A new patient shows up in your office with chronic low-back pain and needs your help.
A new patient shows up in your office with chronic low-back pain and needs your help.Had that patient chosen a traditional allopathic physician and asked for opioid pain medication, they very well might have received a prescription; despite tighter prescribing guidelines and overdose deaths having decreased, the U.S. Centers for Disease Control and Prevention says nearly 60 opioid prescriptions per 100 Americans are still written every year.1 While opioid-related deaths have started to decline, a 2023 survey reveals that 32% of U.S. adults personally know someone who has died of an opioid overdose, and for almost 19% of respondents, that person was a family member or close friend.2 About 2.1 million U.S. adults remain addicted to these medications.3
As doctors of chiropractic, we’re truly able to keep more patients from traveling this difficult path — provided we can offer viable options for helping them live with less pain. That means not only looking at the root cause of their pain, but at two other critical but lesser-known factors: their dopamine levels and the stress in their lives.
Before we explore the holistic approach I recommend, let’s review the typical treat-pain-with-painkillers strategy from the body’s perspective.
Pain, opioids, dopamine and euphoria
To put it simply, opioid drugs block pain. They bind chemically to opioid receptors in nerve cells and prevent pain signals from reaching the brain while triggering a flood of dopamine. The overstimulation creates a euphoric effect, and the brain makes a connection between the substance and the “reward” of pleasurable feelings.
Dopamine is our body’s built-in feel-good reward system, naturally triggered by healthy touch, laughter, sunshine, estrogen, sex, turmeric and a multitude of other stimuli. Dopamine can also be inhibited; magnesium deficiency, just as one example, causes dopamine production to decrease.
Now, as much as our bodies might love that flood of dopamine, they also naturally crave balance. Over time, as dopamine remains elevated, the body compensates by slowing natural dopamine production. Now you need the opioid drug to achieve normal dopamine levels; you have created a dependency. Next stop, addiction!
Meanwhile, in the endocrine system
Opioids have side effects, such as drowsiness and depressed respiration, and they can often have unnoticed-until-it’s-a-problem effects on parts of the body that aren’t experiencing a pleasant waterfall of dopamine. Those effects can make it even easier to become addicted.
For example, opioids have been shown to disrupt hypothalamic‐pituitary‐adrenal (HPA) communication, which regulates the body’s stress reaction via the release of cortisol. When this feedback loop malfunctions, it could result in cortisol remaining elevated, which over time decreases immunity, raises your risk of developing certain diseases and can make you more vulnerable to addiction, as well as to relapsing back into addiction after trying to quit.
Why doesn’t everyone get addicted?
Opioids’ habit-forming potential is affected by many variables, including genetics. For one thing, there are two variants of dopamine receptor DRD2, which regulates how much dopamine our brains receive. About 30% of people only have one receptor variant, which allows less dopamine into the brain, making them more prone to addictive behavior.
To attack pain naturally, take aim at dopamine and stress
Dopamine levels can drop for several reasons, such as sleep deprivation, prolonged high levels of stress or a nutrient deficiency. The symptoms of low dopamine include slow or disorganized thinking, sleepiness, memory impairment, poor concentration, fatigue, anxiety or depression.
Low dopamine levels can also worsen the experience of pain; people suffering chronic pain suffer more when their dopamine falls.
The upside of this connection is that boosting dopamine is a viable way to start addressing pain. Exercise naturally releases dopamine, so going for a walk or doing another low-impact physical activity, such as yoga or stretching, is a good way to start boosting dopamine levels.
Massage therapy, acupuncture, meditation, many herbs and foods, and yes, chiropractic adjustments are also known elevators of dopamine.
As dopamine increases, stress naturally decreases; stress is another factor that contributes to the experience of pain. Anything that decreases stress has the potential to decrease pain.
Now add herbals
In addition to these methods for getting dopamine levels up and stress levels down, you can mitigate chronic pain with herbal remedies. I recommend these to patients looking for an alternative to painkilling medications:
Turmeric/curcumin: Compared to the opioid tramadol, it is equally effective against neuropathic pain but with less degeneration and high levels of regeneration in nerve tissue.
White willow bark is anti-inflammatory and a fever reducer, as well as an analgesic.
Valerian root, known as nature’s Valium, contains valerenic acid, which works similarly to drugs in the benzodiazepine family to relax muscles, reduce spasms and ease nerve pain.
Capsaicin, the hot substance in peppers, is good for neuropathic pain. Used in many warming topicals, it creates a pleasant burning sensation that distracts the brain from the sensation of pain.
Corydalis rhizome is the most effective natural pain reliever after opium itself. It is best used combined with frankincense or myrrh.
Some other medicinal herbs that can counteract neuropathic pain include black cumin, ginkgo, wormwood, bitter apple, saffron, silverberry, kratom, bitter melon, fennel flower, holy basil, gale of the wind, Indian madder and sage.
Final thoughts
By recommending viable, nondrug tools for dealing with patients’ pain, you improve the quality of life for the patients you serve and contribute to easing the burden opioid addiction places on the healthcare system.
CINDY M. HOWARD, DC, DABCI, DACBN, FIAMA, FICC, is a board-certified chiropractic internist and nutritionist in private practice and the owner of Innovative Health and Wellness Center in Orland Park, Ill., where she focuses on individualized care. She is the author of Positively Altered: Finding Happiness at the Bottom of a Chemo Bag and writes for Stopain Clinical. Learn more and contact her at DrCindySpeaks.com.
References
- Schnell M. The opioid crisis: Tragedy, treatments and trade-offs. [Policy brief.] February 2019. Stanford Institute for Economic Policy Research. https://siepr.stanford.edu/publications/policy-brief/opioid-crisis-tragedy-treatments-and-trade-offs#:~:text=According%20to%20the%20Centers%20for,resident%20to%20have%20a%20prescription. Accessed July 12, 2024.
- Kennedy-Hendricks A, et al. Experience of personal loss due to drug overdose among US adults. JAMA Health Forum. 2024;5(5):e241262. JAMA Network. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2819328. Accessed July 12, 2024.
- Chang HY, et al. Healthcare costs and utilization associated with high-risk prescription opioid use: A retrospective cohort study. BMC Med. 2018;16(1):69. PubMed. https://pubmed.ncbi.nlm.nih.gov/29764482/. Accessed July 12, 2024.
