Thursday, March 31, 2016

Alternative to Drugs

While a lot of emphasis at the National Rx Drug Abuse & Heroin Summit in Atlanta, GA, this week was bringing awareness to the scope of the opioid epidemic and the cost in lives and money, there were several sessions that touched on alternatives to drugs, how difficult it is to exercise those alternatives, and how awareness needs to be brought to those alternatives - to doctors, payers, and recovery candidates.

Becky Curtis, founder of Take Courage Coaching and WorkCompCentral's Magna Comp Laude award winner for 2015, has written an open letter to help explain one alternative - pain coaching.

Here's her letter - feel free to copy, paste, distribute or cite to anyone that is of influence or trying to deal with opiate recovery:


Chronic pain has become a very costly and controversial subject these days. The Centers for Disease Control’s recommendation states, “The guideline is intended to ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function…”

After a devastating accident left me partially paralyzed and with burning nerve pain from the neck down, I studied everything I could find on the brain and pain. I trained as a health and wellness coach, then developed Take Courage Coaching™, a telephonic pain-management coaching program for those suffering with chronic pain.

Since 2008, Take Courage Coaching™ (TCC) has been a pioneer in designing, implementing, evaluating, and researching the most effective methodologies for coaching individuals, who live with chronic pain, to learn a self-management approach to their pain. This does not intend to exclude the use of opioids or other medications, but we have consistently found when individuals learn evidence-based strategies to manage their pain, they are able to retake control and live life again. 

In the last 7 years, we have helped 75% of our clients replace opioids with other modalities. The result has been a 54% return to work, increase in vitality and mobility, and reduction in fear avoidance and negative affect.

While speaking to a group of providers at a national pain conference, I shared the following quote: “There is no evidence chronic opioid therapy benefits most people… Unfortunately, opioids remain the de facto treatment for most workers with chronic pain.” [1] When I ask physicians in my audience why this is, their responses are consistent: “it’s easy,” “it’s paid for,” and “it’s what is expected.” 

Pain-management coaching is not easy, it is not paid for and it is not what is expected. But it works. So I am diligently striving to see that it is easily accessible to people with pain, it is paid for, and it is what is expected when people ask for solutions to chronic pain.

Most clients with complicated pain have already tried the “easy,” passive route. Most of us have had numerous surgeries, tried countless medications and a myriad of procedures. Once pain lingers, if we are going to have any success, we will need to put away the expectation that someone else will cure us, and actively engage in simple evidence-based modalities. 

At Take Courage Coaching™, we assess each client with the Non-VA Pain Outcome Questionnaire (POQ) when they start, at 6 months and one year. We have discovered it takes time for neuroplastic change [2] to occur. This is not the fast, easy route, but the changes are measurable and lasting. After measuring data for several years, we have found the best time-frame for coaching a client is one year.

Pain-management coaching is not paid for—yet. Because we have seen statistical significance in our results (in all 8 areas of the Pain Outcomes Questionnaire), this is disappointing. We are only able to be paid by Workers’ Compensation, and we have piloted the program in one VA pain clinic in Oklahoma with significant results. But many of those who really need tools to taper off opioids and get back to life are not able to afford the service out of pocket. Insurers cover doctor visits, ER visits, and medication for chronic pain, but not coaching that provides the patient with a lifetime of tools for self-managing pain—a service that costs less than the average annual direct healthcare costs for an individual with chronic pain. [3]

Pain-management coaching is not what is expected. We expect a pill, a surgery, a procedure to cure us. But what if, instead, providers were educated on this available tool?

As Dr. Sean Mackey testified before the U.S. Senate this month [4], one of his patients—a 73-year-old woman who suffers nerve pain and needs to take one opioid in morning and one at night to sleep—told him: “Please don’t let them take away the medication that’s helping me to function without giving me something else.” Pain-management coaching is that “something else.” Our clients often tell us, “I now have the tools I need to manage my pain. I’m ready to taper off my opioids and get back to my life.”

Let me tell you a story about a veteran who had been bedridden for years due to pain. He was isolated with little human interaction, subsisting on Twinkies, Mountain Dew and opioids 3x per day. Because TCC is a telephonic program, he was able to consistently attend his two coaching appointments each week without leaving his home. 

His coach asked him, “Are you willing to be released from the prison pain has put you in?” He was ready! He had a breakthrough when he realized he had the support and tools he needed to accomplish his goals. They just had to be small enough to not overwhelm him. After working with his coach for 7 months, he made the decision to start tapering off his opioids. He reported his pain was less using his pain management tools than it had been while on opioids. 

His focus is outward now instead of inward. He didn't think he could go on without opioids; he didn't think it was possible. This Veteran is making more plans for living life and is seeking to do more of the things he loves and has missed because of chronic pain. He continues to increase his exercise routine and states he is stronger and enjoying life. He credits accountability for his moving forward—having a coach for support and motivation.

Thank you for taking the time to read this letter. I would love to have a conversation with you about how we can make pain-management coaching a standard of care for everyone who is in chronic pain and particularly those attempting opioid recovery.


Rebecca Curtis, PCC

Take Courage Coaching™


1 Howe CQ, Sullivan MD. The Missing ‘P’ in Pain Management: Now the Current Opioid Epidemic Highlights the Need for Psychiatric Services in Chronic Pain Care. Gen Hosp Psychiatry. 2014 Jan-Feb; 36(1)99-104.

2 “Neuroplastic change” means actual structural changes to the brain when a repetitive process is re-learned. See Michael H. Moskowitz, MD & Marla DePolo Golden, DO. Neuroplastic Transformation: Your Brain on Pain. Neuroplastic Partners, LLC. 2013.

3 (2014).

4 See more at:

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