In what may seem surprising for many, this pain management doctor offers opioids as little as possible, and never for his chronic pain patients.
Dr. Vwaire Orhurhu, a pain management doctor with UPMC Susquehanna, instead opts for a holistic approach, teaching his patients about other methods to deal with their pain through meditation, diet or exercise.
As the opioid epidemic continues to rage throughout Lycoming County and the rest of the country, the addiction often can start with easy access to prescription opioids. As patients become addicted and eventually lose access to the medication, they will turn to heroin or fentanyl.
On the PULSE recently interviewed Orhurhu about his methods for dealing with pain.
Q. How do you help people who just want a quick fix to deal with their pain?
A. If you’re in pain, you don’t want to live with it, you want to get rid of it. And I empathize with my patients who are in pain because I can never fully understand what they’re going through. So their desire for a quick fix, is real. And it’s very understandable.
But the quick fix comes from a lot of the interventional procedures we do. Which is to find a nerve that is responsible for pain and tell it to calm down. Not opiates. Because what happens with opioids. It goes all over your body including non painful areas, and you can’t really control the effect it has on your body. So when my patients come to me and they need opioids, if you haven’t had surgery recently. You don’t get opioids for me.
It is only in the case indicated, anytime between six to 12, or six to 10 weeks after surgery. Above 12 weeks, there’s higher risk of addiction, higher risk of getting to car accidents, and even higher risk of the opioid not working. Because opioid by itself causes pain. It’s called opioid induced hyperalgesia. So patients wonder sometimes, ‘I feel good.’ ‘But how’s the pain?’ ‘Still there.’
That’s opioids. So again, there are a lot of educational parts that patients are aware or not aware of and my job is to help them get through.
Q. Should opioids ever be used for chronic pain?
A. Opioid therapy works NOT for chronic pain. It is controversial in terms of the efficacy of opioid use for chronic pain. So when patients come up to me and they’ve had chronic pain, and are on opioids: I tell them, ‘I can help you, but not by refilling your opiate prescription. But by offering you everything else that you should have had instead of opioids.’
We just talked about some of them. We’ve talked about the exercise part, we’ve talked about postures, we’ve talked about sleep.
A lot of things that they can do that they probably were not aware of. We spent the time to learn together on how to maximize that. And you know what, like I said at the beginning of your body is smart. It knows what to do but sometimes it needs a little help.
And if it needs more help then you can come back to the clinic, and I’ll offer procedures. These are office based procedures, take three minutes, five minutes. And what we do is to help the body to regain function, back to the original things we just talked about that it can do.
If a patient who has opioids comes up to the clinic, it’s not a pleasant conversation because opioids do a lot of things to the body.
And I tell them, ‘That’s why you want more. So it’s not your fault. No no no no it’s not your fault that you want more. It’s not your fault that you know the opiate medications.’
But it’s partly what we have failed to do as providers, you know, so my answer is when they come to the clinic. And they asked for treatment under an opioid I offer them everything else but opiates, I offer them injections, I help modulate generics I tell them how they can optimize their sleep, or they can alter their diet, how they can retrain their brain to drive the pain down to almost minimal.
It takes time. My common quote is, ‘We’re driving together in a semi from Texas to Michigan at 20 miles an hour. It’s not going to be fun because I’ll be boring sometimes, but we’re going to get there.’
So it’s a journey for them, and some patients buy into it, some don’t. But I’m willing to work with them.
Q. What can people work on to prevent chronic pain?
A. I am a firm believer of nutrition: what you eat. And I tell my patients right away. I’m not your weight loss doctor I’m your pain doctor. There are certain kinds of diets that you eat that actually have anti-inflammatory properties, but a lot of patients won’t know about it.
So, when you ask about things to do: There are postures. There is your diet, food that you eat that can have anti-inflammatory properties to help with pain, and then there are also easy things like exercise. And I’m not talking dead lifting 500 pounds in the gym, just simple things like how you move your joints.
And then in addition to exercising. Simple things like meditation. Because I tell a lot of my patients pain is not just ‘You cut your hand and it hurts.’ There is a cerebral part of pain. In fact, the mechanism for pain is it’s going up to your brain and you say, ouch, and then your brain sends information down to reduce the ouchness. Really, that’s what I tell patients.
So part of what’s very powerful with things you can do before you come see a pain doctor is meditation. Tai Chi, yoga, because you know what you’re doing, indirectly: You’re stimulating and retraining your brain to reduce how much it hurts.
So I approach my patients by looking at multiple areas that hurt, multiple sources of pain, where they’re coming from. And give multiple holistic therapies to address it.