Avoiding opioids: Greenfield physician gives a primer on pain relief

  • Dr. Marguerite Gump talks to seniors about pain management at the Greenfield YMCA. Recorder Staff/Tom Relihan

  • We all have to be careful about our pill consumption, Dr. Margaret Gump told seniors at the Greenfield YMCA recently. Sometimes we have to live with a little pain, and sometimes over-the-counter pain relievers are the answer. Metro creative graphics

  • Pills. They can seem to be magical in their ability to erase pain. But ... they can lead to addiction and should be used with caution, says Dr. Marguerite Gump of Valley Medical Group in Greenfield. metro creative graphics

For the Gazette
Published: 11/7/2016 2:51:29 PM

For decades, relief from pain has been closely associated with seemingly magical pills. But for Dr. Marguerite Gump of Valley Medical Group in Greenfield, there are better ways to treat it.

Gump spoke to local seniors at a luncheon during the Greenfield YMCA’s Senior Fitness Fair recently, where she ran them through the types of pain they might encounter and how to best manage it.

Gump said the rise of painkillers’ prevalency as a go-to treatment for pain took place over the last few decades, partly due to influence from the pharmaceutical industry that created them.

“In a period of 10 to 15 years, our approach as providers to pain in general has really shifted quite dramatically,” she said.

Twenty years ago, Gump said, medical assessment was changed to include a new “fifth vital sign” — pain.

That metric was important in hospital settings where patients were recovering from surgeries or grievous injury, but it became so commonplace that people began to look to powerful opioid painkillers as quick relief. 

“It created this dynamic in our society, at least in the United States, that if you have pain, you can take a pill and you will be fixed,” she said. “It feeds very clearly into our instant gratification culture.”

But that’s not the way to go, she said. It may fit into a person’s busy schedule, but treating pain in that fashion has led to a slew of other problems, including overprescribing, false expectations and the deepening addiction and drug abuse epidemic.

“In medicine, I think the good news now is that people are starting to wake up and realize that fixing pain or treating pain is a multidisciplinary approach with so many different avenues,” she said. “We’re getting wiser to our approaches to pain. Nothing changes overnight.”

Gump gave her listeners a primer on the types of pain and the options that exist for managing them.

She said there are two main types: acute pain, usually from injury, and chronic pain, with different types of pain within those archetypes.

Osteoarthritic pain builds over time. Gump called it “the pain of living.” Everyone will develop some degree of that as they use their bodies.

“That will be worse or better depending on our life,” she said.

Autoimmune or inflammatory pain comes from a person’s immune system misfiring and causing swelling around nerves and joints.

Neuropathic pain can be caused by diseases like shingles or arthritis, she said. It’s a burning, stabbing pain from frayed nerve endings.

Then there’s cancer pain, caused by masses growing in spaces where they shouldn’t be, and visceral pain in the internal organs, the type of pain caused by Crohn’s disease.

Gump said the reality in treating pain is that it probably can’t be completely cured. Your doctor’s role is to help you find the right balance to control it.

“No longer do we say, ‘I’m going to get you pain-free,’” she said. “That most likely will end in frustruation for both of us.”

Pain treatments

Instead, she said, she focuses on strengthening the parts of the body where the pain is most severe until they can be comfortably used.

For short-term relief, Gump said, an acetaminophen, like Tylenol, will do, as long as you don’t have liver problems or drink lots of alcohol. Anti-inflammatory drugs, ibuprofens like Advil, can help with joint pain, but they’re riskier because of the damage they can cause to the stomach and kidneys.

“If you take too much of them, they can burn a hole or ulcer in your stomach,” she said. All drugs, including those over the counter, can be dangerous if overused, she said.

There are also medications that can be used to treat autoimmune disease, and thus reduce the associated pain, she said. Other drugs can modify nerve responses to reduce neuropathic pain. Most of those were designed as anti-seizure medications.

Gump said topical medications like lidocaine patches can be effective for joint pain, but insurance companies typically don’t cover them.

“For whatever reason, they’d like you to put things in your body rather than on it,” she said. “If your knee hurts, why take a pill that’s going to affect every part of you rather than put the topical on your knee and reduce risk of kidney and bleeding problems?”

Though opioids have been made out to be the villians of the addiction crisis — and to some extent, they are — the situation surrounding those drugs is more complex, she said. About 80 percent of those using opiods do so properly, she said, and it helps them cope with pain enough to get out to the gym and try to get stronger.

Tom Relihan can be reached at trelihan@recorder.com.

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