Living Beyond Pain During The Opioid Epidemic
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This week on Live in the Brain, we have a very serious topic that you've heard us report about all over Fox News and foxnews.com. It is something that is, if it hasn't impacted you or somebody that you know or love or your family, it sadly is probably only a matter of time. We're going to talk about opioid addiction, the crisis here in the U.S., and really, are there alternatives? How can we find hope in the midst of this for somebody you know is struggling or if you're struggling? And if you're living in chronic pain, and

And I spent a couple of years there myself. So I know that this is something that is very widespread. And we are very blessed today to have Dr. Linda Mental with us. She is a motivational speaker, blogger, radio host of her own show. She's the best-selling author of 20 books. And she's got a new one out. This is called Living Beyond Pain, a holistic approach to managing pain and get your life back.

So, Dr. Mitzel, welcome to Live in the Dream. Good to have you. It's so great. And I'm so glad you're paying attention to the problem of chronic pain because we do hear a lot about the opioid crisis, and it's very serious. But I don't know that people think a lot about the fact that there are 100 million people that are struggling with chronic pain and sort of the fallout of the good work we've done with more regulation with opioid prescriptions and helping patients.

physicians you know monitor their their prescriptions with patients and do a better job with that but then you've got all those patients who are now not on those medications and it's really difficult for people yeah that's a struggle because just because the medication is no longer available doesn't mean that your chronic pain that's right and you know i talk about this in my book i spent a couple of years in really excruciating pain i didn't have access to opioids but i have to say

If I'm being honest with myself, there certainly would have been moments when I was living in that kind of nightmare that I would have used whatever I had available to me because pain really, it takes over you, not just physically, but mentally at some points as well. I had a similar experience and I was prescribed opioids, but I can't tolerate them. So the first time I took one, it was worse than the actual pain I was having, but I

said the same thing. I said, if I could have tolerated those, I would have done anything to make that pain stop. And eventually, I had a surgical solution to it. But in the meantime, I really, really can empathize with people who have to live with this day and day out. And they have to figure out ways to turn down that volume. The key here, Shannon, is that

There are times when you can't eliminate pain. So really good pain management might not be that you can stop the pain altogether, but there are a lot of things that we can do to really turn down that volume on pain and really help the physiology of what happens when people become into a state of chronic pain. So there's a lot that can be done, and that's a hopeful message to people. Mm-hmm.

So tell us about that. I mean, does it depend on the person? Is everyone's physiology different? Is there sort of a checklist of what you should try to tackle, things that you can work through to say, "All right, what are some non-drug options for me?"

So I think it really helps at the beginning to understand what's the difference between acute pain and chronic pain. So acute pain heals pretty quickly. You have about maybe a three-month period. But then chronic pain is when it sustains beyond even what might have triggered that pain.

There's a big difference in what happens in the body physiologically, and some people are more predisposed to pain sensitivity just by their genetics. So there's a great researcher at the University of Michigan who talks about this and shows these charts and says, you know, you might be somebody who could have a lot of pain and you'd never feel much, or someone who would have a little pain and you would feel a lot. That's pain sensitivity. So there's a genetic predisposition.

Then if you have a lot of events in your childhood or you have a lot of pain experiences, you're more geared to feeling pain more sensitively than other people. What happens with chronic pain is that the central nervous system gets what we call sensitized. It becomes wound up.

so to speak. And then what happens in the brain, which is where we feel pain. So if we had no brain, we would never feel pain. So we really don't feel pain wherever we hurt ourselves or hit ourselves or whatever. The brain tells us. It's the brain. Okay. So brain, and that is really important in turning down the volume of pain because the

So many of the techniques we'll talk about are techniques that are mind and body. So the perception of pain is in the brain. So the goal of pain management really is to always improve functioning and to obviously rewire that nervous system and change that perception of pain in the brain. And that's what a lot of the mind-body treatments do. And that's what's good news because these are non-pharmacological approaches. Yeah, I can't remember.

Yeah.

the impulses that your brain would have or to help yourself in those situations. So what you're talking about is anticipation of pain and then fear usually gets in there too because you know what you're going to experience. Yeah, it's coming. Right. So it's interesting. The brain pays attention to the things you tell it are important. So I didn't know this in my experience and boy, I wish I would have known what I'm about to say because it would have helped me so much during that time. But one of the best things you can do is distract away from the pain. Okay.

