What do turmeric, frankincense, white willow bark and red wine grape skins have in common? You might be surprised to learn that they are all naturopathic supplements that the state of Arizona’s Department of Health Services (ADHS) has considered for use with pain management issues associated with the current opioid crisis. “Arizona has been forward-moving in initiatives to reduce opioid use and other substance-use issues that came forward with the crisis,” said University of Arizona College of Nursing professor Angela Brown, DNP, FNP-BC, ANP-BC, CDE, who recently completed a presentation of evidence-based alternative therapies utilized for chronic pain titled, “Chronic Pain Management in Elders: Opioid Crisis Lessons.”
Like many states, Arizona has been hard-hit by the opioid epidemic, with drug overdoses of prescription and non-prescription drugs numbering in the thousands. What many people are unaware of is that the epidemic has also hit elder populations hard. With her practice scholarship, Dr. Brown is striving to delineate the connection between elder pain management, the downsides of traditional pain medications and the positive alternative of integrative therapies and non-pharmacological supplements.
“Arizona has been forward-moving in initiatives to reduce opioid use and other substance-use issues that came forward with the crisis." ~ Dr. Angela Brown
In her clinical practice, Dr. Brown witnessed elder patients who had dependence issues with opioids and suffered negative side effects. “It’s important that we give good care to everyone, but especially elders because they do require comprehensive care and sometimes they get lost in our current system,” she said. Seeking a better way, she launched quality improvement in clinical practice by focusing on elders suffering from osteoarthritis and how best to move away from pharmacological solutions to alternative medications and integrative therapies.
Elders are more likely to have arthritis, bone and joint disorders, cancer and other chronic disorders associated with pain, with osteoarthritis being the leading diagnosis associated with chronic pain in older patients. Between 25 and 50 percent of community elders have chronic pain, while between 45 and 80 percent in nursing homes suffer from pain. Downsides include co-occurring diseases or disorders, the simultaneous use of multiple drugs, declining physical and mental health and increased risk of negative drug reactions.
With the release of the 2018 Arizona Opioid Prescribing Guidelines, Arizona’s solution to these dangerous statistics has been proactive, with Dr. Brown being a primary player in the new rules. Along with UA College of Nursing professor S. Renee Gregg, she is one of two UA faculty who are part of a state task force with ADHS. Dr. Brown is working to change curriculum in the DNP program so that it includes more options than just opioids. “We came together as educators to look at how we’re educating the next generation of prescribers,” she said. That’s good news for proponents of integrative health, who have long argued that alternative therapies are safer, more cost-effective and more effective than traditional pharmacological options.
As a member of the 2017-2018 UA College of Nursing Integrative Nursing Faculty Fellowship, Dr. Brown has become intimately acquainted with the science and benefits of integrative therapies. Elders are significantly affected by the opioid crisis, she points out, suffering side effects like gastrointestinal bleeding, kidney issues, cardiovascular disease and the risk of overdose caused by medication interaction. While opioids like Percocet, Morphine and Methadone represent a clear and present danger, even medications like Tylenol, NSAIDs and antidepressants present health risks. The new guidelines aim to reduce overreliance on opioid therapy, making safety a priority in managing acute and chronic pain.
With her focus on osteoarthritis pain management, Dr. Brown’s presentation shows that the use of non-opioid medications and therapies as first-line treatment for mild and moderate acute pain can be a successful option. In recent years the American College of Rheumatology and the American Geriatric Society recommended such integrative therapies as Tai Chi, acupuncture and chiropractic care. Therapies such as massage, meditation, yoga and music therapy have also gained credence with researchers. Then there are the aforementioned supplements like frankincense, white willow bark and red wine grapes skins, all of which are proven remedies for arthritis, reflux, nausea and pain and inflammation.
There’s still much work that needs to be accomplished state-wide, but Dr. Brown is ensuring that awareness and training in the area of elder pain management moves forward in a progressive way. “There needs to be more dissemination in regards to integrative interventions, and there certainly needs to be more studies,” she says. “In the future, you’re definitely going to see much more information about these alternative therapies. We’re starting with our DNP students to make a difference in the realm of higher education.”