As communities across the nation grapple with an opioid epidemic, the Waianae Coast Comprehensive Health Center has opened a new pain management clinic that uses an integrated approach to reduce reliance on narcotic medications.
“We owe our patients much better than they’ve been getting,” said Dr. Winslow Engel, the pain management program’s clinical director. “They’re suffering not only from the pain, but also the treatments.”
Ho‘okūola Hale opened its doors last October and within six months was treating 350 patients with chronic pain. The clinicians employ a variety of strategies – traditional Hawaiian healing and other cultural practices that promote well-being, acupuncture to manage pain, counseling to develop coping skills and physical therapy and regular exercise to get people moving. Opioid medications may also be prescribed judiciously, at low doses that don’t cause impairment. “If we can use medication to move people two points down the pain scale, rather than obliterate the pain, we can then shift away from that and direct people to the things that really help them more,” Engel explained. “If you want your life to be better, it’s not going to be about the medications.”
The clinic also helps manage patients’ expectations about their participation in a pain management program. “It’s letting people know that we aren’t going to get rid of all their pain. It is more about managing their pain so they can return to some of their daily functioning prior to the pain,” explained program director Dr. Niki Wright. “A 30 percent reduction in pain is considered a huge success.” For some patients, that relief would allow them to return to work, for others it might mean they can walk to the mailbox or play with their children. A clinical treatment team works with individual patients weekly to help them set reasonable goals, as well as achieve them.
Wright noted some doctors across the nation and in our state are no longer willing to prescribe narcotic painkillers in light of the opioid crisis, however, cutting off medication abruptly can lead to other complications. “They go through this terrible physical withdrawal so they end up buying pills on the street, where they can graduate to heroin use. It’s a lot cheaper,” she said. At Ho‘okūola Hale, if prescriptions are needed, the philosophy is to “start low and go slow.”
For new patients, Engel said, “In general I’m going to bend over backward if someone has not yet started on opioids. That’s a set of shackles that no one really wants if they understand it completely.”
Cultural activities may also be part of the treatment – Hawaiian practices like lomilomi, lei making and hula may be employed, as well as healing practices from other cultures. Director of of Hā Ola Village Dr. Kyle Chang developed the health center’s cultural village with the oversight of their Elder’s Council to offer Hawaiian cultural practices to inspire patients to become empowered in their healing and well-being. The health center’s resident artist Sooriya Kumar will also have a role, incorporating meditation, arts and crafts such as copper-work, pottery and jewelry making, farming, cooking and other activities that engage patients in their own healing process.
A grant from HMSA provided the seed money to open the new clinic. “What gave us a lot of traction was the attention to the opioid epidemic,” Engel said. “Managing pain might save lives.”