An Opioid Alternative: Vanderbilt Doctor's Relief Retreats Give Pain Patients Their Lives Back
Becky Crawford didn't have a severe medical event, but chronic lower back pain could cripple her.
She would spend six days a week in bed, lying there for hours before summoning the courage to take the 10 steps to the bathroom.
The medication she took to ease her pain put her in a fog she no longer wanted to push through.
"You get to the point where you don’t want to live like that anymore — being attached to a pill," Crawford says. "There’s better ways, I think."
But, after using opioids in some form for nearly 15 years, she couldn't quit cold turkey. She needed help, a creative alternative to the norm.
Her doctor believed that, too.
Special report: The science of opioids
More: Why a Vanderbilt researcher is using virtual reality to fight opioids
Dr. Tracy Jackson is a pain management specialist at Vanderbilt developing alternative solutions to address Tennessee's opioid crisis.
The relief retreats that Jackson organizes may go against the most persistent approaches to pain — and most of the common practices of her day job — but she wants to help people move beyond the need for opioid-based medication.
"Our health care system really is just set up to help people fail to get better when it comes to chronic illness," Jackson says.
She held her first relief retreat a year ago, for a group of 12 in the secluded woods of West Tennessee.
The results were significant. Three-quarters of those patients have titrated off their opioids, she says. But Jackson, who funded the retreat almost entirely with her own money, faces bigger hurdles — getting the buy-in for nontraditional approaches to pain and getting insurance companies to pay for such treatments.
A jarring realization
Jackson established her career prescribing pain medication.
In her white coat and high heel tan boots, she walks the hallways at Vanderbilt University Medical Center assessing patients with arthritis, back issues, neck stiffness — any ailment that causes chronic discomfort.
She suggests opioid medication in some dosage for many of the patients she sees, but that's not the long-term solution she wants for them.
For many years she has been fascinated with the evolving field of pain.
More: If opioids aren’t the answer for treating chronic pain, what is?
When she took a job at Vanderbilt University as an associate professor of anesthesiology and pain medicine 10 years ago, she created and directed its pain fellowship and served as associate medical director of the outpatient pain clinics.
That's when she came to a jarring realization.
Despite her training and enthusiasm, many of her patients didn’t seem to get better.
Dr. Tracy Jackson checks on the movement in patient Frances Fowler's arm and shoulder at the Vanderbilt 100 Oaks Clinic in Nashville on Feb. 23, 2017. (Photo: Lacy Atkins / The Tennessean)
In fact, the epidemic that is the leading cause of accidental death in Tennessee and the United States isn’t an infectious disease — it is opioid overdose. And these opioids come mainly from doctors treating chronic pain.
The latest numbers from the Centers for Disease Control and Prevention show that opioids were involved in 42,249 deaths in 2016; deaths were five times higher than 1999.
More: Retired nurse couldn't save own daughter from opioids
Revelations like that have spurred Jackson's odyssey of research and education.
She has co-authored guidelines for responsible opioid prescribing in conjunction with the Tennessee Department of Health. She is on the board of directors of the Tennessee Pain Society. And she has lectured extensively nationally and internationally about chronic pain syndromes and alternatives to ineffective opioid-centric strategies.
But, she says, it still isn’t enough.
She believes there is a big-picture problem about chronic pain, and the current health care systems are not set up to address it. She wants to see medical professionals "engaging with patients more frequently on a human, one-on-one level."
So, her path has taken a detour to a rustic retreat to help figure it out.
'They were losing me'
At Gray Bear Lodge in Hohenwald, Tennessee, thick forest and natural springs garnish 150 acres of rolling hills primed for reflection and healing.
Here 12 chronic pain patients, some of whom Jackson had previously treated and others she had not, met for a two-week relief retreat last March.
Becky Crawford holds a pamphlet on a treatment relief program during an appointment with Dr. Tracy Jackson at the Vanderbilt 100 Oaks Clinic in Nashville on Feb. 23, 2017. (Photo: Lacy Atkins / The Tennessean)
The men and women ranged in age from 26 to 72. They had been suffering from chronic pain, on average, 15 years. Because of the daily discomfort many couldn't drive, or couldn't walk. The majority were on long-term pain medications.
