Langevin warned that prescribing opiates for chronic pain could be dangerous. "They are useful when necessary, but there are better options for chronic backache, for instance."
It can be challenging to pay for these non-drug treatments, as most of them are not covered by health insurance, despite their effectiveness.
Langevin was preceded by Dr. Wayne Jonas, a family doctor, integrative expert, and former NCCIH director.
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Insurance covers a limited number of physical therapy sessions, but despite their evidence, other non-drug approaches are rarely covered. Medicare began covering acupuncture in 2020 for the first-ever treatment of lower back problems.
Jonas explained that a dozen acupuncture treatments or yoga classes cost more than generic pain medication, but a system is in place to supply the drugs.
Ben Kligler (executive director of the Office of Patient-Centered Care and Cultural Transformation at the Veterans Health Administration) said that because of these added costs, it is unknown if approaches such as the VA's Whole Health Program will save money. Recent studies on cost-savings were inconclusive, and more are being conducted.
Veterans who took part in Whole Health reduced their average opioid usage much faster and significantly more than veterans who did not. Whole Health participants with chronic back pain were 20-30% less likely to require invasive spine procedures like surgery or neurostimulation than veterans who didn't participate.
Kligler stated, "If people are happier, even if it doesn't mean saving money, then it is still the right thing."
Mountain pose
Mitchell, an Infirmity Memorial Services Chapel in Bluefield minister, had several steroid shots into his sciatica nerve.
It was a temporary fix. He said that it wasn't permanent. Gabapentin, a nerve blocker, also made a difference but not enough. He wanted something else. "I didn't wish to take pills."
His physical therapist recommended he try the Whole Health Program. He was given the option of taking yoga classes and sessions with chiropractors and acupuncturists.
Mitchell, the chaplain of Disabled American Veterans Chapter 31, avoided back surgery with yoga classes with Lydia Cox, acupuncture treatments with Dr. Alfred Russo, and sessions with a chiropractor. STEPHANIE KLEIN-DAVIS, FOR USA TODAY
He was able to reduce the swelling and improve his mobility with a chiropractor. He found some peace through acupuncture and reduced stress.
"Yoga is a truly blessed workout." "You do work out there," said Mitchell. He was a food service specialist for two years and spent the rest of his career at a desk.
The yoga teacher made sure that he didn't push himself too far. "Mountain position, down dog. "Those things may not seem to affect you, but if you repeat them repeatedly, you will see results," said he.
Mitchell, now a level 2 service officer and Chaplain for Disabled Veterans Chapter 31, entered a cycle of virtuousness where he found that the more he moved, the better it made him feel and the more things he did.
He learned to listen to the signals of his body. "Don't hurt yourself by doing anything. "Don't do anything that makes you uncomfortable," he said. Men try to be strong. "I don't even try to be strong anymore."
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Dr. Nancy Ann Cotter
We are trying to change people's minds about what causes health and disease. Your lifestyle is medicine.
Dr. Nancy Ann Cotter is the director of Whole Health for New Jersey. She said Mitchell's answer was exactly what they had hoped for.
Cotter stated, "We're trying to change people's minds about what causes health and disease."
Your lifestyle is your medicine.
Needles and mindfulness
Cotter, an acupuncturist, has said that she is amazed at the effectiveness of the so-called battlefield protocol, developed by an Air Force physician to be used on soldiers in the field. She said that five tiny needles placed in each ear for five days, with a five-minute administration, can change people's perception of pain.
She said that when veterans receive their first treatment of battlefield acupuncture, they cannot believe the difference in their pain. It changes their perception and their idea of what's possible for them.
Many studies have shown that acupuncture is effective for chronic pain. Dr. Jun Mao is a physician-acupuncturist at the Memorial Sloan Kettering Center in New York City. Its use in arthritis of the knee, chronic back pain in cancer survivors, and lower back pain has been supported by extensive clinical trials.
He said acupuncture produces clinically significant pain reduction in 50% to 2/3 of patients. This reduction can last for several months.
Many cancer patients or survivors in pain don't want or can't take any more medication. He said acupuncture could also help breast cancer patients with joint pain caused by aromatase inhibitors. This allows them to continue taking the life-saving drugs.
This series is about
USA TODAY interviewed more than 50 experts and people with chronic pain to better understand the pain problem in America. This reporting led to America in Pain - a five-part series that explores the realities of pain, the pain medications available, the non-drug alternatives, and the scientific advancements offering hope for the near future.
Mao stated that scientists are beginning to understand the workings of acupuncture. The needles in animals stimulate the release of natural pain-controlling hormones. He said that acupuncture can change brain activity in areas of the brain involved in learning and emotion regulation.
