Tackling chronic pain without opioids is not an easy process, for veterans or others

  • Veterans listen as the House Veterans' Affairs Subcommittee on Oversight and Investigations holds a hearing Friday March 4, 2016 in Concord, N.H. The committee met to discuss pain management and best practices for prescribing opioids to veterans in order to prevent addiction.( AP Photo/Jim Cole) JIM COLE / AP

  • U.S. Rep. Annie Kuster, a Democrat, speaks as the House Veterans Affairs Subcommittee on Oversight and Investigations holds a hearing Friday in Concord. JIM COLE / AP

Monitor staff
Friday, March 04, 2016
Many veterans suffer from chronic pain resulting from their service to the country. Many veterans also face issues with overuse of opioids that help ease that pain.

Using nontraditional therapies to help solve the first problem without contributing to the second was one of the issues that came up Friday at an unusual congressional subcommittee hearing, held in a hangar at the New Hampshire National Guard facility in Concord.

“I think we’ve realized that the medications are much more dangerous than we used to think, but we know we can’t just leave patients hanging and say, ‘We’re not going to give you medications any more – good luck!’ ” said Dr. Julie Franklin of the White River Junction VA Medical Center, one of several participants in the two-hour session that featured both of the state’s U.S. representatives.

“The approach of the conventional medical community to things like acupuncture is really changing a lot,” Franklin said. “When I was in residency or medical school I did not receive training (on issues such as) when do you refer for acupuncture (or) when do you think of yoga. I’ve learned a lot recently; I was trained in acupuncture by the VA.”

Experience in alternatives to medication is one of the issues facing the Veterans Administration facility in White River Junction, Vt., which covers New Hampshire, and the VA Medical Center in Manchester, as they push to see when treatments like yoga, acupuncture, aquatic therapy and laser-based pain control can replace pharmaceuticals to control pain.

“Not many specialists are trained in alternative means such as acupuncture,” said Dr. Grigory Chernyak of the Manchester VA Medical Center. “The VA cannot even hire acupuncturists – they are being hired as health technicians with pretty low salary. . . . The situation has been improving, but it’s still not as good as we would like it to be.”

The two doctors spoke at a field hearing of the House Veterans Affairs Committee Oversight and Investigations Subcommittee, hosted by U.S. Reps. Annie Kuster and Frank Guinta.

The subcommittee is chaired by U.S. Rep. Mike Coffman of Colorado.

Titled “Addressing VA Opioid Prescriptions and Pain Management Practices,” it dealt with a wide range of issues. Among those speaking was New Hampshire Attorney General Joseph Foster, who reiterated his position that “we can’t arrest our way out of this situation”; Peter Kelleher, president of Harbor Homes of Nashua, which deals with homeless veterans; and Christine Webber, director of Substance Abuse Services for Easter Seals in New Hampshire.

Among the concerns was the clunkiness of the Prescription Drug Monitoring Program software used by health providers to keep track of painkiller prescriptions, as a way to flag patients who are “doctor-shopping” to get pain medication for nonmedical uses.

Foster noted that New Jersey has rolled out an app that allows providers to check the database and input their data via smart phones, and expressed hope that similar advances could come to New Hampshire.

But much of the discussion centered on the extent of the problem in terms of veterans – roughly half of those who use VA services have some sort of chronic pain – and the range of approaches that need to be taken for the population.

Kelleher discussed the success of a “housing first” model, in which homeless people with drug or alcohol issues are given a place to live without having to first get treatment, because lack of a stable place to live makes it considerably more difficult for people to tackle other problems in their life.

The consensus was that many different approaches will be needed to fight this issue.

“It’s hard to make a rule that will be effective all across the country,” Franklin said. “It has to be done on a case-by-case basis.”

(David Brooks can be reached at 369-3313, dbrooks
@cmonitor.com, or on Twitter @GraniteGeek.)

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