Pain Rehab Program Offers Alternative To Patients Who Want To Get Off Opioids

The thousands of lives lost from opioid addiction may dominate headlines, but in fact the crisis has many faces, an MUSC Health clinical health psychologist says.

The effects of addiction are devastating, but the majority of opioid users are those who are being treated for chronic pain and being managed within the medical system,” says Dr. Sharlene Wedin, an associate professor in MUSC’s Department of Psychology and Behavioral Sciences. “Many of these patients are opioid tolerant or opioid dependent. They want to get off opioids and find alternative ways to cope with their chronic pain.”

Dr. Wedin is part of a multidisciplinary team in MUSC Health’s nationally recognized Pain Rehabilitation Program that works with patients seeking an “exit strategy” from opioid dependence. She says casting aside the pain medication isn’t easy, largely because of the physiological changes that occur when someone takes opioids.

“Opioids work on a variety of receptors in our brain that help to moderate pain. Some effects can be desired, but they can also produce negative side effects such as sluggishness, grogginess, constipation, and degrees of sedation. After being on the pain medications, people develop a tolerance to it and require increased doses to experience the same analgesic benefit.”

The cycle can be vicious. “As we push the dose up, the safety profile changes,” Dr. Wedin says. “When patients try to discontinue their pain medications, they experience withdrawal symptoms, such as nausea, gastrointestinal distress, and generally feel sick. Sometimes patients will stay on meds that are no longer effective because of the withdrawal symptoms. This is a dilemma for chronic pain patients, who feel stigmatized, and providers because they don’t have the tools to help them. Patients are suffering and no longer getting benefits, but there’s no exit strategy.”
By the time patients come to MUSC Health’s Pain Rehabilitation Program, most have sought other types of treatment for their pain, Dr. Wedin says. Some are referred by providers at MUSC or in the community; others want a non-surgical or a non-procedural approach to their pain. They may suffer from lower back pain, osteoarthritis or rheumatoid arthritis, neuropathic pain, or fibromyalgia pain, and know that what they are doing is not working.

MUSC Health’s program is a non-pharmacological approach designed to help opioid-dependent and tolerant patients 18 and older manage their pain and improve their function and quality of life.

The intensive 3-week outpatient program integrates physical, occupational, and behavioral therapies, medication management and nursing care in a group-based setting. Physical therapy sessions emphasize the importance of exercise as a treatment for chronic pain and show patients how to exercise safely. Behavioral sessions focus on the effects of chronic pain on the nervous system and teach cognitive and behavioral strategies that help patients cope with pain and its effects. Patients meet with the treatment team throughout the program to evaluate their goals and progress.

Dr. Wedin says MUSC Health’s program follows CDC guidelines for evidence-based, effective, non-pharmacological approaches to managing chronic pain. Released in 2016, the guidelines are a response to the alarming rise in opioid use. “For the last three decades, opioids were the first line of treatment for managing chronic pain until the opioid crisis started to put scrutiny on prescriptions and the potential harm associated with opioid use. Now, people and providers are looking for alternatives, and some providers have opted out of prescribing opioids.”

Pain rehabilitation offers hope and delivers positive results. “We’re proud of our clinical outcomes,” Dr. Wedin says. “Aside from having an improvement in pain, ninety percent of our patients report an improvement in their quality of life, and that’s really important. Research has shown that chronic pain patients’ quality of life suffers as much or more than that of patients with cancer. In fact, about 1 in 6 of people who suffer with chronic pain have considered suicide or wished they were dead.”

Dr. Wedin says 92% of the patients exited the program on no opioid pain medications, and 93% reported a reduction in stress and said that pain interfered less with their daily activities than when they entered the program. At discharge, patients demonstrated significant improvement in their daily living activities and skills, with an increase of 111% in performance.

“One of the things that we talk about with our patients is the big difference between acute pain and chronic pain,” Dr. Wedin says. “Opioids have their rightful place as a treatment option, especially for acute pain or post-op pain. It gets tricker with chronic pain. Our program offers alternatives. We all need to work together, and this is why programs like this are crucial for changing the culture in how chronic pain is treated.”

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