Oregon Public Broadcasting

Can Changing How You Think About Pain Lessen What You Feel?

Oregon has the fourth-highest rate of prescription pain killer abuse in the nation, so the state is implementing new guidelines that will require doctors to give lower doses and shorter prescriptions.

That's a challenge for patients who've relied on opioids to deal with their pain. Alternative treatments such as massage and acupuncture don't always work. So Providence Health is also offering to re-educate patients about pain to help them deal with pain by learning to think about it differently.

Nora Stern, a physical therapist and manager of the "Persistent Pain Project," spoke to about a dozen patients about the re-education. "This class was designed to help us all start to talk about pain differently. There’s a lot of new information about pain that leads us now to understand what pain is differently and what the options are for treatment.”

We think of pain as pretty simple, she told them. Johnny rides his bike, falls off, scratches his knee and feels pain. But scientists say how we perceive pain is much more complex.  If Johnny’s mother isn’t around, for example, he might not burst into tears. Stern says soldiers in battle, who’ve suffered massive injuries, sometimes don’t register the pain from their wounds until much later. They're too busy trying to stay alive or complete their mission.

“It’s possible because the threat value of what’s going on around them is much greater than the threat value of what happened even in that injury," she said. "They can’t afford to assign pain to that part at that time, because there’s something much greater going on ”

 So, Stern said, pain isn’t just a result of tissue damage. Pain is what the brain says it is.

“The brain produces a pain response as a result of putting together information from the body and information from all these other parts of the system in general," she said. "To decide how threatening that information is and based on the threat value it assigns more pain or less pain.”  The threat doesn’t have to be physical. A painter who falls off a ladder and injures himself may suffer worse pain because he’s worried his injury means he won’t be able to work any longer, to pay his bills and support his family.

“You’re likely to feel more pain if you’re having a hard time in your life and people have that happen all the time,” Stern said.

After Stern’s class, people filed out quietly. People in pain don’t tend to be very chatty.

But Sherry Swafford, who has suffered from neck pain for 30 years, says the class was illuminating. She especially liked Stern's suggestion to think more deeply about daily activities and less about pain.

“I thought about the walking and noticing all the different colors of greens," she said. "I’ve noticed the different colors of things and the smells, just the visual feast there is. But I never really thought about how many different differences there are.”

As a nation, we're used to taking pills for our pain. So patients can turn skeptical when someone suggests they should think differently about their pain as an alternative to painkillers. 

But Oregon Health & Science University neurologist Dr. Eve Klein said there's research behind the suggestion.

“You know there’s as much science behind behavioral therapy and physical therapy as there is behind opioids," she said. "The efficacy actually looks better when we look at what data there is available.”

Back at the pain class, Stern tells her students that sometimes they need to understand that, as she puts it, "motion is lotion." 

“Sometimes, (pain is a) warning us that we just injured ourselves. Sometimes it’s warning us about something else, like we haven’t been up and moving our bodies enough to have a healthy resilient nervous system," she said.

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Oregonian Turns To Heroin For Pain Relief After Opioid Prescription Cut

John is a carpenter, OPB is only using his first name for reasons that’ll become clear in this story.

John grew up in southern Oregon and for 20 years had a successful business installing kitchens. Then, in 2005, he was in a car crash. “I mean, fractured my neck, fractured my back. I had to have my right shoulder replaced," he said.

John was prescribed opioids to deal with the pain.

“After about four years I was on 160 milligrams of oxycontin … and then it was 56 milligrams of oxycodone and that went on for maybe four years.”

Today, he’s a mess. He lives in his pick-up truck and is in constant pain.

Without pain killers he said, he misses work. Which is why he was alarmed recently when his doctor — following new state guidelines — started reducing his dosage.

“The first thing he did was cut me back by a full one-third," he said. "It became an argument with him. Two months later, he cuts me back by another full third," he said.

John concedes he was using too many opioids — but points out it was all legal and under a doctor’s supervision. He said tapering off the drugs left him with terrible pain in his neck and back.

“Your body becomes so jittery and moving around. And just, I mean there’s no place of comfort," he said. "I mean it’s torture.”

John said he stuck with the low doses for seven weeks, then decided to visit Old Town Portland to buy heroin.

 He was incarcerated for cocaine use in the 1980s, which is how he knew where to go for illegal drugs. He said he turned to heroin because he had to have something to deal with his chronic pain.

He didn’t want to inject it, so his solution was to cook the heroin in tin-foil with a lighter — like he’d seen others do — then inhale the fumes.

“But most of the drug just goes up in smoke. So the next time I went to this dealer, I said, ‘Well, how do you do it?’ And he said, ‘Well, I snort it.’ And I said, ‘Well this is black tar, how do you snort it?’ And he said, ‘Oh! You cook it and you put it in a needle except you take the needle off and you shoot it up your nose and snort it,'" explained John. John said he understands the need to crack down on opioids. He knows more than 28,000 Americans overdose and die abusing the drugs every year. But, he said, acupuncture and physical therapy just don’t give him much relief.