And yet when we're in pain, what do we do? - That's all you can think about. - We think about it, we talk about it. I was walking around and I was saying how much I hurt. And then I was making all the conversations about that. That's exactly the opposite of what we begin in terms of changing the brain. You have to use distraction. And so as we look at things like hypnosis, which does work for some types of pain, hypnosis is really about selective attention in which you're distracting the brain to another place.

When you talk about biofeedback and you're using biofeedback, and that's a really good technique for certain types of chronic pain, you are watching a machine, you're hooked up to a number of sensors that show your physiology, your heart rate, your sweating, all those things. And you're watching that and you actually can work on changing your physiology by watching the machine and learning how to calm down your body. So that's a really good thing that you can do.

If you have negative emotions, if you're feeling angry or you're feeling fearful or you're feeling depressed, and there is a very high association of depression with chronic pain, if you treat those emotions and you learn how to really manage those emotions, you might have to treat depression with an antidepressant or you might need some other help.

Maybe some talk therapy along with that. But if you treat that depression, it really helps pain because pain and negative emotions share the same real estate in the brain. So when you work on one, it begins to help another. So I love this story. Let me kind of say this because it'll help with all the different things that you can do to really help your pain.

We all know about the Tour de France. It's been around for hundreds of years, maybe 100 plus. I don't know exactly. But for the first hundred years of that race, the British team never won, and they got really tired of losing. So they decided, okay, we're going to hire some high-powered coach. So they hired this coach who came from the business world, and he had this concept of what he called marginal gains.

And he said, what we're going to do is we're going to look at every aspect of this race. So what does it take to ride a bicycle and ride it really well? We're going to look at everything from the seat to the handles to the color of the bike. We're going to paint the walls in the room white so we can see if any dirt gets on anything and we can see if that matters. We're going to look at the clothing, every little thing. And he said, what we're going to do as we look at every one of those pieces is we're going to improve them 1%.

Each one, 1%. And when we get done with that, the cumulative effect will be that we'll win this race. He thought it might take five years. It took three years, and they've been consistently winning.

So that's the same concept when we're talking about all the different things I talk about in the book of what you can do to turn down that volume on pain. If you start working on several things, so if you work on the attention to pain, if you begin to work on your emotions, one of the biggest things that makes pain worse is catastrophizing and starting to think, I'll never get better. Changing your mind to more positive. Simple things.

Using gratitude in your day. Not waking up and saying, wow, I'm glad I'm in pain. But waking up and saying, you know, I've got some other parts of my life that are really positive. I'm going to force my brain to think on that. You're carving new neural pathways in the brain and you're literally rewiring your brain in a positive way.

Again, the book is Living Beyond Pain by Dr. Linda Mintel, and she is our guest today on Living the Bream as we talk about the really tough struggles of opioid addiction, of the crisis, you know, and of course all of that.

relates back to chronic pain and how you deal with it. I was looking today, something popped up from Oxford University, this study about cancer patients, and they had looked at them and how many of them, when they go through their treatments, they go through cancer. It's an emotional and physical fight for them. But this said that an average of

8.3% of cancer patients, even once they're through with their treatments, they are then have some level of dependency on opioids because it's what they've had to use to deal with the pain. Then you hate to think about somebody defeating and surviving cancer. And now they have a different battle that they're going to have to have.

But I would imagine for a lot of people, this is where it starts. You go through a very difficult physical illness, surgery, accident, whatever it is. These are not years ago, I guess, the stereotype where these are people who are out partying and looking for drugs. I mean, so many of these cases now, it appears such a huge percentage of them are from people who had a legitimate injury or some kind of

issue, they were not people who were looking to become dependent on anything, but that's sort of where many of them have ended up. Yeah, it's very sad. We've seen so many people overdosing with the opioid crisis with 19-year-olds who had their wisdom teeth taken out and were prescribed some pills. But I think it's important, especially with the cancer patients you mentioned, I think it's important for us to always remember that not everybody who's on an opioid is an addict.

So there is proper use of these medications. And the issue is it sort of got out of hand, and we were over-treating in so many times. But there are times when people really use these medications, and they can be effective. The problem is with any opioid, you develop tolerance.

And then you do have a withdrawal if you go off of it. You may not become addicted to it, but the problem with chronic pain is that over time, they're just not that effective, which is why people are looking for other things to do. So for those who would say, hey, listen, I have someone in my life that I think is struggling or they're listening to this and they're thinking I'm struggling. What's the first step?

sort of lifeline they can reach out for? I mean, obviously, your book is there. Is there a website? Or do you recommend counselors? I mean, where do you recommend the first step for them to go? It's hard, because I wanted to say generally, you know, pain management specialist, the co author of the book, Dr. James Cribs is a pain boarded specialist. So he knows and he uses the approach that a lot of people don't know about. He's a doctor of osteopathic medicine.

