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February 15, 2017

Feeling better without medication

Medication may be right for you in the short term, but it doesn’t come without risks.

Research concludes that strong painkillers and medication often used to treat stress, anxiety and insomnia (benzodiazepines), generally shouldn’t be used for very long. This is because they:

  • Can be addictive1,2
  • Could lead to stomach and bowel problems including constipation, reduced sex drive and fertility, drowsiness, irritability, mood swings, depression, muscle tension, headaches, difficulty sleeping3,4,5
  • Can become less effective over time6

Benzodiazepines are recommended for no longer than 4 weeks1. Strong painkillers such as codeine, oxycodone and fentanyl generally shouldn’t be used for longer than 3 days in row7,8.

Better treatments

Studies have shown that there are more effective treatments than medication for chronic (persistent) pain, stress, anxiety and insomnia9,10,11.

You don’t have to wait until your medication is finished to start trying these treatments, you can speak with your doctor about using them right away1. Many of them take practice and you won’t necessarily feel the full benefit of them immediately. But they will help to treat the root cause of your problem instead of being a band-aid solution, so they are likely to help you feel better in the long term.

Counselling

Psychologists can use a range of techniques to help you get your stress and anxiety under control and help you sleep better. They can also help you manage pain.

Mind-body connection

It might seem strange at first to try and fix a problem that seems to be with your body by working with your mind. But research is showing how powerful the mind-body connection is, and how dramatically things like our thought patterns and expectations affect our actual experiences12,13,14.

Controlling your thoughts

One of the most important things you can do to get your pain, stress, anxiety and sleep problems under control, is to improve the way you’re thinking.

It’s natural for us to focus our thoughts on things that distress us, but when we become overwhelmed or worried, we need to think differently. Just like you can control your physical health by eating a well balanced diet and regularly exercising, you can control your mental health by learning how to regulate your thoughts15. Research has shown that the most effective treatment for improving mental health for people with medical problems including chronic (persistent) pain is cognitive behavioural therapy (CBT)16,6. CBT is provided by trained psychologists.

Where to get help

Ask your GP for a referral to a psychologist so you can claim your treatment on Medicare.

Find a psychologist near you

There are also free services available, for example:
MindSpot Clinic: telephone and online counselling
MoodGym: learn cognitive behavioural therapy skills online

Relaxation techniques

Relaxation techniques include breathing and relaxing the muscles16. They can help to relieve the symptoms of stress and anxiety, help you prepare for a better night’s sleep and help you manage pain better.

When you’re feeling stressed or anxious your body releases specific hormones that are part of our ‘fight or flight’ response13. Regularly using relaxation techniques helps reduce this by calming your body so it doesn’t trigger these hormones. This helps you think clearly and deal with the situation better.

Often pain or the worry about not being able to sleep causes stress and anxiety6, so relaxation techniques can help a variety of problems.

Where to get help

You can learn relaxation techniques by:
• Asking your GP
• Going to a psychologist
• Trying a local yoga, Tai Chi or mindfulness class
• Using one of the many online tools and apps, for example ReachOut Breathe

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Exercise and physical therapy

Getting active can lift your mood17 by flooding your body with feel-good chemicals (endorphins) and distract you from negative thoughts. You don’t have to become a bodybuilder, just getting out walking will help. Exercise not only helps you feel happier and calmer, it’s been also proven to help you sleep better17.

If pain is making exercise or even your day to day activities tough, seeing a physiotherapist could help you get going with a program that works for you. It’s important not to push yourself too hard, starting slowly and building up gradually is the way to go18. This will help you avoid setbacks and keep you in a positive frame of mind.

Where to get help

Ask your GP for a referral to a physiotherapist so you can claim your treatment on Medicare.

Find a physiotherapist

Healthy eating

What you eat has an enormous impact on your body and mind. Good nutrition gives your body the building blocks to make the ‘feel good’ chemicals for your brain, as well as those which regulate your mood and your energy levels.

Cutting down on some things (like processed foods, sugar and alcohol)19,20,21, while making sure you’re eating healthy foods (like lots of vegetables, fruit and wholegrains)21, can help your brain and body work together to keep you feeling your best22.

Trying different diets is often not the best way to get healthy. Eating regular, nutritious meals by following the food pyramid guidance is more likely to give you better results in the long term.

Where to get help

If you are struggling to eat well, ask your GP for some help or a referral to a dietitian.

