Editor’s note: In this guest article, RJ Burr discusses how to avoid opioids and surgery for back pain.

By RJ Burr, DC, Cert. MDT, CSCS

The Opioid Epidemic. I’m sure you’ve heard of it and it’s very likely you have a personal experience whether it’s you or someone you know who has been affected by the opioid crisis.

Per the National Institute of Drug Abuse (NIDA), Every day, more than 130 people in the United States die after overdosing on opioids.

Almost everyone will experience low back pain at some point in their lives. According to recently released low back pain series by The Lancet, low back pain is now the leading cause of disability worldwide.

As a result of back pain becoming an epidemic in itself, it’s to no surprise the medication approach to treating low back pain plays a major role in The Opioid Epidemic.

What Are Opioids?

From the NIDA, “Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others.”

Opioids chemically interact with opioid receptors on nerve cells in the brain and body. When prescribed and administered appropriately, prescription opioids are generally safe pain relievers to help an individual manage pain associated with an injury or disease process. Because pain relief from opioids often produces a euphoric experience they commonly become misused.

Because the effects of opioids are so powerful misuse of prescription medication — even when used appropriately by Physician recommendation — the effects can lead to chemical dependence, addiction, overdose, and death.

From the CBHSQ Report, Misuse of opioids typically begins for relatively benign reasons to combat physical frustrations:

• Relieve physical pain
• Relax and relieve tension
• Help with sleep
• To feel good
• Help with feelings and emotions

However, taking opioid medication for the sake of experimentation or to enhance the feeling of other drugs and alcohol leads down a slippery slope where further dosing causes the feeling of being “hooked” or having to have the drug.

For those suffering from addiction and withdrawal of medication, it’s become all too common for them to seek out the readily available and much more affordable “street drug” alternatives such as heroin and other stimulants.

It’s out of the scope of this article to go into detail; however, we can’t turn a blind eye to the business side of prescription medication.

No matter their background, there are good people, bad people, and good people who get caught up into bad stuff. Many accounts of Physicians and pharmaceutical executives abusing their power to inflate their fiscal potential has led to a sad state of affairs for the victims and their families.

The good news is the corporate abuse has led to a serious crackdown and a demonstrative backlash by the people and government.

Why is Treating Pain with Opioids a Problem? A Personal Story

Opioid addiction can happen to anyone.

A good friend of mine, Jim (fake name for anonymity) was a recent college grad who had made it back up to his alma mater for homecoming. Drinking was involved but was not the primary reason Jim took a serious fall down a flight of stairs.

Jim suffered a head injury, needing an emergency airlift to the nearest hospital.

Luckily, Jim walked away with only a concussion, and moderate bumps and bruises — he dodged a bullet.

Jim was living at his parent’s home at the time to earn enough money to afford a comfortable place to live on his own, so he was in a good spot to take the recommendation to take time off from his new career to rest and recover.

In the early phase of his recovery a prescription of hydrocodone (Vicodin) was prescribed to manage some of the pain he was experiencing. Once the prescription had been depleted he turned to anxiety medication (Xanax) he had prior and alcohol. When the Xanax was gone he foraged the medicine cabinet for Opioids which his mother had leftover from a back surgery years prior. As you predicted, he drained his mother’s prescription.

He did not turn to Heroin or other street drugs as many do.

Jim robbed a Pharmacy at knife-point.

Having spoken with him after his four-year sentence in prison, Jim told me even though he wasn’t thinking clearly the addiction made him believe what he was doing was completely plausible.

The good news is Jim was able to turn his life around and is doing quite well today.

He’s one of the lucky ones.

The point is a college graduate living a normal life in the suburbs of Detroit committed a serious felony and could have hurt another individual because of his addiction to opioid pain medication. Granted, he was not abusing opioids for back pain, Jim’s story is all too familiar for the people and loved ones caught in the wave of prescription pain medication.

How Do I Relieve Back Pain Without Opioids?

If you want to avoid opioids and surgery for back pain, it’s imperative to make sure your daily physical habits and behaviors are in line and to seek out appropriate professional guidance from a qualified healthcare practitioner.

First, it’s important to understand opioids and surgery aren’t inherently bad. There are certainly times where pain medication is needed and surgery is a must. However, current low back pain recommendations are based on treatments rather than prevention, and the inappropriately high use of imaging, rest, opioids, spinal injections, and surgery will not reduce back-related disability or its long-term consequences.

There are many non-surgical back pain relief and back pain treatment options available, such as chiropractic, physical therapy, massage, acupuncture, and other alternative treatment methods.

Non-invasive options can be great ways to treat back pain naturally. Although, it’s difficult to know which one will be right for you, without wasting time and money in the process.

When searching for a qualified non-invasive healthcare practitioner asking friends and family or performing a quick internet search is typically the first move. Asking a trusted peer for a recommendation can be a great start but beware of posting on social media, “I have back pain, who should I see for treatment.” You’re opening a pandora’s box of opinions.

No matter where you decide to start, it’s critical to do your own research on qualified healthcare professional. Once you pull the trigger to make that first appointment the vetting doesn’t stop.

