident started a 9-month journey through the medical system—both conventional and alternative—trying to deal with increasingly severe Medically Unexplained Symptoms. I experienced numbness and tingling in my hands and feet as well as significant hand pain, difficulty walking, and pain with exercise. Over time as the mystery deepened, I became increasingly frustrated, fatigued, isolated, and depressed. By the time I found the key to my healing nine months later, I had posted numerous times on SDN and other websites searching for clues about what was wrong.
Remarkably though, the key to my healing came not in a physician’s office but at a cocktail party. That evening in early 2000, I overheard a conversation between two friends: one of them had cured his back pain by visiting Dr. John Sarno in NYC and was encouraging the other to do the same.
I was surprised, but I shouldn’t have been. Dr. Sarno, who passed away this year at the age of 93, was a prominent physician in NYC who wrote about back pain being a psychological issue more than a physical issue. It’s important to note that the pain is not imaginary, but that stresses, past experiences, and our own emotions can alter both brain regions and pain pathways to produce excruciating, profound physical pain—the same type of pain caused by a physical injury.
I went home at the end of the party and read Dr. Sarno’s book again. As I reread the description of who gets pain in this way (kind people who have high standards for themselves, keep their emotions inside, take care of others, tend toward perfectionism and people pleasing—healthcare professionals, anyone?) and why it occurs (too much stress and overwhelming feelings and emotions), I saw clearly where these symptoms were coming from. I was finishing my post-bacc, taking the MCAT, considering getting married, and struggling with questions of spirituality and religion all at the same time. I could probably have tolerated any one of those life-changing issues, but all of them at once was too much for the person I was at that time, so my body held on to the stress for me as I worked all those things out.
The next day, I dusted off my bicycle. I hadn’t biked in almost a year, but I headed out to the lakefront path in Chicago. As I pedaled, the electric shocks shot from my feet up to my hips, but I kept repeating, “This is not a physical issue, this is not a physical issue, this is not a physical issue.” After about 3 miles, the pain started to calm down for the first time in 9 months. By the time I rode downtown and back, I was feeling 80% better than when I started. Over the next several months, I did some journaling, self-reflection, and therapy to sort out pathways for all those decisions. By the time I got engaged the next year and started med school the following year, the pain was gone—and it has never returned.
That experience, though, shaped me a physician. By the time I started school, I knew in my own body the profound effect that non-physical factors can have on our physical being. I vowed that every time I saw a patient who had pain I would ask them what was stressful in their lives. Even as a student, I would get astounding responses. One woman in the ER with back pain told me she had called her boss a racist and worried she was going to get fired. Another woman in urgent care with a migraine cried as she told me how much she missed her 15-year old daughter who had died the previous year from an asthma attack. A woman with bladder pain in an inner-city clinic admitted that her depression was worsening and she was considering suicide. Instead of more testing, she got the psychiatric care she needed.
As I went further in my training, people started listening to me when I explained this connection between mind and body. During my second year of residency, a young woman with migraines took my advice to heart and in the midst of a particularly bad headache she asked her boyfriend to help her sort out a particularly stressful issue. After a good conversation and a long cry, she realized that the migraine had gone away and didn’t come back. I still remember the look of incredulity on my attending’s face when the patient described what happened and said that, in the end, the migraine had simply disappeared: “Poof!”
This idea, that our body can express what goes on in our hearts and minds, has taken on increasing importance and urgency as the opioid crisis has deepened. I recently left my hospital practice to set up a solo practice that has greatly increased my flexibility to do the work that I’m passionate about. My practice has gone from 2% mindbody pain management to over 20% just in three months. I’ve also hosted panel discussions among patients who have greatly improved their symptoms, done webinars with experts in the field, run group discussions among patients looking to heal their symptoms in this way, and hosted other practitioners in my office who want to learn more about how to help people connect mind and body for the purpose of healing. I am working on setting up a series of weekend workshops and ultimately training programs for other healing professionals.
Another foray in this direction has been being the medical advisor to three people who have been healed in this way and are looking to make their own contribution to the world of chronic pain. They’ve used these concepts to create a medical app called Curable. It’s been great fun to work with them on how to take this knowledge that we have and use technology to make it easily accessible to those in pain who need it and want it. It’s been a great help to many of my patients and has been helpful for patients who are struggling and don’t live within driving distance of a physician who can help them heal in this way.
In addition to the app, they’ve developed a highly regarded podcast called “Like Mind, Like Body”; they’ve helped sponsor a study at the University of Colorado where the investigators are getting functional brain images of patients before and after undergoing Mindbody Medicine treatment for their back pain; and they are starting to partner with some of the leading physicians in the world who do this kind of work so that they can continue to be on the cutting edge of medical science, research, and practice.
So one hope I have for you is that you recognize that the twentieth-century paradigm of treating chronic pain has failed. In 2016, 64,000 Americans died of drug overdoses, over half of which were opioid related. Almost all of those patients had been diagnosed with chronic pain, mental health issues, or both. Giving more medication does not solve the problem and, at the moment, seems to be making it far, far worse.
When I lecture to medical students, they ask the questions that you’re asking now. What can I do? What should I do? You can start by recognizing that twenty-first-century research shows that mind and body are related and that’s where the experience of pain comes from. It’s past time to doubt this, and now time to look into how we can leverage that information to heal our patients. As a student, the one thing you have that other health professionals don’t is time. Make a vow to ask patients with pain if there’s stress going on. You’ll be amazed at what people will tell you and how much trust they’ll put in you because you’re wearing a white coat. That alone is healing for people.
If you’d like to learn more, I’m always happy to answer questions. I frequently host students and other practitioners in my office and in my group classes. There is a wealth of information out there now in terms of books and articles and apps about the true nature of pain. The group that runs Curable is happy to lend their knowledge and expertise and to explain how to use their technology to make it easier for patients to get help in this way. My panel discussions and webinars are always free and always broadcast around the country and around the world, so you can attend or listen in to hear how patients have navigated this area of medicine to feel better.
The opioid crisis shows no signs of abating anytime soon. We can’t keep killing people with an outdated treatment of disease—at this point, it’s not all that different than bloodletting in the eighteenth century. Understanding the true nature of pain and effective treatments of that pain will allow your patients access to the most current, cutting-edge options to heal their illnesses. You’ll be astounded by how many of them will ultimately come back and say “Thanks, Doc, you saved my life.”
About the Author
Dr. John Stracks graduated from Yale University with a major in history. After several years as a social worker working with wards of the state, he began a pre-med post-bacc program, ultimately graduating with honors from the University of Chicago Pritzker School of Medicine. He completed his residency in Family Medicine and a fellowship in Integrative Medicine at the University of Michigan. After 8 years in practice at the Osher Center for Integrative Medicine in Chicago, Dr. Stracks started his own solo practice to allow him to focus more fully on patient care, mindbody medicine, and his family. When not seeing patients, you can find him playing sports with his children and spending time with his wife. You can contact him at [email protected] and learn more about his practice at www.drstracks.com.