Pain remedies your surgeon might not know about.
After undergoing surgery or surviving an accident, it’s routine to receive a prescription for opioids (narcotics) – a class of drugs that includes painkillers like oxycodone (OxyContin®), oxycodone with acetaminophen (Percoset®), and hydrocodone (Vicodin®, Lortab®).
This is captured in a scene from the Hulu series Dopesick, in which a man is all but bullied into taking oxycodone as he’s waking up from surgery. (Watch the scene here.)
But didn’t he have any other options? Yes, yes he did. And so do you!
Unfortunately, your doctor might not know about other ways of managing pain, or might not be familiar with how to prescribe those other medicines. You may want to consider showing them this article and talking collaboratively about your care.
What’s so bad about conventional pain meds?
While opioids are effective at managing pain, they come with a slew of pesky side effects like drowsiness and constipation.
Narcotics are also quite addictive: Taking opioids for as little as five days can lead to drug dependency and addiction. In fact, 75% of heroin users in treatment state that their opioid addiction began with a legal prescription for narcotic painkillers.
People undergoing surgery – even minor, outpatient surgery and elective procedures – are therefore at increased risk of opioid dependency, and should avoid opioids altogether if they can.
Over-the-counter (OTC) pain medications are typically safer than opioids, but they also carry risks – especially if used on a regular basis long term. Ibuprofen can be hard on the kidneys. It can also cause a stomach ulcer, as can aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs).
Acetaminophen (also known as Paracetamol, and sold in the U.S. under the brand name Tylenol®,) is hard on the liver: Acetaminophen overuse is the #1 cause of acute liver injury and acute liver failure in the developed world – and the risk is higher in women.
The good news is that there are other ways to control pain besides these drugs.
Here are some of the approaches to pain that I often share with my patients:
Vitamin C has been shown in clinical trials to alleviate pain. That’s thanks to its anti-inflammatory, antioxidant, and opiate-receptor supporting activity.
Taking just 2 grams of vitamin C one hour before surgery has been shown to reduce the need for opioid pain meds post-op. [Similar results have been found in studies of intravenous (IV) vitamin C before surgery.]
Vitamin C is also useful in helping us heal after surgeries or injuries because it supports wound healing and collagen synthesis.
The mineral magnesium can also help alleviate pain by helping the muscles properly relax between contractions. This soothing effect occurs not only in the skeletal muscles (like the biceps and hamstrings), but also in the tiny muscles that line the arteries. This is why magnesium can also help lower blood pressure and improve heart health.
Magnesium also plays essential roles in nerve transmission and protects the nerves from getting irritated from too much stimulation (excitotoxicity). These effects aren’t just seen under the microscope, but also felt emotionally: many folks find that magnesium helps them feel calmer and less anxious. The mineral can also support healthy sleep.
Nervines are a class of botanical (herbal) medicines that support the nervous system in a genrally calming way. Nervine herbs can help relax muscles, ease anxiety, and support restful sleep. They can be taken in the form of teas (tisanes), tinctures, or capsules.
Gentler nervines include skullcap (Scutellaria), milky oats (Avena sativa), catnip (Nepeta), lander (Lavandula) and chamomile (Matricaria chamomilla).
Stronger nervines, or relaxants, include valerian (Valeriana), passionflower (Passiflora), and hops (Humulus).
Particularly hard-hitting nervines for reducing pain are known as anodynes, and include kava kava (Piper methysticum),* which is an ace-in-the-hole herbal muscle relaxant with almost drug-like calming and sedating effects; Jamaican Dogwood (Piscidia); and California poppy (Eschscholtizia).
Nervines are often combined together in lovely formulas sold in the health food store.
*Note: Kava has gotten some bad press over the suspicion that it may cause liver toxicity. The reports suggest that this idiosyncratic response is very, very rare, and doesn’t seem to occur at usual clinical doses. For more details, check out this monograph by Dr. Eric Yarnell.
(If you want to be shocked about a substance’s risk for liver damage, then look no further then acetaminophen – it’s the number one cause of acute liver failure in the developed world!)
Native to Southeast Asia, Mitragyna speciosa (also known as kratom), is a tree in the coffee family.
Kratom contains many alkaloids, including mitragynine and 7-hydroxymitragynine, partial agonists of the μ (mu) opioid receptor. This is the same receptor that opioids like oxycodone and heroin act on.
Kratom is a highly effective, plant-based alternative to harder-hitting pharmaceutical opioids.
It’s important to remember, however, that even natural opiate receptor agonists can be addictive, especially with regular use – so don’t take kratom for every little headache and bruise, limit the number of days in a row you use it, and do not drive a car or operate heavy machinery while under its effects.
Endo-cannabinoid proteins and receptors are found throughout the brain and nervous system of mammals. The ECS has many biological functions, including mood, memory, pain perception, and parts of the immune response. Unfortunately, the chronic use of opioid medications have been shown to deplete the ECS, thereby increasing pain perception and driving a vicious cycle of drug dependency.
Thankfully, cannabis may help offset the damage caused by opioids and rejuvenate the ECS, thereby reducing pain. (Note: for those who don’t like using cannabis, don’t despair: many other natural substances support the ECS! Stay tuned for my forthcoming article on this very topic.)