What a quality healthcare professional will do:

• Completes a thorough examination, assessment, report of findings, and treatment options
• Maps out a clear and understandable plan of action of which you are in agreeance
• Clearly define risks, benefits and alternative options
• Refers out to another healthcare professional when necessary
• Engages in an “active care” approach with movement and exercise rather than “passive care” with treatments that are only done to you
• Holds you accountable for what’s necessary to do to ensure successful results
• Provides meaningful feedback and self-help strategies to ensure you’re making strides and maintaining long-term results
• Forgo administering unnecessary and expensive tests, treatments, and procedures
• Updated on the latest peer-reviewed scientific literature
• Follows the guidelines the latest scientific evidence has to offer

What a sub-par healthcare professional will do:

• Spends minimal one-on-one time where you feel you’re not being listened to and your needs aren’t being met
• Recommends tests, treatments, and procedures when you don’t fully understand why
• Withholds risks versus benefits and not offering you the ability to choose alternative options
• Expects you to follow their recommendations because they’re the expert, and pushes back when you ask thoughtful and concerning questions
• Sells you on long-term care plans with the option to pay a large sum of money up-front
• Instills fear about your condition by using phrases such as, “you have the spine of an 80-year-old” or “I’ve never seen a ____ this bad”
• Employs treatments and “quick-fixes” done to you, without any offering any homework or self-care strategies
• Utilizes expensive technology and machines with poor scientific backing you are told will “fix” you
• Is not up-to-date with current best practices or turns a blind eye because it doesn’t positively impact their pocketbook
• Tells you “you just need to keep getting treatment” when your condition is not improving
• Won’t refer out to another healthcare professional unless absolutely necessary

What Can I Do to Avoid Back Pain and Opioids?

Did you know there are ways to prevent and manage your own back pain without costly procedures or treatments?

The most common type of back pain, called mechanical back pain, is often the result of habitual postures, positions, and movements you subject yourself to on a daily basis. Rather than hope there’s a silver bullet or “magic pill” for instant back pain becomes a problem, it’s best to spend your time to understand then address how you use your body on a daily basis.

Here are three simple tips to help you avoid the costs associated with mechanical back pain.

2. Move your body and move more often! Technology is amazing and modern conveniences are, well, convenient, but it has caused us to become more sedentary than we’ve ever been in our ancestral history. We used to have to hunt for our food. Now, you can “1-click” a meal delivered to your door!
   • Tips for moving more and feeling better
     • Do not sustain one position, especially sitting, for more than 30 minutes at a time. Get up, stand up, take a walk — just move even for a few seconds.
     • Try this postural reset.
     • Drink more water. Hydration is healthy and you’ll have to use the restroom more often which makes you get up and move!
     • Modify your workspace — such as using a convertible or standing desk — to promote more movement throughout the day.
3. When you have to sit, sit up straight! Sitting is not inherently bad but It’s been demonstrated in our culture our spines spend over 90% of the day in some sort of forward flexion, a.k.a., slouching.
4. Slouching places prolonged stress on our joints, tendons, and ligaments causing them to become painful. For example, take your finger and bend it backward as far as you can. Now, pull it back a little more and hold it there. Okay, let go because it’s likely quite achy at this point! The bent-finger example is like what we’re doing to our spines causing back pain from sitting all day.
5. Words of wisdom: There is not a perfect posture. Your next posture is your best posture. Get up and move more often.
6. Seek out guidance from a qualified healthcare professional (see above) as soon an episode of back pain becomes more than just pain. Most episodes of back pain will resolve on its own with time and moving your body within your current limits (ovoid inactivity). However, if your back pain episode is limiting or preventing you from performing normal daily activities comfortably, it’s time to get help.
7. The worst thing you can do is ignore your back pain and try to mask it with medications and over-the-counter pain relievers. The longer you let a persistent or episodic back pain episode go, the more difficult it can become to successfully resolve conservatively. Do not neglect an issue before it’s too late where costly and invasive measures are a must.

By taking control of your daily physical habits by employing the strategies discussed, you have the power to prevent chronic back pain occurring in the first place!

Lastly, it’s important to note not all back pain is created equal. Back pain most commonly is the result of daily postural habits and lack of movement; however, it can be from something more serious. If you’ve tried to correct your back pain without success, it’s best to seek out professional guidance — I can’t say it enough.

---

As the founder of Reach Rehab + Chiropractic Performance Center in Plymouth, Mi, RJ works according to his belief that for you to have a healthy, pain-free lifestyle, you must be responsible for your health by eating well, moving well, and moving often.

RJ received his Doctor of Chiropractic Degree from the National University of Health Sciences (NUHS) and has accrued more than 700 hours of post-graduate work with an emphasis on manual therapy, rehabilitation, biomechanics, nutrition and movement restoration. He’s earned certifications in Active Release Techniques (ART) and Titleist Performance Institute (TPI) medical track, and can sit for the American Chiropractic Rehab Board Diplomate (DACRB) and Certification in Mechanical Diagnosis & Therapy (McKenzie). He also continually treats recreational and professional athletes at races, tournaments, and other competitions.

 

• Patient Safety