Dr. David Gottsegen: Choices in primary care widen gateway to addiction

By DR. DAVID GOTTSEGEN



SOUTH HADLEY — The best way to address health problems is through primary prevention. Preventing the flu through hand washing and vaccines is preferable to treating people already sickened by the disease. It is better to prevent injuries from motor vehicle accidents by using seat belts and car seats and by not driving drunk than it is to have to repair broken bodies after the accidents.

The same is true for the scourge of painkiller addiction that is ravaging western Massachusetts: Better to prevent the addiction than to punish and try to treat the addict.

For just as there is an epidemic of deaths from addiction to narcotic painkillers, there is another: the epidemic of dangerous addictive drugs prescribed by doctors. Like all primary care providers, I have experienced how these drugs have devastated my patients. And this does not just include young patients sick or dying from heroin or oxycodone overdoses.

It includes their families. I am aware of cases where a parent has died of an overdose after getting addicted to oxycodone after a minor orthopedic injury, children who have found addicted caregivers dead and young patients who have had to be given up to foster care because of their parents’ narcotics habit.

I teach relaxation and self-regulation skills (clinical hypnosis) to my patients for chronic pain and other conditions. It is unfortunate that their doctors did not teach these parents these skills.

There is an epidemic of infants who develop neonatal abstinence syndrome and have to spend weeks suffering withdrawal in our region’s hospital nurseries. The majority of them are withdrawing from methadone or suboxone (buprenorphine and naloxone), given to mothers to break them from their addiction to more dangerous narcotics. These mothers are similar to many of my young patients who are addicts. They start out on oxycodone products prescribed by doctors. Then, after getting hooked, many switch to heroin, which is a lot cheaper.

I am aware of cases where patients with abdominal pain have been given narcotics in an emergency to make the exam easier. The risk of masking tenderness of appendicitis, and missing making the diagnosis, was never considered. Other patients with abdominal pain and constipation are treated with oxycodone in emergency rooms, even though narcotics are known to be constipating.

It is as if some doctors are addicted themselves to unthinkingly and reflexively prescribing these drugs.

I have successfully treated hundreds of young people with chronic headaches and abdominal pain with hypnosis and by teaching them self-hypnosis. Yet patients who are admitted to hospitals with migraine headaches routinely get potentially dangerous, and often ineffective, cocktails of pain killers and anesthetics rather than learning skills to alleviate suffering — skills they can use for a lifetime.

Certainly, for those who have just suffered significant physical trauma, had major surgery or suffer from the pain of cancer, narcotic medications can be useful and even necessary.

But the medical community has all but ignored good scientific evidence that therapies like clinical hypnosis, biofeedback, mindful meditation, physical therapy and acupuncture are actually superior to medicines for treating disorders like headaches, stomachaches and back pain. And these treatments are far safer. As I tell my patients, the only major side effect to clinical hypnosis performed by a well-trained health care provider is relaxation. And that’s usually considered a good side effect!

Part of the problem is that the experience of pain is complex and subjective. But in the typical medical setting, once the patient’s pain has been labeled with the universal pain scale number — from one to 10 — the assessment of his pain is a fait accompli. But when a young person comes in telling me his pain is a “six,” that is just the beginning. What does that six mean? How does it affect his life? How much anxiety is involved? And what can he do to make to make it better?

As one of my mentors taught, “pain is pain, but suffering is optional.” I will often substitute a “suffering” scale for the pain scale.

One can have pain but learn to alleviate the suffering. And I will relabel “pain” as discomfort. Embedded in that word is “comfort.” I’ll often have a young person keep a comfort scale. As they learn ways to help themselves, they are able to see those scores increase, as the suffering scores decrease.

It may be easier to give a medication to a patient than to spend more time talking with him or her, teaching relaxation and coping skills. But to teach a patient suffering a panic attack in an emergency room simple diaphragmatic breathing takes only several minutes. It is so much better, not to mention cost effective, for a patient to learn a technique she can use for a lifetime rather than receiving the usual treatment: the addictive Valium derivative lorazepam.

It is good that Hampshire County is getting $550,000 to combat the heroin and oxycontin epidemic, which has killed so many western Massachusetts residents.

But the “community stakeholders” need to include not only law enforcement and public health officials, but community physicians willing to learn more about the risks of prescribing oxycontin and related drugs and consider safer and more effective alternatives.

David Gottsegen, M.D., practices with Holyoke Pediatric Associates in South Hadley and Holyoke. He is a clinical instructor with the Tufts University School of Medicine at Baystate Medical Center in Springfield and holds a certificate from the American Board of Medical Hypnosis. He can be reached at opinion@gazettenet.com.