Of the many cannabinoids found in the cannabis plant, cannabidiol (CBD) is the most researched for its medicinal value. Unlike tetrahydrocannabinol (THC), CBD is non-psychoactive – meaning it doesn’t get you high. CBD is also legal to sell in the United States, so you can usually find it online even if you live in an area that doesn’t have cannabis dispensaries. CBD may be smoked, eaten, absorbed rectally or vaginally, and/or applied topically. It is generally safe to use.
While CBD has great effects on its own, it usually does a better job of relieving pain when it’s combined with a small amount of THC. (Here’s my favorite product line.) The interaction between CBD and THC’s phytocannabinoids and terpenes – also known as “the entourage effect” – makes a winning combination for pain relief (but might make you feel a little “stony” if you’re not used to it).
Applying cold to a painful area help numb the pain and reduce the heat and swelling associated with inflammation. Applying cold to a body part can also slow down bleeding, as it causes vasoconstriction (the narrowing of blood vessels). It’s no wonder, then, that the use of ice packs has been shown to reduce post-operative pain and narcotic use and to speed up recovery. A general rule of thumb for cold applications is to wrap ice packs in towels and apply them for no more than 20 minutes at a time.
Because water is an excellent conductor of temperature, submerging the affect body part in a bucket or bathtub of ice water may work even better than applying an ice pack. In fact, an entire branch of medicine known as hydrotherapy, or balneotherapy is dedicated to the application of hot and cold water to the body for healing purposes. In recent years this branch of medicine has been taken to the next level by a man by the name of Wim Hof.
There is no shortage of studies showing that acupuncture can help with pain. Acupuncture stimulates the body’s production of beta-endorphin, serotonin, and other substances that help us heal. In other words: acupuncture supports the body’s innate healing response.
Acupuncture has also been shown to reduce post-operative nausea and vomiting, as well as to reduce the need for pain medication after surgery.
While some folks fear the insertion of the acupuncture needles, people typically tolerate the treatment well and report feeling very relaxed during and after their sessions.
Ketamine is a versatile molecule with robust effects as an off-label treatment for pain associated with surgery, chronic pain, and cancer-related pain. Whether injected, sprayed up the nose, held under the tongue, dissolved rectally (or “boofed,” as the kids say these days), or applied topically, ketamine can help control pain without the need for opioid drugs.
It’s still addictive when used regularly, however – though not nearly as addictive as opioids – and is thus a controlled substance requiring a doctor’s prescription. Due to the drug’s sedative and dissociative effects, people should not drive or operate heavy machinery while on ketamine.
Unlike opioids, which cause depression over time, ketamine has shown great promise in recent decades as a treatment for depression, mood disorders, and even drug addictions. In fact, the FDA has approved a ketamine nasal spray (sold under the brand name Spravato®) for the treatment of depression.
Neuraltherapy & Neuralprolo
Neuraltherapy is a system of medicine that involves injecting small amounts of a local anesthetic (such as lidocaine or procaine) just under the skin over the area that hurts. (This is called a “subcutaneous injection” in medicine.) Neuralprolo is done much in the same way, only it’s 5% dextrose that is injected just under the skin.
In both cases, the substances work on the peripheral nerves to calm down their firing patterns, soothing them to send and receive fewer pain signals. This soothing, anti-inflammatory effect then reflexes back into the deeper nerves of the body, triggering a domino effect of less pain.
Even though the anesthetic wears off shortly after the injection, the benefits of a treatment typically last for about 5-7 days and can help with both acute and chronic pain. As an added bonus, these subcutaneous injections can also help with acute anxiety. (In fact, if I have a patient having a panic attack in my office and they aren’t afraid of needles, I’ll inject them 1 to 3 cc of procaine. It works like a charm!)
Although most conventional practitioners have never heard of neuraltherapy, it has been around for a while, helps with pain, and has relatively few risks or side effects. It’s even safe in pregnancy in most cases.
After surgery, many people want “Vicodin®, not herbal tea.” But pain is a way in which the body communicates, reminding us to take it easy as we recover. While a little medication can help us sleep and keep us from suffering as we heal, numbing our ability to feel pain entirely may tempt us to overexert ourselves, thus undermining the healing process. Sometimes, rest and patience are the best of medicines, and pain can guide us.
This article by an American woman who underwent surgery in Germany is a great comparison of how we think about and relate to pain in the West versus in other countries.
Although our bodies feel pain in response to physical stimuli (say, a broken bone), the perception and response to pain is largely mediated by the nervous system and brain. Several studies have demonstrated the power of meditation and other mindfulness practices to ease the nervous system, thereby reducing acute and chronic pain.
Meditation reduces stress hormone levels and eases inflammation, and thus can help alleviate pain. After all, a relaxed brain registers less pain than a stressed one.
Mindfulness practices can also support the release of endorphins, our body’s own natural pain relievers.
You have options!
Although opioids and NSAIDs are routinely recommended by conventional healthcare practitioners, they are by no means the only strategies we have for treating pain.
Although the ideas listed above are generally considered safe, it’s always a good idea to check with your healthcare provider before making any changes to your (or your child’s) treatment plan.
A shorter version of this article first appeared online at Reset.Me.
These references are all included as links within the article above.