The Food and Drug Administration is working to address how the opioid epidemic response has affected chronic pain patients, who often can’t get relief.
SOMERVILLE — At just 19-years-old, Joseph Faro of Bridgewater was robbed of his lifelong dream in the blink of an eye.
He tries not to see it that way and, at 27 now, he is adjusting to life as a civilian, future accountant and fiancé.
It has been, and continues to be, a journey fraught with obstacles and pain. But Faro is nothing if not determined. It’s the trait that got him through difficult high school years, Marine Corps boot camp at Parris Island, and many months of surgeries and rehab after an IED explosion in Afghanistan in 2010. That grit also helped him kick an addiction to prescription painkillers that doctors in the Veterans Health Administration were all too eager to prescribe him.
In many ways, it’s understandable why doctors would dole out heavy-duty opioid painkillers to patients like Faro. The explosion shattered his skull, severed two arteries in his legs, punctured his right lung and nearly ripped off his left arm. Facilities like Bethesda Naval Hospital, where he woke up a week later, treat scores of wounded like Faro every day.
He looks back now and says of the VA health system, “It’s so big and so underemployed. That’s the only way to handle it. Treat, don’t diagnose.”
“Nobody told us to do pain management (a specialty which incorporates a variety of interventional treatments),” he said of his return to Camp Lejeune with his best friend, Tim Conner, from the same Marine unit who also was critically wounded just weeks after Faro. Instead, both were sent with an arsenal of prescriptions for painkillers and physical, occupational and speech therapy.
Both believed, naively in hindsight, that they would be able to return to active duty.
But as days turned into weeks back at Camp Lejeune, but not back with their unit, the two lance corporals began ignoring doctor’s appointments and physical therapy sessions to instead sit in their tiny room, doped up, playing video games or watching Netflix.
“You’re just not fully aware,” he said. “You’re a very distant version of yourself.”
It’s ironic that when they were injured, they were deployed to the town of Marjah in Afghanistan’s poppy belt in a push to oust the Taliban and diminish its control of the world’s illicit opium supply.
One day Faro and Conner looked at each other and decided enough was enough.
They made a pact to flush every pill down the toilet. They had more varieties than Faro can recall. “Percocet. Everything. You name it.”
Faro says they spent the next two weeks in agony, ‘puking our minds out.’ But with each other’s help, they remained resolute.
Faro credits the shared experience of combat, PTSD and survival they both endured – a relationship closer than any other friendship could be – with getting them through those agonizing weeks.
The sad reality in the aftermath, though, was the lasting pain. Faro has a metal plate where part of his skull used to be. Doctors did not expect him to walk again. When he proved them wrong and walked out of the Hunter Holmes McGuire VA Medical Center in Richmond, Va., he still would have miles to go.
It started with pain management, a combination of therapies to help him with nothing stronger than muscle relaxants. After his discharge, he returned home to New Jersey where a friend’s father, a chiropractor, adjusted him and he discovered newfound relief. When the friend moved, Faro asked the VA to find him a chiropractor. It took months for the paperwork to go through for the referral, but he finally was connected with Westfield chiropractor Antonio Pugliese for persistent hip, back and shoulder pain. “He really took the time to sit and listen, and he did a lot of testing and trials to see what was working,” said Faro.
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“It’s so debilitating when you have back pain,” he said, adding that back pain is the only thing that has tempted him to go back on painkillers. Instead he gets regular adjustments. For all his other pains, he has learned self-treatment through gym workouts, yoga two to three times a week and jiu-jitsu.
Dr. James Matthews, a Marlton chiropractor, said in the past three years his practice has shifted. Roughly 50 percent of his practice now is treating patients in recovery from opioids or “benzos,” which are benzodiazepines, such as Xanax. They come from all walks of life, from executives to the homeless, he said.
“It opened my eyes a lot. I didn’t have any experience (with opioid addiction),” he said. He gets an average of five new patients a week who are in recovery. “If you told me 10 years ago I’d be doing this, I wouldn’t have believed it.”