All of them, no matter their background, shared one common sentiment — a drastic sense of isolation and shame. Crawford was among them.
More: Chronic pain sufferers feel stigma amid opioid crackdown
A 58-year-old grandmother, she started having back pain in her late 20s. As it evolved to arthritis and fibromyalgia, her primary care doctor prescribed hydrocodone. First, she took a pill once a day. Then every six hours. In 2009, she started wearing a Fentanyl patch. It kept everything "even keel," she says.
But she didn't improve. Instead, her quality of life declined. She stopped cooking for herself and her husband, eating only takeout. She didn't visit her daughter in California, frightened by the torturous discomfort of travel. And for the last three years, she cringed every time she simply needed to walk to the bathroom.
"My family felt like they were losing me," she says. "I just wanted to be able to live life again."
Becky Crawford listens to Dr. Tracy Jackson at the Vanderbilt 100 Oaks Clinic in Nashville on Feb. 23, 2017. Crawford attended a relief retreat that Jackson held in March. (Photo: Lacy Atkins / The Tennessean)
Crawford met Jackson through the Osher Center for Integrative Medicine at Vanderbilt.
Then she found her former self alongside the creek and among the log cabins at Jackson's secluded relief retreat.
'It's like there's a sabertooth tiger in your midst'
Days at the lodge began with a group session.
In a window-filled space, the retreat attendees sat together on the floor. A talking stone was passed around the circle as they all reflected on topics such as what they grieved or feared.
Conversations were meant to trigger physical pain through tough, emotional discussion.
One woman shared the worry that her kids would grow up never knowing the person she used to be. Another, the concern that she would not become a productive member of society. They expressed anxiety about being terrible romantic partners and fears about being judged for the prescriptions they took.
While each person spoke, three minutes at a time, the others were asked to gauge their physical reactions — quicker breathing, increased heart rate, tension in their bodies — and how that related to their pain levels.
Then Jackson explained the science behind it.
Dr. Tracy Jackson talks with her fellow doctors and internists at the Vanderbilt 100 Oaks Clinic in Nashville on Feb. 23, 2017. (Photo: Lacy Atkins / The Tennessean)
"When you feel shame and isolation, your ‘lizard brain,' as I call it — which is scanning your environment for safety — feels like you are not safe," Jackson says. "And it's like there’s a sabertooth tiger in your midst."
That stress activates a person's fight or flight system, which makes people anxious and causes tension and insomnia — and increased pain, she says. "Ultimately, the body crashes."
"But this does not mean they are broken," Jackson says. "It means they are resilient. It is exactly what their brain has been trained to do at times of great physical and psychological stress."
The relief retreats, she says, work to help retrain the body's reactions.
"It's not a quick fix, but when it is done — and it's done frequently in a support community with compassion and without stigma — the brain changes," Jackson says.
An impossible thing to do
In the afternoon at the relief retreats, the focus switches to movement therapy.
There is no Wi-Fi here, little cellphone reception. Retreat attendees stay in small rooms in the main lodge or tiny one-person cabins. They eat no red meat or processed food, and very little dairy.
And midday, they walk through the trees to a yoga studio, to be in nature.
There is massage, acupuncture, a warm water pool, reiki sessions using the Japanese healing energy technique, and instruction to prepare them for restful sleep.
The schedule repeats again and again over the two weeks at the retreat.
On some days, patients would wake up and rate their pain a nine on a scale of one to 10.
Had it happened at home, many would assume their day would be horrible and perhaps stay in bed. They would attempt not to move because they didn't want to hurt.
But they would reach for a prescription opioid.
Dr. Tracy Jackson talks with patient Johnson Sadler at the Vanderbilt 100 Oaks Clinic in Nashville on Feb. 23, 2017. (Photo: Lacy Atkins / The Tennessean)
At the relief retreat, they began to understand that pain can change throughout the day and that moving can help. Prescribed opioids are allowed here, but many attendees are prepared to detox as they try new, drug-free pain management techniques.
