Facing Chronic Pain Without Drugs

CNN—July 14, 2011

For two years after a hip surgery that didn't work out as well as he'd hoped, pain shot down Jim Heckler's leg like electrical shocks. Several doctors, eager to help Heckler feel better, prescribed various narcotic painkillers.

"I was taking whatever they gave me," says Heckler, a 47-year-old businessman.

His doctors were fine with Heckler taking narcotics long-term, but Heckler wasn't. He sought out Dr. Vijay Vad, a sports medicine physiatrist at Hospital for Special Surgery in Manhattan, where Heckler lives, in hopes of finding a different approach.

Vad suggested Heckler get off the narcotics as soon as possible, lose weight, do back exercises, take up yoga, ride a bike, ice frequently and take fish oil, glucosamine and chondroitin supplements.

Heckler dropped from 240 to 208 pounds, did the exercises, took the supplements and while the pain has never gone away, he says it's now tolerable enough that he doesn't have to take painkillers.

Heckler's experience raises a question hotly debated among doctors: Should patients take narcotic painkillers long term? The answer has never been more important, as a new Institute of Medicine report says 116 million Americans adults have chronic pain, a number larger than many previous estimates.

A Percocet every day?

On the one side are doctors such as Vad who do everything they can to avoid opioid painkillers such as Percocet and OxyContin. He estimates that only 5% of his chronic pain patients take these pills daily.

"The majority of my patients come in with lots of narcotics, and I'm the clean-up guy," he says.

On the other side are doctors, many of them pain medicine specialists, who believe narcotics can be used safely on a long-term basis by patients with problems such as lower back pain.

Vad says he avoids narcotic painkillers for two major reasons.

First, they can be addictive. According to the new Institute of Medicine report, studies show about 3% of chronic pain patients who regularly take opioids develop abuse or addiction, and 12% develop "aberrant drug-related behavior."

His second reason is that the patients become desensitized to the drugs, so they need higher and higher doses to combat the same amount of pain. In time, he says the pills fail to truly mask the patient's pain.

This story originally appeared at CNN.com.