Change Your Brain Every Day - What’s the Alternative to Opioid Medication? PT.2 - Dr. Wayne Jonas

Episode Date: February 14, 2018

For the first time in years, the human life expectancy recently went down instead of up. Many believe that the opioid crisis is to blame. In the second episode of a series with Dr. Wayne Jonas, Dr. Daniel Amen and Tana Amen discuss why removing opioid medications from the equation won’t necessarily solve the problem.

Welcome to the Brain Warriors Way podcast. I'm Dr. Daniel Amen. And I'm Tana Amen. Here we teach you how to win the fight for your brain to defeat anxiety, depression, memory loss, ADHD, and addictions. The Brain Warriors Way podcast is brought to you by Amen Clinics, where we've transformed lives for three decades using brain spec imaging to better target treatment and natural ways to heal the brain. For more information, visit amenclinics.com.

The Brain Warriors Way podcast is also brought to you by BrainMD, where we produce the highest quality nutraceutical products to support the health of your brain and body. For more information, visit brainmdhealth.com. Welcome to the Brain Warriors Way podcast. So we're back with Dr. Jonas. Such an important talk we're having. In our last episode, we talked about integrative medicine and how people heal. And we're back today, we're gonna talk about the opiate medication crisis and how people are abusing it and how to manage chronic pain.

Right. Which is a huge issue. Here at Amen Clinics, we did a big NFL study at a time when the NFL was having trouble with the truth and high levels of damage in their brains. But the possibility for recovery in many and a number of our patients were cognitively impaired because of their opiate use, because no one had really taken a holistic view to pain management. And so if you imagine

all the people with brain damage and then add on that chronic use of opiates, which does not make you smarter when you were telling the story about this guy in the last episode, who was having trouble getting off the floors floors is thinking for myself, I would do everything I could to stay away from opiates because I wouldn't want to be cognitively impaired, that that would hurt my life more than anything else. So talk to us about your experience and what's going on in America and some of the solutions you've thought about. Well, if anybody hasn't heard about the opioid crisis or the opioid emergency,

they just haven't been paying attention to the news. You know, the last two presidents have had commissions and each declared that there's a crisis here. And it is a problem. There's no question about it. 60,000 people died last year, over 60,000, from opioid overdoses. There is an estimated 12 million people

who are abusing opioids, often for chronic pain, that shouldn't be taking them and are getting damage from them. For the last two years, there's been a decline in the life expectancy of Americans for the first time in about 80 years, and the reason is the opioid epidemic. So there's no question that the opioid epidemic is a problem. But the solution that the medical side has taken, that these presidential commissions

have taken, is to restrict opioids, to simply take away the medications. And this is not going to solve the problem, because really, the opioid crisis is just the tip of a much more broad problem that you mentioned to here, that we have, which is a chronic pain mismanagement problem. I call it the not-so-opioid problem. And it's really about that we have not implemented non-drug, non-pharmacological approaches for the treatment of chronic pain. I didn't learn those in medical school, and I do not work in a system that has yet figured out how to make that available for everybody, despite the fact that all of the guidelines now say that you should use non-pharmacological

approaches for pain, first and foremost and continuously. The American College of Physicians, the FDA, the CDC have all said use non-drug approaches. Now patients have already been trying those things. They were called complementary and alternative medicine approaches, right? Acupuncture, yoga, nutrition, supplements, this type of thing, mind-body practices. But the healthcare profession, the medical profession, doesn't know how to put those together because they weren't trained in it, and they're not paid for, and they're not structured to deliver that.

So I'll give you an example. I had a patient. This was a military person, but she was a woman. Her name was Sally. She was on the way to the Pentagon to a big meeting. She managed a huge program on about five hours of sleep, and she ended up rear-ending another car. She had a car accident. She was taken to the emergency room. She had x-rays, put on non-steroidals, told to go to physical therapy, which she did once, started to feel a little bit better, and then went back to her job on five and four hours of sleep.