And they use something called osteopathic manipulative treatment. It's called OMT. A lot of people don't realize that a number of their chronic pain situations are based in their structural problems in their body. And if you don't change the structure, you're never really going to fix the pain. And so he does a lot of treatment with this OMT.

You have to make sure that when you're looking at a pain clinic that you're looking at board-certified physicians, that you have psychologists that really understand what chronic pain is all about. I think understanding that you've got this wound-up nervous system and this rewired brain, and so when somebody is trying to work with you, if they are using the right techniques, they're going to work.

So if they're using cognitive behavioral therapy or something called acceptance commitment therapy, those are evidence-based treatments for chronic pain. So you want to ask a pain provider, you know, what are the evidence-based treatments? Do you know, you know, tell me what you think they are. And you can go and look them up. You can look them up in the book and you can see because we only put in the evidence-based treatments. Okay.

But there's also just a lot of lifestyle things that people can start to do. They can do exercise. I know people are afraid to exercise when they're in pain. I had someone on a call-in show say, "I exercise and no matter what you tell me, I feel worse." Well, the research says that exercise doesn't worsen pain in any way. Now, you have to do it properly and under supervision maybe.

I kind of think the endorphins. I mean, I used to really struggle when I was younger with migraines. And until I got them under control, a lot of times for me to go for a run. If I wasn't in so much pain that I couldn't just get out the door and go for a run, but if I could, I did usually feel some physical relief afterwards. And I don't know if it's

The endorphins are just getting the circulation going. It's both. And then looking even at your diet, are you eating an anti-inflammatory diet because so much of pain is based on inflammation? If you use alcohol, it can be very dangerous with pain medications and the interaction effect. And it really just masks pain. It doesn't do much. And then you've got potential for another addiction, which you don't want. Smokers, interestingly enough, have more pain receptors in their body and feel pain more intensely. Huh.

So here's another good reason to stop smoking, right? We're going to get healthy on all fronts to tackle this. That's right. You also talk about a personal pain plan. Now, how does that work for somebody who's like, listen, I'm at the end of my rope. I want to tackle this head on. I'm willing to try something different. What does that entail?

So it's that concept of marginal gains. So what we're going to do is look at every aspect of your life and we're going to look at where can we tweak it, maybe 1%. Maybe we can get you up into a Pilates class or some kind of movement. Tai Chi is an evidence-based approach or yoga, a lot of people do for pain. So we can begin a little bit there. Maybe we can make a few of those lifestyle changes. Maybe we can start to work on the way you think so we can ramp down that catastrophizing in your mind

We can get rid of those negative beliefs of I'm never going to get better. I'm never going to get up. I'm not going to be able to ever be with my grandchild or whatever that belief is. Changing those beliefs. So we look at changing your beliefs, changing your thoughts to more positive thoughts, changing your emotions and trying to manage emotions and make them more positive, ramping down your stress.

That's really important. That is hard in 2019 for most folks. It is. It's managing it, though. And really the attitude. I love what Viktor Frankl, most people know who he is. He was a survivor of the Holocaust. And he said, you know, you can't do anything about the difficulty you find your life in, but you can choose your attitude accordingly.

And what we find is that when we have a more positive attitude or what we call a growth mindset where you're looking at the challenges in life and you're saying, okay, what can I learn from this? How can I grow from this? Now what can I do with this? Could I use this to help other people? Or can I use this to maybe put it to the side and try to serve in some way? Right.

So really interesting data on when you reach out and you do something for someone else, your pain gets better. And again, I think the brain is focusing away and it's focusing on something else. So the pain plan is to look at all these aspects. There's a chapter in the book where you go through and you look at all these aspects of your thinking, your emotions, your lifestyle, and then what are the evidence-based approaches that you could try?

When I was in that pain, horrible chronic pain, the same kind of experience you did, I did use acupuncture for a while. And it does work. It's an evidence-based approach. Yeah, I've used it too. But it didn't stick. And the reason it didn't stick. No pun intended. Yeah. If you're familiar with acupuncture. That's right.

It didn't last for me. And the reason was because we didn't get at the right root of the pain. So, again, don't give up. Don't be frustrated that you don't know, you know, that nothing is changing because, again, there's just so many aspects of your life that you can change, that you do have control over, that you can begin to rebuild. Yeah.

