Pain is complex. It's hard to quantify. Pain can be acute or long-lasting. And it changes over time. That can make pain difficult to treat. Opioids play an important role in medicine. They can provide relief to cancer patients whose pain can be excruciating. Opioids can deliver a reprieve for chronic pain patients whose daily lives are often consumed by pain. But this is where their role gets a little murky.
Medical literature has tied long-term opioid use with higher rates of addiction. And some patients may even develop a hypersensitivity to pain after taking these medications. This can make treating pain complicated. The nation's opioid epidemic has prompted a reckoning of sorts, where pain management techniques like mindfulness and yoga – long used in pain clinics around the country – appear to be gaining broader acceptance.
“Part of it is as we've realized the risks associated with opioid therapy, and that's really what's happened in the last few years, is we understand the risks a lot better than we understand the benefits,” said Scott Junkins, medical director for the Pain Management Center at the University of Utah. “While it's unfortunate that that's what has had to happen I think it does lead us to say 'Well, we can't rely on on this medication and so what are other options?'”
“So certainly mindfulness is one tool we like to think of patients being able to learn, and use and develop,” he said. “The same for yoga and modifications to yoga that is one of the keys is that many times we have to modify the type of mindfulness meditation or the type of yoga because everybody has an individual story and an individual pain and they respond differently to the same intervention.”
Junkins is hopeful that the opioid epidemic will help shine a light on other ways of treating pain more effectively using best practices and data. Just a mile away, in the department of social work at the University of Utah, professor Eric Garland, is building a case for Mindful Oriented Recovery Enhancement or (MORE), a technique he developed that may be a promising treatment for chronic pain management and even opioid addiction.
“I've already conducted several studies of Mindful Oriented Recovery Enhancement and the data that's emerged from these studies suggests that MORE may increase physiological responsiveness to natural pleasure. So we've seen this in brain data coming from EEG and we've actually seen this in autonomic nervous system data coming from measuring heart rate responses and what we've found is people completing MORE their brains and bodies become responsive to natural pleasure and the more responsive their bodies become to natural pleasure the less desire they feel for opioids, which is really amazing.”
“What it suggests,” he said, “is people can learn how to train their minds in such as way as to reclaim their sense of contentment and sense of meaning in everyday life. And that in doing so, this may actually reverse the downward spiral of addiction – that's my hope. We still need to gather more data to test that hypothesis, but it looks pretty promising.”
Garland directs the university's new Center on Mindfulness and Integrative Health Intervention Development, created this spring with $17 million in federal grants. Garland has several multi-year clinical trials underway with chronic pain and active duty military and veteran populations. He hopes MORE may help reduce the risks associated with opioid use by helping patients better cope with pain and take fewer medications. But you may be wondering what exactly is mindfulness?
“Many people when they think of mindfulness they think of meditation,” he said. “But really at heart it is a simple way of training the mind to focus on your present moment experience as a way to stregthen your awareness of what you're experiencing in the present moment and to then gain some greater self-control over what you're experiencing – you're not just reacting automatically, but rather you're responding consciously, and intentionally choosing how you want to respond to life's challenges, and, at the same time, being more open to and appreciating the joy and the potential goodness that's all around you.”
While the majority of patients prescribed opioids take them as directed, some studies have found that about one in four won't. A question we need to keep circling back to is: why? Why do people abuse pain medications like opioids? For social worker Steve Jones, the root of abuse may be related to trauma.
“I'd be curious to meet somebody who genuinely had been in recovery for awhile and and had a lot of insight from their opioid addiction and looked back and was like 'No, there was no trauma,'” he said. “The vast majority of my experience is that there is some sort of trauma, and that can be a big definition – it can cover a lot - but there is some trauma there, particularly if it goes real bad.”
Two years ago Jones opened Full Circle Yoga in Salt Lake City. The studio fuses his practice working with people with addictions, anxiety disorders, and chronic diseases, with trauma-informed therapies. He found through his own recovery from addiction over a decade ago, that it was during a yoga class, laying with his feet up a wall, that all the voices in his head – the ones screaming negative thoughts – quieted.
“And I was noticing how quiet my brain was the support of the ground beneath me, and it just happened there and I thought 'Whoa.'” Jones said. “That was profound because I was probably seven days clean and sober and the chatter was incessant. I had this itty-bitty committee, there's another word we throw in there, that goes on in our heads that is just telling us all the negativity and everything in the story, and it was gone.”
He recognized that is own clients could benefit from this type of therapy and he became credentialed to teach trauma-informed yoga.
“The body is really where we experience the world,” Jones said. “We experience things through our senses and through interception and proprioception so what's happening right now in my body, my heart rate or my breathing, how I feel when certain things are stimulating to me in one way or another, whether it produces anxiety or joy. If we're a trauma survivor, we're kind of detached from the body in that way and we're not familiar with what's going on. So yoga produces the means to which we may be comfortable in our own body.”
“Now that's not to say that every yoga class is a hit or that it's a guarantee,” he said. “But for what it does when it is helpful for folks is it gives them a little bit of control to regulate their body in response to stimulants so that they can perhaps create more options or choices in how they want to move through their life.”
Full Circle is a welcoming place off Main Street. In one corner, a banner lists the studio's patient bill of rights. Jones also hands out paper copies. Among those rights include a person's right to feel safe and loved. And Jones means it. He believes tackling the opioid epidemic involves compassion and using best practices informed by science. He also feels a responsibility to make sure people suffering from addiction and mental health disorders know the studio is there for them.
“Yoga is for everybody, mental health has to be for everybody, and redemption has to be for everybody,” Jones said. “Because there is nothing special about me; there's nothing special about anybody I've know that has recovered. Everybody is just a normal person and they all deserve this. So if there's people out there that are struggling and trying to find a different way, or they're even contemplating that there might be an easier, softer way out there, keep searching. Don't give up.”
“And the other thing is if you need a class, if you're out there and you're struggling and you need to go yoga so you won't drink or drug or whatever, and you don't have a dime to your name or a pot to piss in, just come and I'll gladly take care of your class for you,” Jones said.
This series is brought to you in part by the Association for Utah Community Health, providing training and technical assistance to health centers and affiliates across Utah. More information available here.