FAQ #7: How do naturopathic doctors help people manage chronic pain without highly addictive opioids?

A service for consumers from the American Association of Naturopathic Physicians (AANP) and the Institute for Natural Medicine (INM)

Anyone who has ever experienced chronic pain knows how debilitating it can be. Yet the most commonly recommended conventional medical solution—prescription opioid painkillers—is turning out to be worse than the problem. Opioids may stop the pain, but at a high price: growing numbers of deaths due to opioid overdose and higher rates of addiction and misuse.

As a medical discipline that emphasizes a holistic approach and natural treatments, naturopathic medicine offers safe and effective alternatives to highly addictive drugs for managing chronic pain. Licensed naturopathic doctors are educated at four-year, post-graduate medical schools to start with non-drug approaches to chronic pain management, and use opioid painkillers as a last resort.

Naturopathic doctors are also trained to develop personalized pain management treatment plans. These plans take into account each individual’s lifestyle, nutrition, work and leisure activities, current and past stressors, and relevant previous injuries—in other words, the root causes of each person’s pain and all its manifestations. The plans use various combinations of dietary recommendations and nutritional supplements along with botanical medicines to help reduce inflammation and the pain it causes. Exercise, physical rehabilitation, and mind-body approaches that are known to reduce perception of pain are also included in the plans.

In addition, naturopathic doctors recognize the value of working closely with conventional and alternative medical providers and will make appropriate referrals for further diagnostic work-up, treatment support, or surgical intervention as indicated. In turn, a growing number of conventional medical doctors refer patients and colleagues looking for a fresh perspective for difficult-to-treat chronic pain to naturopathic doctors.

For more information on naturopathic medicine see FAQ #2 in this service, available here.

Perspective: a national crisis that is only getting worse

Drug overdose is the leading cause of accidental death in the United States. Of the more than 52,000 deaths due to drug overdose in 2015, prescription opioid painkillers such as oxycodone, hydrocodone, codeine, morphine, and fentanyl accounted for about 20,000. Of the 20.5 million Americans over the age of 12 who had a substance use disorder in 2015, 2 million involved prescription opioids.

How did this happen? According to the National Institute on Drug Abuse, in the late 1990s, pharmaceutical companies reassured health care providers that people would not become addicted to prescription opioids. As a result, physicians began to prescribe them at greater rates, leading to widespread misuse. Between 21 percent and 29 percent of people who are prescribed opioids for chronic pain misuse them; between eight percent and 12 percent develop an opioid use disorder.

Opioids aren’t the only dangerous pain management drug. Numerous studies link aspirin to a broad range of side effects ranging from gastric ulcers to cerebral bleeding. And a growing body of research links ibuprofen to adverse health effects, including increased risk of heart attack and stroke, gastrointestinal complications including ulcer, acute kidney failure, anemia, DNA damage, hypertension, and miscarriage.

The Centers for Disease Control and Prevention estimates that the total economic burden of prescription opioid misuse alone in the United States is $78.5 billion a year.

Naturopathic doctors play an important role in the opioid wars

Along with medical professionals from other disciplines, naturopathic doctors are actively engaged in collaborative efforts to solve America’s opioid problem. This includes participating in working groups to develop better pain management practices and modify national prescribing habits to limit the overuse of opioids. One example is the policy brief for the PAINS project, “Never-Only Opioids: The Imperative for Early Use of Non-Pharmacological Approaches and Practitioners in Pain Care.” Naturopathic doctors played a leading role in the development and dissemination of the brief.

The AANP and the INM would like to acknowledge Len Wisneski, MD, FACP, and Holly Lucille, ND, RN, for their contributions to the content of this FAQ.

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