Alternative pain therapies may reduce addiction risk

Amber Myers knows what it’s like to live with pain.

Just over a year ago, she was enduring a minimum of three migraines a month. One was tied to her menstrual cycle. Starting as a low-grade headache a few days before her period began, she says, the migraines would grow in intensity until it felt like every part of her head, from her skull to her eyes, was being squeezed.

Then there were the tension migraines. Usually the result of overwork, the pain would start as a spasm between her shoulder blades that would travel up her spine and become a piercing pain at the base of her skull that felt like “someone had shoved a needle into my skull until it came out through my eyes.”

Drugs to treat the migraines left her spacey or, worse, unable to recall words. That was a problem, she says, when trying to deal with customers at Nature’s Vitamins & Herbs, where she works as an herbalist.

“I couldn’t talk to them about their health care, because I couldn’t remember the words I needed,” she says. “The drugs treated the pain, but they didn’t prevent the migraines.” So, like many others who live with chronic pain, Myers eventually turned away from traditional medical treatments in favor of alternative modalities.

From workplace injuries to bad joints to migraines, millions of Americans deal with chronic pain. A 2015 National Institutes of Health review of data from a National Health Interview Survey found that more than 11 percent of adults, or 25.3 million people, suffer from daily pain that lasts at least three months.

Often, that leads to dependence on medications such as opioids. But as the Centers for Disease Control and Prevention tightens guidelines for prescribing opioids, alternative treatments for pain are attracting increased attention.

Whether it’s herbs, other ancient practices or cutting-edge technologies, alternative therapies can help people cope with pain and even overcome opioid addiction, local practitioners say, offering effective relief without the side effects of some prescription drugs. More research is needed, however, to assess the safety and effectiveness of alternative treatments, some of which can also cause serious health problems.

Cannabidiol for chronic pain

One of the most popular remedies these days is CBD.

Pharmacist Mike Rogers, co-owner of Nature’s Vitamins & Herbs, says CBD gives his customers relief from pain without side effects or fears of overdosing.

“Cannabidiol is from cannabis plants, but it contains less than 0.3 percent THC,” Rogers explains. “Most chronic pain comes from a combination of inflammation and damaged nerves. Opioids make the brain not sense the damaged nerves, but CBD is a potent anti-inflammatory as well as a pain reliever. We sell more CBD for chronic pain than anything else.”

Rogers says anywhere from 40 to 60 customers a day come in seeking CBD in one form or another. “I had one customer who came in here on a walker to get CBD,” he reports. “The next day he came in without the walker and thanked me for helping him.”

Like most therapies, however, CBD isn’t equally effective in all cases.

“It’s not 100 percent for everyone,” says Rogers. “Some are perfectly fine with it. Some of our customers, it helps cut the pain down and tones it down so they can feel better. Some of them, it doesn’t have an impact on them at all.”

CBD comes in several different forms — capsules, topical ointments, vape juice and oil — each with different uses, pros and cons, he explains. You might use the ointments on your knuckles to ease arthritis pain, says Rogers, or use vape juice in an electronic cigarette to get more immediate pain relief. CBD oil is taken orally, held under the tongue for a minute and then swallowed.

Prices vary widely: The products Rogers sells range from $20 to $275. “The price really depends on the concentration of the CBD in the bottle,” he explains, stressing that CBD can be an affordable alternative to prescription drugs costing thousands of dollars a year.

“It was my customers who really got me interested in CBD and getting more experience with that,” Rogers reveals. “But then my son had awful asthma and was on a number of medications. We took him to a homeopathic doctor who recommended that we try CBD; within a month he was off all of the medications. … It’s not that we were recommending it; it was that people came to us with all these god-awful conditions, and they said that CBD would help them.”

CBD is also what changed Myers’ life: Her doctor recommended it to help with her migraines.

“For me, having CBD has been a godsend,” she says. “I thought, OK, I’ll try this for a month and see what happens.” After a month, says Myers, “Things were a little better. Then I tried it for another month and things got better still. After six months, I was like, ‘Wait: Something’s missing here. I haven’t had a migraine in a while!’ And I haven’t had one since. That was six months ago.”

