Opioid free: Pain ‘like a thousand bee stings’ now a manageable ‘nuisance’
FARGO — Excruciating back pain became Jim Sagissor’s constant companion. He walked stooped over. Driving his car on a road trip became unbearable. Worst of all, narcotic painkillers were taking over his life.
“To me, I was not addicted,” he said. “My family said I was addicted. They said you have to do something. They said you’re stoned.”
In fact, Sagissor had tried a variety of alternatives, including epidural injections. Nothing brought real relief.
“The pain would never go away,” he said. “Just an excruciating pain.”
The constant pain made Sagissor irritable and distant. “I wasn’t myself,” he said. “Didn’t really care about much.”
The pain stems from severe injuries Sagissor suffered in an accident in 2011 when he was riding his motorcycle around Lake Traverse, near his home in Wheaton, Minn. He sustained compression fractures of his vertebrae, a punctured lung, shattered collarbone, leg injuries and a brain hemorrhage.
Paramedics weren’t sure he would survive the ambulance ride to the hospital. He was transferred by helicopter ambulance to Sanford Medical Center, where he was in intensive care for six days. He was hospitalized for a month, followed by 18½ months of physical therapy.
Slowly, his body mended. But the pain never abated.
Sagissor, a former hardware store owner who still works part-time at age 68, endured the pain for six years, ultimately relying heavily on opioid painkillers, taking 12 or 16 pills a day “just to, let’s say, exist.”
He almost gave up hope. Then he decided to try a device called a spinal cord stimulator, which uses a pair of electrodes to deliver a weak electrical current to the spinal cord, preventing the pain signals from reaching his brain.
He was outfitted with a temporary spinal cord stimulator to test its effectiveness.
“I had instant relief,” he said. “I didn’t want to take it out.”
A few days later, a spinal cord stimulator was implanted during an outpatient procedure, and its battery delivers an imperceptible, pain-killing current around the clock. “I don’t even know it’s running,” Sagissor said.
The device was implanted in August 2017, providing the first real relief from chronic pain since Sagissor was severely injured in the May 2011 motorcycle accident.
Within days, Sagissor was opioid free and has been ever since.
He can adjust the device’s settings using a remote control. He charges the battery daily.
“You feel so much better,” he said. “I was skeptical about this implant.”
Now he’s a believer.***
Doctors are actively seeking alternatives to opioids to manage chronic pain. Studies suggest five of every 10 opioid addicts got hooked through a prescription.
Opioids, in fact, work best for acute pain of short duration — and new studies suggest over-the-counter pain relievers can be just as effective for some types of acute pain.
“We’re trying our best to find various alternatives to opioids to help patients manage pain,” said Dr. Rohit Mahajan, director of the Pain Management Clinic at Sanford Health, who implanted Sagissor’s spinal cord stimulator.
The spinal cord stimulator, he said, “is a really great tool for people that suffer with nerve pain.”
Back and leg pain, a condition called sciatica, shingles, diabetic neuropathy and multiple back injuries are forms of chronic pain that can be treated successfully with a spinal cord stimulator, he said.
The problem with narcotic painkillers is that patients develop a tolerance to them over time. Even at higher and higher doses, the drugs gradually become ineffective at controlling pain.
And some patients end up with an addiction.
Despite opioids’ reputation as powerful painkillers, a team of researchers at the Minneapolis Veteran Affairs Medical Center recently found that opioids worked no better than over-the-counter medications or other non-opioids at reducing problems with walking or sleeping — and they provided slightly less pain relief.
“It’s kind of a landmark,” Mahajan said of the VA study, which was published earlier this year. “It’s startling.”
In addition to a spinal cord stimulator, the device providing relief for Sagissor, pain specialists can implant morphine pumps inside the body.
“You can give much smaller doses than if you were to take the medication orally,” Mahajan said. The pump delivers the morphine to the spinal column, where the drug is needed, enabling the much smaller doses.
As a result, “We expose patients to a lot less of opioid medication,” Mahajan said. “There are many patients who might benefit from something like this.”***
A morphine pump, in fact, has given John Cunningham significant relief from pain he compared to “a thousand bee stings.” He suffered from years of chronic pain from a stab wound to the chest he suffered 18 years ago.