Matthews says he has a lot of success with these patients, namely by calming their nervous systems to help with the leg pain and sleeplessness most addicts suffer during withdrawal. The key, he said, is to help patients in the very beginning, when relapse is most common. “When you’re coming off benzos or opioids, you feel just awful during that detox period,” he said. “Chiropractic alleviates that pain.”
“Why was manual therapy not the first referral source? If we can fix that, we don’t have an epidemic,” said Matthews.
Matthews says he was most surprised to learn from his patients that many of them started taking prescription painkillers recreationally as teenagers, either after being prescribed opioids post-surgery or for sports injuries, or by experimenting with leftover pills their parents were prescribed.
“The importance of getting rid of those pills cannot be understated,” he said.
Furthermore, he cannot understand why non-drug treatments such as chiropractic or physical therapy are not the first line of defense in treating pain.
“It blows my mind that these kids are given Percocet.” said Matthews. “Why was manual therapy not the first referral source? If we can fix that, we don’t have an epidemic.”
“Send them to physical therapy – I don’t care – but something has to change,” he said, adding that he first discovered the benefits of chiropractic when he was a strong safety for the Cherokee High School football team. “I went to get through football.”
Penny Skounakis, 68, feels the same way about opioids, especially when she hears about 15-year-old addicts. The Franklin retiree believes chiropractic could have kept her from becoming addicted to prescription painkillers after a bad fall in the kitchen where she worked 25 years ago. She credits it with saving her life, said her son Dr. Andreas Skounakis, who was a chiropractic student at the University of Bridgeport during his mother’s addiction. He translates for his mother, who speaks in her native Greek.
Skounakis underwent two back surgeries and a myriad of prescription pills to cope with her pain.
“I remember when I would come home from college, she would sit on the couch and not move, literally, she was so drugged,” he said. “If she didn’t have her meds, she would go into a panic, a cold sweat and be very agitated.”
One day, she simply decided she was through with the drugs. “Those six months were probably the hardest because of the pain,” her son said. She would go see a doctor and they would recommend the same cycle of ‘pain therapy,’” he said. Severe leg and back pain plagued her along with withdrawal symptoms. He worked on her when he was home, and she started seeing the late Dr. Vito Russo, a Clifton chiropractor, regularly. Her pain subsided drastically and today she rarely even takes an over-the-counter pain reliever.
More and more, pain management methods are being encouraged by lawmakers and medical advisory boards as first-line treatments before pharmaceuticals.
The National Association of Attorneys General called the opioid epidemic “the preeminent public health crisis of our time” and urged America’s Health Insurance Plans, a trade group, to take proactive steps to prioritize non-opioid pain management options over opioid prescriptions. The attorneys general called for insurers to encourage doctors to prescribe “effective non-opioid alternatives, ranging from non-opioid medications (such as NSAIDS) to physical therapy, acupuncture, massage and chiropractic care.” The American College of Physicians (A.C.P.) published new clinical guidelines with the same advice in late 2016, citing evidence of benefits of those same conservative therapies.
According to a National Institutes of Health study, it is estimated that more than 100 million people suffer from chronic pain in this country, and for 38 million of those looking for relief from persistent, moderate-to-severe non-cancer pain, back pain is the issue. A recently published article in The Lancet medical journal said that more than half the total number of people taking opioids long term have low back pain.
Meanwhile, lawmakers wring their hands about what to do and continue to pump millions of dollars into treatment programs and the overdose antidote naloxone (NARCAN).
“What happens when you take those pain pills is you get addicted. You go to heroin. I’ve seen plenty of it in my job,” said retired Englewood police officer Tim Reilly. He suffered three bad lower discs and a pinched nerve from sitting in the cruiser for eight hours a day. Twenty years ago, he started going to a chiropractor. “I have to go. That, or it’s surgery,” he said.
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On – 10 Jul, 2018 By Jane K. Martinez