The kratom controversy

A more controversial herbal pain treatment is kratom, a tropical tree whose leaves contain natural alkaloids. For hundreds of years, the leaves have been chewed, smoked or brewed into tea in Southeast Asia to relieve pain and boost energy.

Amid the U.S. opioid epidemic, kratom has caught on as a way to manage pain and ease withdrawal from opioids. “Supporters regularly tout it as a natural treatment for conditions like chronic pain, anxiety and depression,” HuffPost reports. “Others claim it’s a safer alternative to traditional opioids, both legal and illegal, which has also contributed to kratom’s increasing popularity as a step-down treatment off of painkillers or heroin.”

Former Asheville resident Taylor Griggs, who moved to Raleigh last year, says he used kratom to help him deal with an opioid addiction. More than a decade ago, Griggs crashed his car while going 120 mph, wrapping it around a tree and breaking his back in seven places. The pain, he says, was intense.

“I lay in bed in agony,” he recalls. “I didn’t have any insurance, so I had no way to get treatment. A friend of mine sold me fentanyl; one day he ran out of it and recommended I use heroin instead. I didn’t want to take it; I was completely against the idea, but eventually I tried it because of the pain. Within six months, I was addicted. I lost everything: my family, my friends, my job. It took me 10 years to break that habit.”

Griggs says his experience with kratom inspired him to provide the herb to those with chronic pain or drug addiction: He now sells it through his business, Kustom Kratom. “It helped me,” he says simply, “and this is my way to pay back. I want to be able to help people who are going through what I went through.”

Even so, cautions Griggs, kratom should be the last resort for people in pain, because it can be addictive as well.

“If you’ve got pain, try yoga, surgery, focus on your breathing, whatever else works,” he advises. “But if you know you’re going to be in pain for the rest of your life, kratom may be a solution for you.”

Clinical herbalist John Janeski says he’s seen kratom work miracles for some of his clients but agrees that it should be used only in certain cases and even then not taken lightly.

Kratom, however, is just one of the more than 200 herbal therapies Janeski offers. “It’s not the focus of my business,” he stresses. “I don’t sell it to everyone: I won’t sell it to kids, and I won’t sell it to someone who I think will be using it for the wrong reasons. I want to make sure, if they’re using it for pain, that they’ve tried acupuncture and bodywork and worked on their diet. There are other herbs that are more commonly known that may help. I really think this is a solution for those in dire straits who can’t find relief anywhere else.”

Kratom comes in powdered form and can be mixed into a drink or brewed like tea, he says.

“I know an individual, a local man, who was in a car accident. He suffered severe injuries including multiple broken bones,” says Janeski. “As a result, he now lives in constant pain. There are days where this person can’t prepare his products for sale at local farmers markets. Kratom helps him relieve the pain and keep going.”

According to a December 2016 article by Walter C. Prozialeck in The Journal of the American Osteopathic Association, one of the problems with assessing the risks is that “No controlled clinical trials on the safety and efficacy of kratom have been published.” Nonetheless, the author, who chairs the Department of Pharmacology at the Chicago College of Osteopathic Medicine at Midwestern University, concluded: “In my opinion, the therapeutic potential of kratom is too large to be ignored. Well-controlled clinical trials on kratom or the many active compounds in kratom are needed to address this issue.”

Earlier in 2016, Prozialeck reported, the U.S. Drug Enforcement Administration announced plans to classify kratom as a Schedule I controlled substance, a category that also includes heroin and LSD. Faced with opposition from patients and advocacy groups, the agency postponed the move.

But in 2018, U.S. Food and Drug Administration Commissioner Scott Gottlieb, a physician, issued a public health advisory warning of kratom’s “potential for abuse, addiction and serious health consequences.”

The most common reported side effects, noted Prozialeck, are anxiety, irritability, nausea and vomiting; high doses have been said to result in tachycardia, seizures and liver damage.

