Addressing Pain, Sleep, and Opioid Misuse in Rural Michigan Through Health Education
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EmailThis video explores the connections between pain, sleep, and opioid misuse in rural Michigan communities.
Objectives:
- Introduce Michigan State University Extension.
- Identify key information about opioids.
- Explain the Substance Use Spectrum.
- Identify MiSUPER resources for opioid use and Harm Reduction.
- Explore the relationship between pain and sleep.
- Examine the role of health education.
- Explore Tai Chi for Arthritis and Fall Prevention, mindfulness, and the SLEEP program.
- Navigate health education program enrollment.
View upcoming sleep education classes on our SLEEP program events page. To learn more and sign up for other MSU Extension health programs, visit our website at www.extension.msu.edu/healthprograms.
This work is supported by the Rural Health and Safety Education program, project award no. 2024-46100-42884, from the U.S. Department of Agriculture’s National Institute of Food and Agriculture.
Video Transcript
[Music] In this video, we will be discussing opioid use, which may be distressing for some viewers. We ask that you please take care of yourself as needed. In 2023, Michigan experienced 2,931 deaths from drug overdoses, according to the CDC. Roughly 75% of these overdose deaths involved the use of opioids. Michiganders living in rural areas often face hardships that may increase the risk of using drugs, including poverty, stigma, unemployment, fewer harm reduction services, and health provider shortages, to name a few. According to data from a Health Resources and Service Administration report, nearly 2.7 million Michiganders live in a designated Health Professional Shortage Area for primary care providers, and nearly 3.7 million Michiganders live in a health professional shortage area for mental health care. 67 out of 83 counties in Michigan report primary care shortages for the entire county, including all but two of Michigan's rural counties. Opioid misuse, which can be defined as using opioids in any way other than prescribed, can disrupt sleep, worsen pain, and contribute to poor mental health outcomes. Michigan State University Extension is working to reduce known risk factors related to opioid misuse and increase behavioral protective factors among Michigan's rural adults. This work is supported by the USDA National Institute of Food and Agriculture. Let's begin by introducing who Michigan State University Extension is. MSU Extension is part of the National Cooperative Extension System that connects community members with expertise from professionals at land grant funded universities. MSU Extension helps people improve their lives by bringing the vast knowledge and resources of MSU directly to individuals, communities, and businesses. MSU Extension has been helping communities for over 100 years, since 1914. We have experts specializing in services across four institutes, including Agriculture and Agribusiness, Children and Youth, Community Food and Environment, and Health and Nutrition. Nearly 90,000 people participated in an MSU Extension Health and Nutrition program, either in person or online, in 2023. You can learn more about our work at www.extension.msu.edu. Next, let's discuss what opioids are and why someone may use opioids. Opioids are a classification of chemical compounds that activate our body's natural opioid receptors, which trigger the release of dopamine, the feel-good hormone, and blocks pain signals in the body. Our body naturally makes some types of opioids, including endorphins, which provide the runner's high sensation that some people experience during exercise. Opioids may be prescribed by a healthcare provider to treat pain symptoms. Some examples of prescription opioids include: oxycodone, also known as Oxycontin or Percocet; hydrocodone, also known as Vicodin, Lortab, Lorcet, or Norco; hydromorphone, also known as Dilaudid; meperidine, also known as Demerol, oxymorphone, also known as Opana and fentanyl, morphine, codeine, and tramadol. These opioids may be used legally when taken exactly as prescribed. If these medications are used without a prescription, in larger amounts, or more frequently than the prescription states, this behavior would fall under the category of opioid misuse. Some opioids, such as heroin, on the other hand, are always illicit or illegal to use. People may use opioids for many different reasons. Some of the most common reasons why people have reported using opioids include to relieve pain, feel good, and relieve tension. The Brain Opioid Theory of Social Attachment provides a theoretical framework for understanding why someone may use opioids to relieve social pain. Research findings have shown that using an opioid can increase feelings of social connection with others and withdrawal from opioids or blocking opioid receptors makes people feel more isolated and socially disconnected. Social isolation, in turn, is one of the major risk factors for relapse, which may explain why opioid use disorder is so difficult to overcome. We often hear from people living and working in recovery say, "The opposite of addiction isn't sobriety, it's