“It’s a really upsetting story and one thing that’s so upsetting about it is that it’s actually quite common,” said Dr. Eve Klein, a neurologist working on pain management. She said when somebody’s been on opioids so long, tapering often doesn’t work. She hasn’t met John but thinks he should probably go to a methadone clinic.

“And then once he’s on something like methadone and he’s stable and he’s out of that rat race of needing heroin every six hours. Then he can start looking into things like, 'OK, what am I going to do about pain management now?,'” she said.

Congress just passed a bill to reduce opioid addiction. Democratic Oregon Sen. Ron Wyden voted for it, but said it’s only a ‘half measure.’ He’s said more legal options for dealing with pain are needed, “If all you do is restrict choices to medication, the addiction does not vanish magically. You’ve got to have prevention and treatment.”

Meanwhile, John lives in his truck and seeks relief where he can. He’s terrified of the traffic stop that could land him in jail.

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Oregon Tries To Improve Access To Dental Care

About a quarter of Oregonians on Medicaid get a dental visit each year. That compares to almost three-quarters of the general population.

Cavities and gingivitis might not sound like a big deal. But over time, poor dental health can lead to inflamed gums. And the bacteria from inflamed gums travel through the bloodstream causing everything from heart disease to cancer.

Oregon Tries To Improve Access To Dental Care

About a quarter of Oregonians on Medicaid get a dental visit each year. That compares to almost three-quarters of the general population.

Cavities and gingivitis might not sound like a big deal. But over time, poor dental health can lead to inflamed gums. And the bacteria from inflamed gums travel through the bloodstream causing everything from heart disease to cancer.

Rep. Alissa Keny-Guyer, D-Portland, especially wants women who are pregnant to be seen.

“It’s a very short window of opportunity and we know that at least 50 percent of them have dental carriers. And we know that that leads to premature birth," she said. "So how do we get to them really quickly and make sure that they see a dentist?”

The state has launched a work group to improve dental care access for Oregon’s poorest residents. It's expected to have a list of ways to improve access by September.

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Is Oregon's Public Health System Meeting Needs?

Oregon’s public health system is “minimal” in a third of communities, according to a new report commissioned by the Oregon Health Authority.

Public health deals with everything from immunizations to ending tobacco use. It also covers tests for lead and monitors factory emissions, which have been relevant issues in Portland and elsewhere statewide lately.

The state estimates it can conduct about five health assessments a year, but five times as many are needed to address environmental risks.

Lynne Saxton, director of the OHA, said the shortage of health workers is apparent across Oregon.

“In my travels across the state in the last year, many counties have said to me, 'We have one person trying to meet the entire needs of the public health system in our county and it’s simply not sustainable,'” she said

Oregon spends about $25 a person on public health each year. That compares to $40 in Washington and $95 in Idaho.

The state estimates it needs an extra $30 million out of the next legislature to modernize the system.

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Oregonians Spent More Than Needed On Health Prodcedures Last Year

Oregonians could have saved 28 percent on their health procedures last year if they’d shopped for the best price, according to a new study from the Portland cost transparency company HealthSparq.

People with health insurance don’t usually shop the best cost on procedures like an MRI or hip replacement.

But over the last five years, insurance deductions have increased from around $300 a year to $3,000 a year. HealthSparq CEO Scott Decker said that increase is pushing people to shop more.

He estimates 11 percent of unnecessary spending in overall health care costs in Oregon could be eliminated by shopping.

“You can find even with your insurance, three, four or five times variation in price. So we need to be conscious consumers of health care, just like we are of anything else we shop for,” Decker said.

The HealthSparq study found patients could save 5 percent by shopping for tests and surgical procedures; 1 percent by shopping for medications; and 5 percent by using telehealth — that is, contacting a doctor over a video call service like Skype.

Such savings would amount to about $90 per person, per month.

The HealthSparq report used data from 237,000 people, who accounted for more than 500,000 cost estimates during 2015.

HealthSparq's shopping applications is embedded in 70 health plans across the U.S. and allows comparison shopping within network.

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Oregon Adopts Federal Opioid Prescribing Standards

Oregon has adopted new federal standards for the prescribing of opioids.

More people die from drug overdoses every year in Oregon than in car crashes.  And 43 percent of those overdose deaths are associated with opioids prescribed by a doctor.

State epidemiologist Dr. Katrina Hedberg said doctors and the public need to be educated on using fewer opioids, for shorter periods of time.

“It is not that we want people to be in pain. It is that we have one tool and there need to be a variety of tools that are used to address chronic pain."

She said patients need to look to tools like acupuncture, exercise, and learn to function with low levels of pain.

The state task force on opioids will continue to meet into the summer to consider other issues, like how to deal with pain from dental work.

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