After reviewing the literature, however, Prozialeck wrote: “I can reach no other conclusion than, in pure herbal form, when taken at moderate doses … pure leaf kratom appears to be relatively benign in the vast majority of cases.” And he adds that “Several investigators who closely examined these issues concluded that kratom is not as dangerous as traditional opioids and that the potential benefits may outweigh the risks.”

Kratom is illegal in Alabama, Arkansas, Indiana, Rhode Island, Tennessee, Vermont, Wisconsin and Washington, D.C. It’s also been banned in municipalities such as San Diego; Denver; Sarasota County, Fla.; and Jerseyville, Ill. And while kratom is currently legal in North Carolina, that may change, notes Janeski. In 2016, state legislators introduced SB830, which would have made kratom a controlled substance. But after support groups expressed opposition to the bill, Sen. Tom McInnis (R-District 25), the primary sponsor, amended it to ban sales of kratom to people under age 18.

A blended approach

Some local practitioners, meanwhile, employ a mix of conventional and alternative treatments.

At the Mountain Area Health Education Center, for example, treating pain involves more than just pushing pills. For starters, cognitive behavioral therapy helps patients think differently about their pain. “We have lots of data on how behavioral therapy can actually reduce their pain by 2 percent,” says Dr. Blake Fagan. “Essentially, we’re training them to replace negative thoughts about their pain with more positive thoughts.”

But MAHEC, he notes, also uses a number of other alternative therapies to help patients deal with pain.

“There is good, solid data that treating a patient’s depression that is a result of that pain actually helps to decrease their pain,” says Fagan. “With physical therapy, we tell the patients to get out and move. Whether it’s yoga, exercise or tai chi, just move and it will help you in the end. Sometimes it’s hard for patients to hear ‘If you’ll just get out and walk every day, and you can make it for two weeks doing that, you’ll see a difference.’ They may not want to do that, because it hurts when they walk, but it will help, and they will feel better.”

Fagan, however, also stresses the need for more scientific research to assess different therapies’ effectiveness.

“We have data on behavioral therapy. We have data on treating patients’ depression. We have data on acupuncture,” he says. “But there haven’t been any randomized, controlled trials on CBD or kratom. I don’t think we in the medical community can say these are safe alternatives, because we just don’t know.”

Kratom, for example, can lead to much worse problems than the ones it’s being used to treat, he says. Although he’s seen patients use kratom to get off of opioids, it’s had no effect on others — and still others have become addicted to kratom and gone on to addictions to more harmful substances, such as heroin.

Alleviating pain with acupuncture 

Another ancient Asian pain remedy is acupuncture. Small, thin needles applied to specific points on the body can provide almost immediate relief, says Aimée Schinasi, co-owner of The People’s Acupuncture of Asheville.

“Acupuncture helps so many different things, from emotional pain to menstrual pain to lower back pain. Pain is what it’s best for,” the licensed acupuncturist explains. “It hurts for about 30 seconds, and then it feels better. … It depends on the patient as to how long the effect lasts.”

The therapy can help people avoid having to use pain medication and get off of meds they may already be on, says Schinasi.

“I’ve had people literally crawling through the door for help,” she recalls. “I had one woman who was on multiple opioids for pain from numerous back surgeries. She was able to use the acupuncture treatment to get off of most of her opioid medications. … If people can come here first, we can prevent them from going on opioids in the first place.”

Schinasi also uses the procedure herself. “Last month my shoulder freaked out, and I could barely move my head,” she reveals. “I visited the chiropractor, I got a massage, but it was the acupuncture that … knocked it out.” Treatments, she says, might range from once a week to once a day, depending on the pain level.

And while many alternative therapies aren’t covered by most health insurance, that’s offset by their relatively low cost, Schinasi points out. “Our services are on a sliding scale, between $25 and $40 for the initial visit and between $15 and $35 for every visit after that,” she notes. “A patient who is in severe pain that requires several visits can afford $15 a visit — $15 is nothing when you’re hurting. But with doctor visits sometimes costing hundreds of dollars, a patient may forgo treatment or rely on medication instead.”