About three months later, she was picking up her suitcase to get on a plane and she heard a pop and she couldn't stand up and she had excruciating pain down her back. She called 911. She panicked. She said, I need to go to the emergency room. Something terrible has happened. She went in the emergency room, more x-rays, CT scans, etc. But now because she was already on medications and physical therapy, she was placed on opioids. She took the opioids and she said, I love this stuff. This is great. It relieved her pain rapidly. And so she kept taking them.

And then she began to go around and need more and more. And as you know, the more opioids you take, the more tolerance you develop that. So the more on higher levels that you need, and the less and less pain relief you get from it. So you get more of the side effects, less of the benefits if you start doing it chronically, but that's what happened to her. And she started what our healthcare profession tends to do with these people is that she gets on the merry-go-round of pills and procedures. She gets injections. She gets more physical therapy. She goes to the surgeon.

She gets electrical stimulation devices and this type of thing, and she continues with her opioids. Finally, she goes to a behavioral medicine person. They say, you're depressed. They put her on another medication. This is the platinum level health care right now. And this is the real reason why we have the opioid problem right now is because we do not provide the kind of underlying components that can help people heal from their chronic

pain that they can engage in themselves that are recommended now by all the major guidelines, the non-pharmacological approaches. So I really like something you said, because I think it's true, at least from my experience in not only working in the medical industry, but also some personal experience. Taking away the medication is not going to solve the problem. In fact, I think people who are desperate will turn to illegal sources. They'll turn to whatever way they can get out of pain. And that pain is often physical. Like you said, sometimes there's underlying other issues. As somebody who grew up with an uncle in my house who was a heroin addict, I know this to be true.

He was in the military and had pain, was hurt, and became a heroin addict. And as a result, I have chronic pain, chronic back pain. But because of my experiences as a child, there's no way I will take any kind of narcotic for that pain because I don't want to go down that road. As a nurse, seeing this in the clinics and seeing how awful it was, you know, I see how these people go down that road in my mind to hell, just getting off of them is hell. They will find a way to get what they need. And taking the medication away is not going to be the answer. So I really think that you're touching on something. We've got to do

better about figuring out what's happening with them, whether it's the chronic pain, whether it's the emotional pain, we've got to help them fix that pain from the inside out. In the next episode, we're going to talk about chronic pain and childhood trauma. So there could be other factors that set people up, that actually change their biology, that set them up to be more vulnerable to chronic pain. So when I was a medical student, I fell in love with hypnosis. I actually took a month elective at UCI, UC Irvine in hypnosis. And so when I went to Walter Reed as an intern, I was hypnotizing everybody. And we had one of the world's most famous or one of them, academic hypnotist, Hal Wayne. And he was my- I knew Hal Wayne very well, actually. And so we did a lot of it for chronic pain and found it to be very helpful.

And now what I know what I know, I mix that with omega-3 fatty acids, supplements like SAMe or 5-HTP if they get into loops of pain. And it can be so helpful to begin to wean people off opiates. You can't take them off and not replace it with something effective and helpful. But personally, I've found hypnosis to be incredibly valuable to help people with this. I think that's exactly right. I think both of you have made the point. And actually, this was the situation with Sally. She was doctor shopping because she needed more opioids.

And then finally, they said, well, we need to take you off. Why don't you go over to this addiction center and get off? She refused to do that. And then they said, well, we don't know what to do. Let's send you to Dr. Jonas and get this alternative stuff. She was taking supplements. She was taking supplements, but she wasn't taking them with a knowledge. She was trying to integrate them herself, and she wasn't talking to her doctors about them because they didn't ask. So when she came in to see me, the first thing she said is that, she says, Dr. Jonas, I'm not crazy and I'm not addicted, I'm in pain. She didn't want me to just throw more stuff at her or say that there was something mentally wrong with her. And so I began to ask her some of the integrative health questions that I do in the Hope Note and that type of thing to try to find out what she did in these areas. We learned about the supplements, but she wasn't doing them right.