Find a dietitian
Nutrition Australia

References
[1] The Royal Australian College of General Practitioners, “Prescribing drugs of dependence in general practice, Part B – Benzodiazepines,” The Royal Australian College of General Practitioners,, Melbourne, 2015.
[2] M. Y. Frei, S. Nielsen, D. M. D. H and C. L. Tobin, “Serious morbidity associated with misuse of over-the-counter codeine–ibuprofen analgesics: a series of 27 cases,” Med J Aust, vol. 193, no. 5, pp. 294-296, 2010.
[3] Alcohol and Drug Foundation, “Benzodiazepine facts,” 5 May 2016. [Online]. Available: http://www.druginfo.adf.org.au/drug-facts/benzodiazepines. [Accessed 7 February 2017].
[4] Alcohol and Drug Foundation, Misuse of Pharmaceutical Drugs: Fact Sheet, Alcohol and Drug Foundation, 2013.
[5] R. Nicholas, N. Lee and A. Roche, “Pharmaceutical drug misuse problems in Australia: Complex issues, balanced responses,” National Centre for Education and Training on Addiction (NCETA), Flinders University, Adelaide, 2011.
[6] D. Bartlett, “Managing insomnia: what we’ve learnt in the last 10 years,” InPsych, vol. 36, no. 2, 2014.
[7] NPS Medwise, Fact sheet – Safe prescribing and supply of opioid medicines, Surry Hills, 2016.
[8] N. Medicinewise, “Nurofen Plus Tablets (combination simple pain relievers) CMI,” 17 December 2012. [Online]. Available: http://www.nps.org.au/medicines/pain-relief/combination-simple-pain-relievers/ibuprofen-codeine-combination-simple-pain-relievers/nurofen-plus-tablets-combination-simple-pain-relievers. [Accessed 16 February 2017].
[9] Pain Australia, “National Pain Strategy: Pain management for all Australians,” National Pain Sumit Initiative, Sydney, 2010.
[10] eCentre Clinic, “Chronic Pain,” Macquarie University, 2015. [Online]. Available: https://ecentreclinic.org/?q=ChronicPain.
[11] NPS Medicinewise, “Benzodiazepine dependence: reduce the risk,” 08 July 2015. [Online]. Available: http://www.nps.org.au/publications/health-professional/health-news-evidence/2015/reduce-benzodiazepine-dependence-risk. [Accessed 29 July 2016].
[12] H. Fields, “Chapter 18- Pain modulation: expectation, opioid analgesia and virtual pain,” Progress in Brain Research, vol. 122, pp. 245-253, 2000.
[13] B. McEwen, “Protective and damanging effects of stress mediators: central role of the brain,” Dialogues in Clinical Neuroscience, vol. 8, no. 4, pp. 367-381, 2006.
[14] A. Ploghaus, L. Becerra, C. Borras and D. Borsook, “Neural circuitry underlying pain modulation: expectation, hypnosis, placebo,” Trends in Cognitive Sciences, vol. 7, no. 5, pp. 197-200, 2003.
[15] Better Health Channel, “Cognitive Behavioural Therapy,” September 2016. [Online]. Available: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cognitive-behaviour-therapy. [Accessed October 2016].
[16] S. G. Hofmann, A. Asnaani, I. J. J. Vonk, A. T. Sawyer and A. Fang, “The Efficacy of Cognitive Behavioral Therapy: A Review of Metaanalyses,” Cognitive Therapy Research, vol. 36, no. 5, p. 427–440, Oct 2012.
[17] Beyond Blue, “Staying well: a guide to recovering from anxiety and depression,” Beyond Blue.
[18] Better Health Channel, “Exercise programs,” State of Victoria, 2016. [Online]. Available: https://www.betterhealth.vic.gov.au/health/healthyliving/exercise-programs. [Accessed 16 February 2017].
[19] Better Health Channel, “Managing and treating anxiety,” 2016. [Online]. Available: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/anxiety-treatment-options.
[20] E. Selhub, “Nutritional psychiatry: Your brain on food,” 17 November 2015. [Online]. Available: http://www.health.harvard.edu/blog/nutritional-psychiatry-your-brain-on-food-201511168626. [Accessed 21 10 2016].
[21] J. Sarris, A. Logan, T. Akbaraly, G. Amminger, V. Balanza-Martinez, M. Freeman, J. Hibbeln, Y. Matsuoka, D. Mischoulon, T. Mizoue, A. Nanri, D. Nishi, D. Ramsey, J. Rucklidge, A. Sanchez-Villegas, A. Scholey, K.-P. Su and F. Jacka, “Nutritional medicine as mainstream in psychiatry,” The Lancet Psychiatry, vol. 2, no. 3, pp. 271-274, 2015.
[22] S. E. Lakhan and K. F. Vieira, “Nutritional therapies for mental disorders,” Nutrition Journal, vol. 7, no. 2, 21 January 2008.
[23] K. A. Jones, S. Nielsen, R. Bruno, M. Frei and L. D. I, “Benzodiazepines – Their role in aggression and why GPs should prescribe with caution.,” Aust Fam Physician, vol. 40, no. 11, pp. 862-5, November 2011.
[24] F. J. Penedo and J. R. Dahn, “Exercise and well-being: a review of mental and physical health benefits associated with physical activity.,” Curr Opin Psychiatry., vol. 18, no. 2, pp. 189-93, March 2005.
[25] M. M. Islam, K. M. Conigrave, C. A. Day, Y. Nguyen and P. S. Haber, “Twenty-year trends in benzodiazepine dispensing in the Australian population,” Internal Medicine Journal, vol. 44, no. 1, pp. 57-63, 2014.
[26] C. E. Griffin, A. M. Kaye, F. R. Bueno and A. D. Kaye, “Benzodiazepine Pharmacology and Central Nervous System-Mediated Effects,” The Ochsner Journal, vol. 13, no. 2, pp. 214-223, 2013.
[27] D. Cunnington, M. Junge and A. T. Fernando, “Insomnia: prevalence, consequences and effective treatment,” Medical Journal of Australia, vol. 199, no. 8, pp. 36-40, 2013.
[28] F. Keefe, “Cognitive behavioural therapy for managing pain,” The Clinical Psychologist, vol. 49, no. 3, pp. 4-5, 1996.
[29] I. R. Molton, C. Graham, B. L. Stoelb and M. P. Jensen, “Current psychological approaches to the management of chronic pain,” Current Opinion in Anaesthesiology, vol. 20, no. 5, pp. 485-489, 2007.
[30] J. Sarris, A. C. Logan, T. N. Akbaraly, G. P. Amminger, V. Balanzá-Martínez, M. P. Freeman, J. Hibbeln, Y. Matsuoka, D. Mischoulon, T. Mizoue, A. Nanri, D. Nishi, D. Ramsey, J. J. Rucklidge, A. Sanchez-Villegas, A. Scholey, K. P. Su, F. N. Jacka and I. S. f. N. P. Research, “Nutritional medicine as mainstream in psychiatry,” Lancet Psychiatry, vol. 2, no. 3, pp. 271-4, March 2015.