Talking with U of M

Talking non-opioid approaches to pain management with U of M

Roni Evans (left) and Gert Bronfort (right)
Roni Evans (left) and Gert Bronfort (right)

While many people rely on opioids for pain management, there are complementary approaches that can be used instead of or in conjunction with painkillers. As an alternative to opioids, non-opioid approaches to pain management, such as mindfulness, massage therapy, spinal manipulation and exercise are options to assist patients safely and effectively in managing their pain.

September is National Pain Awareness Month. Roni Evans and Gert Bronfort with the University of Minnesota talk about non-opioid approaches to pain management, what the trends are locally and nationally, and the health conditions most commonly associated with non-opioid approaches. 

Q: What health conditions are commonly associated with non-opioid pain management approaches?
Dr. Bronfort: Pain is actually one of the most common reasons for seeking complementary approaches. The most common types of pain for which complementary treatments have been studied include low back pain, neck pain, osteoarthritis and headaches. Other painful conditions commonly associated with non-opioid pain management include fibromyalgia, rheumatoid arthritis, endometriosis, irritable bowel syndrome pain and cancer pain; however, there is less research evidence for these. 

Q: What are examples of non-opioid approaches to pain management?
Dr. Evans: Some approaches include treatments that are considered more conventional, as well as complementary health approaches. Conventional non-drug treatments are typically offered in medical health care settings and include device-based approaches like traction, ultrasound, electrical stimulation; rehabilitative exercise; and psychological-based approaches like cognitive behavioral therapy. Traditionally, complementary health approaches were offered outside mainstream medicine, but that is changing. There is a large range of complementary health approaches including natural products and mind-body treatments. Some examples that have been studied for pain include acupuncture, massage therapy, meditation, relaxation, music, spinal manipulation, tai chi, qi gong and yoga. These approaches are increasingly being integrated with medical care as interest and research grows.  

Q: Why do people choose non-opioid approaches to pain management?
Dr. Bronfort: There are several reasons that may vary from person to person. A frequent one is the desire to avoid unwanted side-effects of medications. It’s important to note though that even complementary approaches have risks and side effects associated with them. A common misconception people have is that because complementary treatments tend to be more ‘natural,’ they are automatically safe, and this isn’t the case.

Other reasons include people looking for something that is more than a ‘band-aid approach.’ We commonly hear people want to fix or cure their pain problem, not mask it. However, we now know that pain isn’t necessarily something that we can fix, especially as we get older. Pain is part of being human and is something we need to learn how to manage and cope with. Complementary health approaches that promote self-care and other more conventional non-drug strategies, like exercise, are good ways to do this. 

Q: What are the trends locally and nationally in approaches to pain management?
Dr. Evans: There is definitely increased attention, both locally and nationally, to pain management, especially in response to the opioid crisis. Nationally, we’ve seen the emergence of the National Institutes of Health HEAL Initiative aimed at addressing opioid misuse and addiction, and enhancing pain management through more research. The National Center for Complementary and Integrative Health is playing a pivotal role in that effort. 

Locally, we see more instances now of conventional medical providers working with complementary providers and approaches. This is the case with our own study team which currently includes a range of health providers, including chiropractors, physical therapists, psychologists, nurse practitioners and medical doctors. We are working together to tackle low back pain with non-opioid treatments in one of the largest NIH pain studies to date. 

Q: What you are doing to advance research in non-opioid approaches to pain management? 
Dr. Evans: My research is focused on answering some critical questions about non-drug approaches for pain management. For instance, how do we increase awareness of the research that currently exists to support complementary health approaches for pain? Many people don’t realize there’s actually quite a robust evidence base to support complementary treatments so raising awareness — and removing some of the barriers to their use — are important steps.

We’re also examining the types of things people can do themselves to better care for their pain on their own. In other words, how can we help them develop healthier pain care habits that keep them active and less reliant on expensive and at times risky treatments such as drugs and surgeries? Some of the non-drug approaches we’re exploring are affordable mindfulness-based interventions and manual treatments integrated with supported self-management to help patients develop better pain coping skills. We’re also doing more connecting with our surrounding communities to figure out how to ensure everybody has access to non-opioid pain management approaches.

Dr. Bronfort: Currently I am leading a large study of over 1,000 patients with acute low back pain. With other researchers from the Universities of Pittsburgh and Washington, we are training chiropractors and physical therapists to be better prepared to support patients in their self-management, and seeing if this is more effective than typical, drug-focused medical care. In collaboration with the U of M Coordinating Center for Biometric Research and in direct response to call for proposals to the NIH HEAL Initiative, members of our research team proposed establishing a national center to address personalized therapies for chronic low back pain. Our goal is to do this by comprehensively probing the underlying mechanisms of back pain from a ‘biopsychosocial context’ — in other words, a whole person perspective — using innovative technologies such as artificial intelligence and genetic and epigenetic profiling.

Dr. Roni Evans is an associate professor and the director of the Integrative Health & Wellbeing Research Program at the Earl E. Bakken Center for Spirituality & Healing at the University of Minnesota. Her areas of expertise include self-management strategies, complementary and integrative therapies (mind-body), wellbeing and musculoskeletal pain.

Dr. Gert Bronfort is a professor in the Integrative Health & Wellbeing Research Program at the Earl E. Bakken Center for Spirituality & Healing. His areas of expertise include self-management strategies, complementary and integrative therapies (mind-body), wellbeing, musculoskeletal pain and spinal biomechanics.

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