After decades of chronic pain, one of Dr. Phillip Weidner’s patients reported that she was finally able to pick berries again.
“She told me we had saved her marriage,” Weidner said. The pain that had been affecting his patient’s moods for years had resolved and she was feeling like her old self. “When people are able to return to a subsistence lifestyle, personally, that’s the best compliment we could get.”
Weidner runs the pain management clinic at the Alaska Native Medical Center. He doesn’t prescribe opioids -- ever. And he’s seeing results, without the potential adverse effects that can come along with powerful prescription drugs.
Weidner is part of a growing wave of medical practitioners who are abandoning prescription-based practices, instead focusing on more holistic healing. For Alaska Native patients, healing can also mean leading a more traditional lifestyle.
Born and raised in Anchorage, Weidner went out of state for medical school. He received a pain medicine fellowship from Oregon Health & Science University before returning to his hometown, where he wanted to start a pain clinic at ANMC. He secured an audience with the Alaska Native Tribal Health Consortium administration, and funding was allocated in the fall of 2013 to establish a pain management practice. The clinic saw its first patient on December 8 of that year.
From the beginning, Weidner knew he didn’t want to prescribe opioids. He was concerned in part with logistics, but he had a more personal reason as well.
“How would you want your mother or your loved one to be treated?” Weidner asked.
Opioids can be problematic, especially with long-term use, he said. Beyond the threat of addiction or overdose that has dominated recent news cycles, opioids suppress the immune system and can cause myriad side effects.
When Weidner was in medical school, he was taught “the sky's the limit” when it comes to prescribing opioids, he said. Now, that’s changing. Younger doctors entering the field are more cautious.
Changing times, changing treatment
The move away from opioids is part of a larger trend, doctors say.
“In general, the medical community is moving toward non-opioid-based and non-prescription-based treatment for pain,” said Dr. Anne Zink, chief medical officer for the State of Alaska.
Before going to work for the state, Zink helped implement major changes in the emergency room at Mat-Su Regional Medical Center, which she said decreased its opioid prescriptions by 80 percent between 2015 and 2018. Its multi-modal approach included using Alaska’s new system for sharing drug prescription information across hospitals and working side-by-side with patients to reframe the conversation around opioids.
Zink gives nearly all her patients a handout that explains that taking ibuprofen or acetaminophen -- both over-the-counter drugs -- is often more effective than taking oxycodone, an opioid.
At the ANMC pain clinic, the most common complaints are neck and back pain, and widespread generalized pain.
“We’re seeing patients that have had pain for 40 years,” Weidner said.
Weidner views pain like an onion -- start peeling away the layers to arrive at the center, or the cause of the pain, from which other symptoms resonate. Once he has made his diagnosis, Weidner will perform procedures such as freezing nerves, stimulating the spinal cord, or soft tissue work.
Additional treatment recommendations are provided to the patient’s primary care provider -- the person who knows the patient well and is best suited to help tackle pain management in a long-term, meaningful way, Weidner said. Those recommendations can include activities such as stretching, change in diet, behavioral health and decreasing inflammation.
Sometimes people may still need prescriptions, which Weidner does not prescribe but will recommend to the patient’s primary care provider as an additional option.
“The goal is for everyone to get the best result with the least amount (of prescription medication) possible,” Weidner said.
Holistic recommendations are more challenging for both the patient, who must invest in their care, and the provider, who must approach pain management differently, said Zink.
But the payoff can be huge: A pain-free life.
Adopting a traditional lifestyle: ‘Clinical berries’
Evidence is mounting that non-pharmacological treatments are a path to freedom from pain.
Listening to music has been shown to ease the pain of fibromyalgia. Medicaid may begin prescribing acupuncture instead of pills for back pain. And techniques like stretching, muscle manipulation and resistance can help ease cognitive dysfunction brought on by pain.
“Medicine can play an important role in it, but (as patients) we actually have a lot more power to control our pain,” Zink said.
Traditional lifestyles can help facilitate optimal health, said Dr. Tina Woods, senior director of community health services at Alaska Native Tribal Health Consortium.
“Our Alaska Native culture -- and when I use the term culture, we’re talking the language, the traditional foods, the traditional plants, the land, the relationship to each other -- all of those things, they work together,” Woods said. “They're not separate from one another. And they certainly address preventing chronic disease.”
Woods recently attended the 2019 Unangax Plant Symposium, during which she heard from Tribal members that they want more options -- including traditional medicine and plants, chiropractic, physical therapy, and acupuncture care -- in rural clinics.
During one session, an Elder asked why doctors don’t prescribe traditional foods before they turn to medication. Imagine, Woods said, if doctors prescribed “clinical berries” for low vitamin C levels, rather than a supplement in pill form? Not only do berries provide antioxidants and vitamin C, berry-picking itself is a form of exercise that also offers the opportunity for increased mindfulness and being present in nature.
“It’s not just about the plant,” Woods said. “It’s about being connected to the culture while promoting holistic health.”
Pain manifests on multiple levels, Weidner said -- psychological, emotional, spiritual and physical. By treating the whole person, patients can move toward a pain-free life.
This story was sponsored by Alaska Native Tribal Health Consortium, a statewide nonprofit Tribal health organization designed to meet the unique health needs of more than 175,000 Alaska Native and American Indian people living in Alaska.
This story was produced by the creative services department of the Anchorage Daily News in collaboration with Alaska Native Tribal Health Consortium. The ADN newsroom was not involved in its production.
CORRECTION: An earlier version of this sponsored story inaccurately stated that mailing opioids is illegal. Pharmacies are permitted to send prescription opioid medications via U.S. Mail.