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Just Saying No to Pain Meds

Image of a male doctor taking the pulse of a female patient.

Dr. Robert Friedman uses Chinese pulse diagnosis to determine deficiencies or excesses in a patient’s energy in order to guide acupuncture treatment. The technique is well over 2,000 years old.

By Tom Cramer, VA Staff Writer
Monday, November 17, 2014

Steve Jobs, the late co-founder of Apple Inc., once made the following observation: “Less is more and usually more effective.”

Increasingly, the Department of Veterans Affairs (VA) appears to be taking the same view when it comes to dispensing pain medications. At the Ralph H. Johnson VA Medical Center in Charleston, for example, a little less than three percent of the total patient population is on chronic opioid therapy. That’s five percent below the national percentage for patients receiving such drugs.

An opioid is a drug such as morphine or oxycodone. They ease pain, but they can also cause physical dependency.

The Right Reason

“Opioids have been around for 3,000 years,” said Dr. Robert Friedman, head of the medical center’s Pain Management Team. “They’ve been around that long for a reason. They work. But it’s important that we find the right dose, for the right patient, for the right reason. And that’s what our Pain Management Team here in Charleston does.

“We spend a lot of time learning about the patient,” he continued. “Because the fact is, there are a lot of Veterans who’ve been on opioid therapy for a long time who would do just as well, if not better, without opioids — or on a reduced dosage.”

During the last five years, Charleston’s Pain Management Team has helped more than 400 Veterans ease off their pain medications. “A big part of our success,” Friedman observed, “is getting patients involved in their own care, educating them about pain management and supporting them as they try alternative methods for dealing with chronic pain.

“There’s nothing magical about what we’re doing,” he added. “All we’re doing is taking the time to talk with our patients and learn about them.”

Twinkies and Milkshakes

The pain specialist said his team takes a holistic approach to treating each patient.

“Pain changes your brain,” he observed. “It captures territory associated with mood, emotional regulation and problem-solving. So we don’t just ask the patient how much pain they’re in. “We also ask them things like: ‘How are you sleeping? How is your mood? What is the quality of your life? How are you getting along with people around you? How much are you exercising? What are you eating?

‘What are you eating?’ That’s right. Diet and pain are interconnected. “Let’s face it,” Friedman said. “You’re not going to get rid of your pain by eating Twinkies and drinking milkshakes. You are what you eat.”

An Army Veteran, Friedman said he attacks his patients’ pain the same way he would attack an enemy on the battlefield with a team of highly trained professionals.

“We use an interdisciplinary team approach to pain management,” he explained. “This team includes the Veteran, doctors, nurse practitioners, pharmacists and mental health professionals, all working together. We establish a personalized health plan with each Veteran to minimize their use of chronic opioids, reduce their pain levels through alternative methods and improve their quality of life.”

Plan B

So if you’re in chronic pain and they’re easing you off opioids, what’s Plan B?  (It better be good.)

Friedman said his team’s holistic approach to pain management involves various complementary treatments and alternative therapies. “We use multiple tactics to take back your brain from the pain,” he said. “If we can, we prefer to use things like mindfulness meditation, yoga, herbals, fish oil, aromatherapy and acupuncture for Veteran patients living with chronic pain.”

“When Dr. Friedman puts those four needles in the top of my head, all the pain from my waist down is totally non-existent,” said 51-year-old Navy Veteran Steve Pulliam. “I can walk with no pain.  It all goes away. It’s amazing.”

Pulliam had been under the care of Friedman’s Pain Management Team due to a crushing injury to his right foot and an impact injury to his left knee — both sustained in separate incidents during his time in the Navy. Then came the cancer diagnosis in August 2013.

“They told me I had a large mass on my pancreas,” Pulliam said. “We tried some chemotherapy to shrink it, but it ended up spreading anyway. So we opted to discontinue chemo so I could have some quality of life with the time I have left. They tell me I have anywhere from six to 18 months.”

 You’re not feeling the pain, so you’re not thinking about it. It puts you square in the middle of calmness. 
— Steve Pulliam, pain patient at the Ralph H. Johnson VA Medical Center, Charleston, S.C.

The Sound of the Ocean

Pulliam said he looks forward to his weekly visits to the Charleston VA’s Pain Management Team.

“These treatments they’re giving me are making a huge difference in the quality of my life that’s not attainable by any other means,” he said. “It gives you a sense of well-being and eases your mental and physical tensions.  It’s amazing when they put the needles in … the gastrointestinal pain goes away, the orthopedic pain goes away.”

But acupuncture is just one of many tools in the Pain Team’s toolbox.

“They use body oils … lavender and rosemary,” Pulliam said. “They put that on your stomach. After a few minutes you can actually taste it. After a few more minutes, you start to feel the effects. The lavender calms the pain in your gut and the rosemary helps with your overall calmness. They also have soft music playing in the background, or something relaxing like the sound of rain falling, or the sound of the ocean.

“I know it all sounds like a bunch of mumbo-jumbo,” he added. “But it works.  I’m proof of that.”

Then there’s the heat lamp.

“They use an infrared lamp to heat up certain parts of my thoracic area,” said the Navy Veteran. “The heat penetrates your skin and reaches the organs inside, warming them up. So you’ve got the heat, the needles and the oils, all working together. You feel like you’re on vacation in the islands, lying on the beach, soaking in the sun. You’re not feeling the pain, so you’re not thinking about it. It puts you square in the middle of calmness. All your stress, all your worries go away. You’re free.”

But how long does the vacation in the islands last? The pain stays away for about a day-and-a-half, on average, Pulliam reported.

“If you can take away the hurt for just a little while, it makes all the difference in the world,” he said. “It gives you more strength, more power more endurance to keep going. It resets your hope meter.”

To learn more about pain management at the VA, visit