And you can get to a point where you're going to feel a whole lot better. Because when you're in the worst of it, it is hard to feel hopeful or to not catastrophize it, as you said, to feel like, well, this is the rest of my time that I have alive on this earth is going to be in this position and I'm never going to. What's the point of life? I mean, that's where I got was sort of why would I continue living like this? Because I'm in chronic pain all the time. And, you know, everybody's story is different. Finding the right doctor, the right counselor, the right therapist, whatever it is.

and finding the right therapies. Again, the book is Living Beyond Pain by Dr. Linda Mintel and Dr. James W. Cribs. And I think it will be very encouraging to people. And like you said, if the first thing that you try doesn't help, there are so many places that you can go. And something else you said really reminded me of a good friend of mine. I won't embarrass her because she's so humble. I won't use her name, but she's somebody who lives with chronic physical challenges all the time. She, to me, is one of the most beautiful people I know because like you said-

She doesn't let it stop her. She's so positive. Every time I see her, she's helping someone else. She's taking someone else into her home. You know, she's looking out for other people. She's very hospitable. She's hosting people. She's raising money for causes that she believes in. I mean, she really has a life that I admire.

I admire her so much. And when I see her, I don't see the physical things ever that she's dealing with. I just see her as one of the most beautiful people that I know inside and out. And so she's taken the challenge of there are times that we suffer and there are times we can't change that suffering, but we can improve the suffering by the attitude. And there is such power in the mind. That's a point I really want to make, that when you choose with your mind to

to say, "I'm going to look for other things that I could do to help people like she's doing. That I'm going to focus on others. I'm going to look where I can serve. I'm going to look at what could I do to maybe make my life a little bit better in different ways." Because there's always some small thing that you can do to shift it around. When your mind is focused in a positive direction despite the circumstances,

then you do feel better in life and you do have purpose. I think everybody has purpose in life. When you're someone who's struggled with pain, now you can talk to someone who's in pain and encourage them. The most important part of this is to stay hopeful. And it helps to have people around you that will lift you up as well and say, look, you can't do that, but you can do this. Okay, so it's a new normal for your life.

But, you know, we can still, there's so much you can still do and so much you can still contribute. And for people in pain, they might be working from their home instead of going somewhere because of that. Maybe you have a job where you can, you know, shut it down for a little bit and then pick it up again with an online job. So there's lots of ways to accommodate that.

work with it, but to have some goals that are still positive so you stay hopeful. Yeah, so life may look different than it was before, but it can still be a good life. I know that you and I also share, and I know for a lot of people in these situations too, they have some sort of faith tradition or some belief that's helpful in their life. And

I got to think, I mean, for me, when I was at my worst, that was my lifeline. What role does faith play or, you know, the sense of having a hope or of something bigger that there's maybe purpose in this whole thing? It plays a big role. And Dr. Koenig at Duke is one of the leading researchers in the area of how spirituality, religiosity, faith works.

really impacts health and there is a huge benefit in terms of what happens even in the brain. Even something like prayer changes the brain for the positive. There have been studies on this that show when you pray, your brain changes in a good way that really helps with pain.

One of the things that happens when you're in a lot of chronic pain is that you do reevaluate your life. You look at what are your priorities, what's positive about your life. You try to focus on that. It brings you into a deeper sort of walk, right?

with your faith and things get realigned in a good way. And that deep intimacy that you can get from that faith perspective by having that relationship with God can really make a difference in a person's life. It is the lifeline. I just taught a lecture in nephrology with people that were in end-stage renal disease. And one of the things that the patients were saying over and over, if I didn't have faith, if I didn't have God,

I probably would have committed suicide because it was so difficult for me. But that was the thing that bolstered me and kept me hopeful. And as long as I have breath...

there's probably something that I can do in this life that I still have purpose. That's really important to hold on to. I 100% get that conversation. Again, the book is, one more time, Living Beyond Pain, a holistic approach to manage pain and get your life back. There are so many good practical strategies and things that you can try. I hope that it will be an encouragement to people out there if they're dealing with this or someone they love. Thank you for taking the time to write it, doctor. Good to have you with us. It's been great to be here. Thanks for giving attention to chronic pain.

from the Fox News Podcast Network. Hey there, it's me, Kennedy. Make sure to check out my podcast, Kennedy Saves the World. It is five days a week, every week. Download and listen at foxnewspodcast.com or wherever you listen to your favorite podcast.