On the first day of the retreat, only two people walked the half mile up and down a hill through the woods to the yoga studio. The rest took provided shuttles.
By the sixth day, 10 of the 12 people walked it. And they couldn't believe it.
"It seemed like an impossible thing to do," Crawford says. "But I realized I have the strength within me to do this."
Alternatives and insurance
Insurance often influences whether and to what extent individuals can afford treatment services, according to The Sycamore Institute, a public policy research center in Tennessee. Even insured individuals can have trouble accessing needed treatment.
And, as opioid use reaches epidemic levels, types of pain treatment continue to evolve.
Dr. Tracy Jackson instructs doctor Sandy An on what medication to give to a patient at the Vanderbilt 100 Oaks Clinic in Nashville on Feb. 23, 2017. (Photo: Lacy Atkins / The Tennessean)
Americans spent $14.7 billion out of pocket for visits to complementary and integrative health practitioners such as chiropractors, acupuncturists and massage therapists in 2012, according to the National Center for Complementary and Integrated Health.
While more people have used these services over the last decade, most didn't have insurance coverage for them. Only 25 percent of adults seeing a practitioner for acupuncture and 15 percent using massage therapy had coverage for those approaches, according to the 2012 National Health Interview Survey.
Crawford paid $1,500 to attend the relief retreat, which she believes was significantly affordable. Just food and lodging alone for two weeks could cost that much, she says.
A pain physician, psychologist and physical therapist also donated their services at the retreat. And the cost included six months of weekly follow-up with one of those professionals.
Without the donated time — and Jackson's personal funding — the cost may have been $20,000 to $30,000 per person.
Although chronic pain is the No. 1 reason people see a doctor, Jackson says, and the top reason people are out of work, "our treatment outcomes are abysmal, and alternatives to opioids are not readily available or covered by insurance."
"So the cycle continues, with no end in sight."
Life in control of pain, not the power of pain pills
As Jackson expected, many of the patients' spouses and children were cautious when they arrived at the retreat for family sessions.
This is Tennessee, not California. "They would say, 'This sounds very hippie to me, are you brainwashing my family members?' " Jackson says.
But as progress continued, even when retreat attendees returned home, the approach proved itself to the patients.
One woman, who didn't have a driver's license because it was too painful to drive, took a trip to California. Another started applying to colleges and walked up and down sand dunes.
And Crawford worked with her doctors and retreat health coach to continue a detox plan and set new goals.
She made a promise to herself to cook a couple of meals a week. She began to walk a loop around her neighborhood, first twice a week, then three times, then two loops.
A lover of photography, she started taking photos again.
And one evening, she rolled down her car windows, turned up the radio and let the bass vibrate through her. She was feeling something other than hurt. She had forgotten how much she loved music.
"When you live in pain you lose yourself," she says. "To recognize that you can have some control and you can put it in its place and enjoy some of the things you enjoyed before ... it's like, wow, my senses are alive again."
Reach Jessica Bliss at email@example.com or 615-259-8253 and on Twitter @jlbliss.
Drug take-back day planned for April 28
Household prescriptions have long fueled Tennessee's opioid crisis, often serving as a supply source for longtime addicts who forage through relatives' homes looking for pain pills or for curious teenagers seeking to experiment.
The National Prescription Drug Take-Back Day aims to provide a safe way to dispose of prescription drugs and educate the public about the potential for medication abuse, particularly opioids.
The next take-back day is 10 a.m. to 2 p.m. April 28.
To find a collection site near you visit takebackday.dea.gov.
In October, Tennesseans dropped off more than 68,000 pounds of prescription drugs at collection points around the state operated by the federal Drug Enforcement Administration.
Tennessee's take-back total surpassed those in Kentucky, Michigan and Ohio combined.
Resources to help with substance abuse
The Tennessee REDLINE from the Tennessee Department of Mental Health and Substance Abuse Services offers information about resources and guidance about abuse for those who are dependent or a loved one.
For immediate help and information on treatment, call 800-889-9789. www.tn.gov/behavioral-health.