NIH Heal (addiction) Initiative to promote alternative therapies for post-surgical pain

[shak8]

Pain treatment at the NIH is under the rubric of addiction to opioids. Therefore, since alternative/integrative therapies are, according to them, shown to be helpful in alleviating some pain, surgeons at the Mayo clinic will be part of a pilot study in verbally suggesting alternative therapies in lieu of opioids post-surgery. It will be okay to do so in electronic medical records.

https://heal.nih.gov/news/stories/non-medication-pain-treatments-surgical-care

So little progress on new pain meds, alas. We have to resort to this...our tax dollars at work. I'd like to evaluate the efficacy of alternative therapies on moderate to severe pain, but I don't have the patience ATM.

 

[cassava7]

Although not for acute or post-surgical pain, NICE's evidence review of non-pharmacological therapies rated nearly all of them as low to very low quality (GRADE). Most studies of alternative therapies use subjective outcomes (pain measures) without objective ones and cannot be blinded, thus reported improvements are likely to be an artefact of poor methodology, at least when the effect size is found to be small or moderate. An important example is acupuncture.

It is indeed disappointing that the NIH have an institute dedicated to complementary and alternative medicine in the first place, and that it is pushing useless therapies onto patients in pain.

 

[Hutan]

That's terrible @shak8.

There's that story about Mao promoting traditional treatments* and traditional healers when China was not able to meet its people's demand for good healthcare. I'm not sure how much truth there is to the story, but that is what this sounds like. Health care system stretched, not enough doctors to go around? Might as well divert the people who can't be fixed easily and cheaply out to the wonders of alternative medicine. Might keep some of them happy for a while.

Of course some of the decision-makers signing off on this and some of the surgeons suggesting alternative therapies will really believe that they work, but I bet that a fair percentage of them will know that they don't.

*I'm not dismissing traditional knowledge in its entirety, not at all, but the story had Mao knowing that things like acupuncture didn't work, but promoting them anyway.

This is a great article I think:
https://slate.com/technology/2013/1...-mao-invented-it-but-didnt-believe-in-it.html

In case you missed it, Oct. 7–13 was designated Naturopathic Medicine Week, according to a Senate resolution sponsored by Sen. Barbara Mikulski and passed by the Senate with unanimous consent. Among the reasons the Senate cited:

• Naturopathic physicians can help address the shortage of primary care providers in the United States.
• The profession of naturopathic medicine is dedicated to providing health care to underserved populations.
• Naturopathic medicine provides consumers in the United States with more choice in health care.

Mikulski and the rest of the Senate may be surprised to learn that they were repeating 60-year-old justifications of Chinese medicine put forward by Chairman Mao. Unlike Mikulski, however, Mao was under no illusion that Chinese medicine—a key component of naturopathic education—actually worked. In The Private Life of Chairman Mao, Li Zhisui, one of Mao’s personal physicians, recounts a conversation they had on the subject. Trained as an M.D. in Western medicine, Li admitted to being baffled by ancient Chinese medical books, especially their theories relating to the five elements. It turns out his employer also found them implausible.

 

[Milo]

Later, if the patient goes to a physical therapist, the therapist might consider integrating massage into the care plan or suggesting that the patient use a cold pack at home, if the patient expressed interest in those options.

Good grief. Deep into alternative medicine, i see

What’s next, anesthesia under hypnotherapy?

 

[Hutan]

A cold pack isn't a full-on alternative therapy, of course.

When the Mayo Clinic enhanced EHR system is switched on and a patient who is scheduled to have surgery logs onto the site, he or she encounters a “conversation guide” about pain. The guide explains the likelihood of pain after surgery and the reasons for limiting opioids, and it offers several non-medicine options a patient can choose to add to his or her pain management plan.

The system offers options in three categories: movement (yoga, tai chi, and walking); physical (acupuncture, acupressure, massage, transcutaneous electrical nerve stimulation, and hot and cold therapy); and relaxation(progressive muscle relaxation, paced breathing, meditation, guided imagery, music listening, and aromatherapy). All these approaches do not involve medicine but have been shown by multiple research studies to reduce pain.

But, I don't believe those 'multiple research studies'. We've seen too many rubbish ones. If a cold pack really helps post-surgery pain, why wouldn't you tell everyone, rather than just the patients who look at the menu and think it's a good idea?

 

[Mithriel]

In orthopaedic trauma wards they use physiotherapy and movement to help bones and muscles heal. So that the patient can move the are given opioid painkillers. If they do not have adequate pain relief they cannot do the movement that will help them heal, have less infections and be out of hospital much quicker. Most patients do not want to take painkillers so they the benefits are explained to them.

There is very little risk of addiction to opioids if they are taken as prescribed. Possibly care would have to be taken if the patient was alcoholic or other problems.

The opioid epidemic was caused because of medical and social factors in the US but nowadays they include all deaths from heroin and fentanyl as part of the same problem wildly exaggerating the risk to someone being operated on for a hip replacement.

Someone taking oxycontin for pain, even if they have to increase the dose periodically is not in any more danger than anyone taking medication.

I suspect that people have gained from the idea.

The DEA is very powerful plus echoes of prohibition linger and like social workers with parents of children with ME who felt the were doing something against child abuse but in a very comfortable setting, stopping painkillers after an operation feels like you are doing something against drug addiction that is much more comfortable than going after Colombian drug dealers.

The media sense a story. The BBC had a piece about the dangers of pregabalin but when you read it it was about someone who was taken about 10 times the prescribed dose.

Then their are the alternative medicine practitioners and we know all about them.

Everybody wins except us.