And so the first thing we did is we said, well, let's make sure we're integrating these appropriately with your medications so that you don't get interactions and you begin to get some positive benefit from that and make sure they're high quality. She was just going out buying them willy-nilly and didn't know what she was doing. I asked her what she did besides medications to help her pain. And she said, well, heat and stretching help. So I bought a hot tub and I get in the hot tub in the morning for an hour and I stretch and stretch and stretch. And if I do that, I can kind of get through noon. Okay. So I said, well, what about what about yoga well I went out and I saw a yoga practitioner and they were going into pretzels this way in that way and I got hurt in other words she didn't integrate an appropriate integrative therapeutic

yoga practice into her own treatment and nobody had done that before with her made sure that they were part of the team. She didn't realize that her sleep and her stress were aggravating her chronic pain. They were upping the inflammation in her body, and then that was causing cortisol, and she had no stress management techniques or anything like that. And she didn't even realize that that was actually

one of the main contributors to her pain. So when we asked her those things, we actually then found out what kind of a team she needed in order to get better. She'd had a team before. It was the pain specialist, and it was the surgeon, and it was the pharmacologist, etc. The team we put together included the pharmacologist, but now with education around appropriate use of supplements, and we have a pharmacologist that knows that, so that's a great asset. It was a yoga practitioner who had therapeutic experience

and was trained in dealing with people with chronic pain, especially back pain. We had to get her family on board because she had to actually incorporate this in her life. So we brought in a behaviorist or a health coach to help her move this into her life, address the sleep and the stress problems with that. And she told me after her first visit with a therapeutic yoga practitioner, that her pain was down to two. It was the first time it

had been down below five and about five years. She wasn't cured because we had to support her. She went through the behavioral changes necessary to make that routine part of her life with the sleep, with the stress, and with therapeutic yoga. And in about three or four months, her pain was consistently down to two. And in about six months, she talked about going back to work again. That's integrative health, where they come together, the pharmacology, the supplements, the behavioral components, the nutritional aspect, and the evidence-based modalities like yoga, which has been demonstrated

to be very effective for back pain if properly done. And that's what an integrative model looks like. And it's the kind of healthcare model that we need. I love that. And there's one thing that I, maybe you can comment on this is I practice karate which for scoliosis and chronic back pain I've been told for the last 10 years that I need to quit um but it makes me happy and I think there's a component to maybe I need no it makes me really happy and there's I shouldn't laugh yeah I'm the one one of the ones that tell her you know with your spine you cannot hit things but I love it so. I can't even begin to tell you. So hitting things makes me really happy. So, but there is a component. Yeah. There's a component to being happy that makes you feel

good. How do you, you've hit on the key, a key aspect and you keep doing this. Okay. Over and over. And I'm really glad you do it. How do you organize all these things? How do you decide what I should do? Okay. You have to find out what matters to you. You have to know this is meaningful because now you're going to get motivated in those areas. And in my book, I describe that process. It's fine to look at all the different sort of modalities, non-pharmacological modalities, but then how do you actually decide where is your healing journey? And you do it by finding what's meaningful for you. And so the patient has to be in the driver's seat. So this is why I ask patients, not just what's the matter, but what matters to them. This will start you on a healing journey. They're in

the center of the component. But when you are actually happy, doesn't that in and of itself help healing? Yes. As long as you don't continue to damage. So I've modified it a bit, which makes me sad, but for me, the best... This is why you need guidance, right? Right. So for me, the worst day in... It's easy to be in the driver's seat. Right. The worst day in Kempo is better than the best day in yoga. It's just the way my brain works because I like the intensity. Maybe there's a fighting yoga. Yeah, maybe. But the point being that when you're happy, you feel better. We're going to have to stop because we're going to go and we're going to continue to talk about chronic pain and childhood

trauma. Stay with us. Thank you for listening to the Brain Warriors Way podcast. Go to iTunes and leave a review and you'll automatically be entered into a drawing to get a free signed copy of the Brain Warriors Way and the Brain Warriors Way cookbook we give away every month.