And economics aside, “We’ve seen everything here,” she notes. “We’ve seen all kinds of people who fall into addiction — from nurses with easy access to those things to those who have become addicted to opioids following surgery. I 110 percent stand behind acupuncture as one of the best alternatives to opioids.”

Empowering patients via biofeedback

Meanwhile, some newer therapies use technology to help ease pain.

At Focus Centers of Asheville, biofeedback can help patients learn to control their body to decrease pain, says Phil Ellis, the facility’s director.

“Our method is to connect an individual patient to an instrument that illustrates how their body is working,” explains Ellis, a licensed psychologist who’s board-certified in neurofeedback. “It may show an image that shows their skin temperature. … We tell them to imagine looking at a thermometer and focusing on their desire to see the temperature drop. Most people can do that. … Getting feedback like that is very rewarding. Eventually we get to the place where the patient can do it on their own.”

Biofeedback is best for pain associated with muscle tension and headaches, notes Ellis, but it can also be used to steady heart rates and help with insomnia.

“Studies have shown that biofeedback changes the way our patients view pain,” he says. “Our patients say they have seen a 20 to 30 percent reduction in their pain levels after therapy.”

Feeling the pulse

BioQPulse, used in Europe since the 1960s and approved by the FDA five years ago, combines reflexology with electrical stimulation applied to pressure points on the hands and feet, says Chris Taylor, who owns Physio Physical Therapy and Wellness in Asheville.

“These low-level electromagnetic pulses increase blood flow, boost energy production and help the nervous system calm down and relax,” says Taylor. “It’s great help for fibromyalgia patients and those with chronic pain. We’ve seen great results on people with nerve injuries. It helps stimulate nerve healing and growth.”

The therapy, he notes, alleviates pain at the source, rather than merely masking it with drugs.

“Basically, everything we do in our practice is set up to treat pain without drugs. BioQPulse is just one piece of the puzzle. But all of these therapies can help someone get off of opioids or not start them in the first place.”

Beam me up

Another local practice, Chiropractic Physicians at Biltmore Park, specializes in K-Laser therapy. Chiropractor Michael Masterman, who owns the clinic, says that while many kinds of laser therapies can alleviate pain and promote healing, K-Laser therapy goes deeper into the tissues and works to repair the muscles as well as stimulate healing.

Using red and near-infrared light, he continues, the lasers penetrate deep into the body to increase circulation, drawing water, oxygen and nutrients to the area. This creates an “optimal healing environment” that reduces swelling, muscle spasms, stiffness and pain.

Masterman says he’s helped several patients get off opioids. The therapy works, he says, because the lasers address the underlying problem instead of just treating the symptoms. Several drug rehabilitation centers now refer some of their patients to the clinic to help them get off opioids and other painkillers, he reports.

Damage control

Schinasi, too, believes alternative pain treatments are the best way to avoid opioid addiction.

“If you can get in somewhere and get alternative care, you can avoid surgery and the nerve damage, the scar tissue and other issues that cause pain,” she points out. “If you can avoid the pain, you can avoid getting on opioids. And the best way to avoid getting addicted to opioids is not to start using them in the first place.”

Fagan of MAHEC agrees that the increasing problems with opioids are something all health care providers need to be aware of — and the focus needs to be on avoiding getting patients addicted to begin with.

“The public health analogy for opioids is to think of a river that’s swiftly moving, and there are people in the river drowning,” he says. “You’ve got to go in and rescue those people who are drowning. But more than that, you’ve got to do something to prevent the people upstream from pushing people into the river in the first place.”

Ultimately, Fagan maintains, it’s up to patients to determine what’s best for them.

“If they decide to do alternative therapies, I would want them to make sure that whatever they do decreases their pain, increases their function and they don’t have any adverse reaction to the treatment,” he says. “With each of these new therapies, they need to go in with a little bit of skepticism, and if it’s not working they need to stop. I would say that about traditional medicine and painkillers too: If it’s not working, tell your doctor.”