Here’s an interesting piece from Mayo Clinic on an intensive therapy program for chronic pain patients, including those for whom opioids are no longer a viable solution. Perhaps they once were, but over time they’ve become the problem.

Mayo Pain Expert: Holistic Approach Helps Patients Ditch Opioids

Not surprisingly, it’s an approach geared to the psychological, social and emotional factors that strongly influence the experience of chronic pain. Probably the first question any addicted pain patient will ask a counselor is, “without opioids, what do I do for the pain?” It’s essentially the same query we get from those dependent on benzos when they confront the prospect of insomnia or anxiety. Or those coming off alcohol– “If I can’t drink, then what do I do for fun or relaxation? Besides, all my friends drink.”

What replaces chemicals for someone new to recovery? To put it bluntly, life. It feels as if a vacuum has been created that suddenly needs to be filled. But if someone tries to fill that vacuum with a single activity, taken to excess– it can lead to a whole new set of problems.

You’ve probably heard the old joke about the fellow who was all messed up on drugs. Then he found the Lord, and now he’s all messed up on the Lord. The same rule could be applied to long distance running, or intense exercise, or extreme diet, or weird herbal drinks and supplements. If a life in balance is the ideal, then a broader approach has a better shot at sustainability.

The Mayo program is built around a 3 week course that resembles the Day Hospital model from behavioral health. About half are opioid users, but all taper off opioids during the program. That’s because long-term opioid dependence is no longer seen as widely effective for chronic pain.

For some reason, the Mayo model costs $40,000. Based on experience, I’m guessing there’s quite a bit of margin built into this cost. It effectively eliminates the great majority of potential self-pay customers. That’s too bad, because those folks hurt, too. Still, it’s entirely possible that a good clinical team could offer comparable care at a more affordable cost. Here’s hoping someone takes up that challenge.

The article notes that 80% who enroll complete the three weeks, which is admirable, and that “many” former patients report abstinence from opioids on followup contact. That’s not rigorous science, but I imagine the program does produce a number of satisfied graduates or it wouldn’t have lasted forty years.

Despite these flaws, programs such as this, that address the wider nonmedical needs of opioid dependent pain patients, are exactly what we need more of, if we hope to change the system that gave us the current epidemic.