Neurologists still have a long way to go to understand pain

More than 100 million Americans suffer from chronic pain. And many of these men and women end up seeing neurologists about their pain. For example, half of multiple sclerosis patients experience severe chronic pain as part of their condition. Chronic pain is one of the most common symptoms of Parkinson’s disease as well.

Tragically, neurologists don’t yet really understand the mind-body connection in treating pain, as I’ll explain in a moment. And mainstream medicine has little to offer when it comes to chronic nerve pain.

Big pharma hasn’t developed a real “breakthrough” for chronic pain in a very long time. So, plum out of options, many neurologists still fall back on giving the old, time-tested opioid (narcotic) drugs to their patients.

But today, prescribing an opioid drug for chronic pain is a risky proposition. In fact, I just listened to my friend Governor Charlie Baker of Massachusetts give a press conference stating that prescription opioid drugs represent the biggest drug epidemic in history.

Sure–the drugs work over the short-term. Indeed–they come from the poppy plant (Papaver somniferum), Nature’s original pain reliever. This past April, at the American Academy of Neurology’s annual meeting in Washington, D.C., researchers presented data that showed opioid drugs work better to relieve pain than do gabapentin, serotonin, SSRIs, and the natural pain-reliever capsaicin.

But the body learns to tolerate opioid drugs. In other words, over time, the body needs higher and higher doses to deal with the same amount of pain. Years ago, doctors dealt with this tolerance by simply increasing the doses.

As a result, opioid abuse and overdose became a public health epidemic in the U.S. In fact, the deaths related to opioid abuse increased substantially between 1999 and 2010.

Plus–new data should help crystalize the issue.

The National Institutes of Health recently conducted a review of randomized clinical trials on opioid drugs. They found insufficient data to determine the long-term efficacy of opioid drugs for pain. In other words, the drugs might not work well over the long-term when it comes to treating pain.

Furthermore, they found a strong dose-dependent link to mortality. In other words, the higher the dose, the greater a person’s risk of experiencing a fatal overdose. In fact, at doses from 50 mg to 100 mg, the risk of overdose increased up to four times. And in doses over 100 mg, the risk for overdose increased up to nine times.

Some data suggests the problem has begun to subside somewhat, now that the government and health care industry has started regulating and cracking down on the abuse. Physicians and patients also have greater awareness about the drugs’ potential problems.

Washington State became the first of six states to impose a dosing threshold for opioid drugs. Since then, opioid-related deaths have decreased in Washington by 27 percent.

Many neurologists now believe opioids are inappropriate for patients with chronic pain. In fact, the majority of neurologists at the AAN Meeting recommended that patients shouldn’t receive opioid drugs as the first line of treatment for chronic pain associated with headache and low back pain. They said we should reserve opioid drugs to treat short-term pain conditions.

Fortunately, more mainstream neurologists now recognize what they call a “multi-modal” approach to managing pain. This broad approach includes lifestyle and psychological interventions, such as cognitive behavioral therapy and physical therapy.

But that’s as far as they go.

They still don’t widely recognize the promise of “mind-body” approaches–such as meditation and biofeedback–to relieve pain.

Before you try a mind-body approach to pain relief, you need to learn what “personality type” you have. Because personality type determines which treatment will work best for you. For example, science shows hypnosis or meditation works well for some personality types. But not for others.

Take this short online quiz to learn which personality type you have. Then, you can make a better-informed decision about which mind-body techniques will work best for your chronic pain.

To learn more about using mind-body approaches to deal with pain, read my book with Mike Jawer, Your Emotional Type: Finding Treatments That Work for You


Three Major Controversies in Neurology: A Debate,” Medscape ( 5/18/2015