Then a football coach living in Houston, Cunningham, who now lives in Fargo, was jumped in a parking lot at night and stabbed in an attack that police said was a street-gang initiation. Doctors told him he was lucky to survive, but the wound caused a lot of nerve damage to his chest wall.
For the next 17 years, Cunningham took oral pain medications. He experienced firsthand the drugs’ diminishing effectiveness.
“Pretty soon your body builds an immunity, so you have to try something else,” he said. A year ago, his physician’s assistant told him that, with more restrictive prescribing guidelines for opioids, he would fall under pressure to wean off narcotic painkillers.
“They are going to cut your oral pain meds,” he said, recalling the warning he was given. Also, he was worried about liver and kidney damage that can result from long-term opioid use.
A psychologist screened Cunningham for his suitability for a morphine pump — Sagissor also was screened to qualify for a spinal cord stimulator — and passed.
“So I did it,” Cunningham said.
After the pump was implanted during an outpatient procedure, Cunningham experienced “very significant” alleviation of his pain. He goes in once every six months to refill the pump, a procedure he said takes 10 minutes.
“For me it’s been a godsend,” he said. “It’s fantastic. For me, it’s the best decision I’ve ever made.”
Pain remains a part of Cunningham’s daily life, but at much more bearable levels of intensity. “My pain level now is a four,” Cunningham said, referring to the 10-point wall chart in clinics that patients use to gauge their pain levels. “I can live with that.”
Before getting his pain pump, Cunningham’s pain level was six or seven on a “good day,” and eight on a “bad day,” with pain radiating from his left side. Without the morphine pump, he added, “on the entire left side of my body it’s like a thousand bee stings.”
Now, up to four times a day, if his pain is elevated, Cunningham can increase his medication dosage.
Mahajan, who implanted Cunningham’s morphine pump, told him that he’ll always have to cope with a certain level of pain. “But now it is truly manageable,” Cunningham said. “Now it’s more of a nuisance.”***
Other alternatives to narcotic painkillers include acupuncture, chiropractic care, injections of non-opioid drugs, massage therapy, physical therapy and over-the-counter pain remedies. Sometimes when all else fails, behavioral health counseling helps people cope with chronic pain.
Mahajan said he doesn’t hesitate to refer his pain patients to other specialities for treatment. He thinks of himself as a quarterback or coordinator, steering patients to what he thinks will work best for them.
Chronic pain causes people to withdraw and limit their activities. “Sometimes we get stuck in the pain and feel like we can’t do anything because of the pain,” Mahajan said.
Cognitive behavioral therapy and support groups help many suffering from chronic pain, he said.
“I see pretty much all types of pain,” said Desiree Zielke, a Sanford clinical psychologist. “Usually they get referred to me after they’ve tried everything else.”
Cognitive behavioral therapy focuses on getting people to change their behavior. Among other things, It trains people to increase their engagement with pleasurable activities and teaches relaxation strategies.
“Just adding in behaviors that are helpful,” Zielke said. The therapy teaches people to manage their thoughts. Patients are taught to think: “I can do this. I have to do it differently.”
“I call it re-framing thoughts to make them more powerful,” Zielke said.
Kara Richardson-Cline, a clinical psychologist at Essentia Health, uses cognitive behavioral therapy and biofeedback techniques to help her pain patients. Her patients come to her grieving “because you lose a lot — your job, your identity, your purpose.
Biofeedback helps patients better understand how their body is responding physiologically and how to achieve mastery over it, including how to relax.
“That gives them power over their condition,” Richardson-Cline said.
Pain patients who have been on narcotic painkillers for a long time also have to overcome anxiety when they are coming off the medication. “When that’s all the patient has, that’s a very anxious, anxiety-provoking prospect,” she said.
Over time, people with chronic pain suffer physical deterioration as a result: muscle loss, atrophy, changes in their nervous system. Earlier intervention with behavioral therapy can prevent some of that decline, Richardson-Cline said.
“The sooner we people, the better,” she said. “A lot of patients are fearful that they’re being dismissed” he referred to a behavioral health specialist for pain. “It’s quite the opposite. I see only patients with physical conditions.”