Yoga and tai-chi are complementary practices that have also been well-researched. A study of 300 cancer patients found that massage reduced pain. Hypnosis is also helpful for those undergoing painful procedures.
Sills stated, "I believe this is a tremendous progress." Sills said that 15 or 20 years ago, these therapies were not part of the daily experience of players or considered to be mainline treatments. Now, they are locker room staples.
While mindfulness can be harder to sell than massages, Cotter says it can have a transformative effect. It teaches people to be in a different way.
She said that it helps by encouraging people to divert their attention from the pain. "That changes people's sense of control over pain."
Personalized approach
Patricia Lafontant, a nurse from the operating room, would return home after a 12-hour work shift and be unable to relax because of her back pain.
Pain patches and creams only provided temporary relief. Her doctor prescribed muscle-relaxing drugs, which did help but made her sleepy. Lafontant explained that she would have to be sure not to work the following day after taking the medication.
Lafontant, from Port Washington in New York, was eager to participate in a clinical study testing the effectiveness of yoga, massage, or both. "I was excited to try something different than I had been doing."
CHRIS PEDOTA/USA TODAY NETWORK, NORTHJERSEY.COM
Studies show that exercise, physical therapy and yoga, meditation and massage, acupuncture, and other modalities, can help some people. However, these modalities will only work for some.
Langevin stated that each person must find out what works best for them. It's up to the person to heal themselves. She said that the treatment was just a way to help.
Lafontant was part of a study to see if individualizing treatment for pain would produce effective results.
All 57 of the volunteers were healthcare workers. They had two weeks to follow their everyday back pain management strategies by receiving in-home massages or yoga instruction at home twice a week. Then, the order was changed again, and the participants were asked to rate their pain and record the number of pain medications they had taken.
Karina DAVIDSON, the director of the Institute of Health System Science at Northwell Feinstein Institutes for Medical Research and the researcher who conducted the study, says that some people found the approach successful, while others had a negative experience.
Davidson says it takes time to determine the patterns of effectiveness by yourself. Perhaps your back hurt worse one week due to stress about your daughter, or maybe it was the Yoga class you took.
She said that rather than clumping everyone together to say "yoga is effective" or not, the study was designed to allow each participant to determine if it worked well for them.
Lafontant worked at North Shore University Hospital for the duration of the trial. She said that it helped her notice her back pain worsening after long days spent in the operating rooms, where she was moving equipment, positioning and lifting patients, and standing by the surgeon's side.
Making time for her spiritual, physical, and emotional health made a huge difference. Yoga and massage proved more effective than medications in helping her realize that her "crazy muscular spasms," caused by emotional stress, were not only physical.
She was so impressed by her improvement that she undertook two pieces of training: one in holistic nursing and another in nurse-health coaching. Now, she is entering a new phase in her career.
She said her participation in the trial had "forever altered my view of health and healing, both for myself and my patients." She examines her patients' physical, mental, emotional, and spiritual aspects and then helps them select integrative health methods less likely to have side effects.
"Personal and professional, it was a victory."
Pain in the US
Beyond medication
Jennifer Mokos, 39, of Champaign, Illinois, was skeptical about a recommendation from a sleep specialist to attend a pain center.
Mokos' downward spiral began eight years ago with a severe case of salmonella food poisoning. She was so sick that she spent days in bed with a bucket.
Her ankles then stopped working. She had trouble controlling her blood pressure, heart rate, and other autonomic functions. All day long, she slept well. But at night? Not so much.
She was hooked up to an automatic feeding pump, using a wheelchair, and taking 63 medications daily. Each one had its side effect. The nausea was far more problematic than the pain.
Jennifer Mokos, 39, of Champaign, Illinois, was skeptical when a specialist who treated her for sleep problems suggested she visit a pain clinic. AJ MAST, FOR USA TODAY
She was asked about her most significant goal on the first day at the Mayo Clinic's pain rehabilitation center. What would make her consider the program to be a success? Mokos aimed for the stars: she'd love to eat solid foods again for the first time in over seven years and walk out of her house without assistance.
Wesley Gilliam is the clinical director of the center. He explains that chronic pain has three primary dimensions.
Pain is a sensory experience that occurs somewhere in the body. It is perceived as an intensity.
Gilliam also said that pain is "a profoundly emotional experience." Chronic pain that is poorly managed strips people of "the things that make them unique... the experiences that give them joy." This is in itself depressing and anxiety-provoking.
He said the pain has a cognitive element, as people have to understand it. He said that if people have a constant loop in their heads of "this pain is killing my life," this will be part of their pain.
Mokos was monitored for her heart rate and blood pressure several times daily during the intensive 40-hour week in the pain center. Every day, she underwent intensive physical and occupational therapy sessions and pain psychology. Her opioids were gradually tapered.