connection." Different patterns of opioid use may be understood by considering the Substance Use Spectrum. This framework is helpful for understanding different patterns of substance use and how we can meet people where they are to discuss prevention and potential treatment options, if appropriate. The substance use spectrum can be divided into four different sections, beneficial use, casual or low-risk use, high-risk or harmful use, and chronic dependence or substance use disorder. Someone may use drugs for beneficial use, such as using a medication as prescribed by their doctor or for ceremonial purposes. They may engage in casual or low-risk use, like having an occasional drink. High-risk or harmful use refers to a pattern of using drugs that is risky, such as combining drugs, or potentially dangerous, like driving under the influence. And chronic dependence or substance use disorder refers to high-risk use that becomes compulsive, despite its negative consequences. Some important features of the Substance Use Spectrum to note are that people do not automatically move to the harmful side of the spectrum. Some people casually use substances for many years without developing a substance use disorder. People can be at different points on the spectrum for different substances, and there is risk at every point along the spectrum. There is also an opportunity to address and reduce risk of harmful consequences without necessarily reducing use. MSU Extension's Michigan Substance Use Prevention Education and Recovery Team, or MiSUPER, offers training opportunities and resources related to opioid use and harm reduction. To learn more about these topics and download our digital harm reduction guide, you can visit the MiSUPER website at www.extension.msu.edu/misuper. Let's hear more from an MSU Health Educator about the connections between pain, sleep, and opioid misuse and how MSU Extension's programs can help. Pain and sleep have a bi-directional relationship. Pain can disrupt sleep, and poor sleep can influence pain. Restorative sleep normalizes pain processing. Improving one can positively impact the other, which promotes overall health. Let's look at the mechanisms behind pain and sleep. Sleep deprivation affects the central nervous system, or the body's primary processing center, which leads to a decrease in the mechanisms that inhibit pain. These changes can result in heightened pain perception and decreased pain tolerance. Ultimately, when we do not sleep well, we can perceive more pain and tolerate less pain. This is because sleep deprivation impacts areas of the brain that are involved in pain processing. Sleep deprivation can lower the activation thresholds in these areas, which increases sensitivity to pain stimuli. It is important to pain management to sleep well. Let's look a little closer at pain and sleep. Chronic pain can disrupt sleep architecture, which can reduce deep sleep and increase wakefulness during the night. This prevents restorative processes that occur during deep sleep. This perpetuates the pain cycle. Anxiety and depression are common experiences with chronic pain. These conditions can worsen sleep disruptions and pain perception. The result is a complex situation that can benefit from a multifaceted approach. We can use self-management strategies to improve symptoms and daily life. Health education can support these strategies. Education and skill building have been shown to improve pain management. Some non-pharmacological, or non-medication-based, approaches to pain management include: using our minds in goal setting, problem solving, thinking activities, managing thoughts and emotions; using our bodies in physical activity; using techniques to improve sleep; and behaviors like our daily habits. To support these skills, Michigan State University Extension has two program bundles. The evidence-based Sleep Education for Everyone Program is offered with Tai Chi for Arthritis and Fall Prevention. The SLEEP program is also offered with our mindfulness program. Both Tai Chi and mindfulness have been found to be associated with pain management and pain reduction. You can participate in Tai Chi for Better SLEEP and/or Mindfulness for Better SLEEP. Tai Chi for Arthritis and Fall Prevention is an evidence-based program. It uses slow, gentle, and controlled movements to improve balance and health. It originated in ancient China and is an internal form of martial arts that embraces the mind and body. It is based on Sun style Tai Chi and was originally developed for Arthritis. Tai Chi is an effective exercise for health of the mind and body, including mindfulness, muscular strength, balance, and flexibility. Participants have shared that the program has significantly impacted their lives. All the movements can be done seated and with modifications. One participant shared, "The entire Tai Chi exercise workout has been so helpful for me in my health management. It helps me get started on motion that is reasonable and not painful. It has truly helped me with my balance and with coordination in my legs, which is so badly needed due to the polyneuropathy." Another participant shared, "I am a completely different person since starting this class. I am more steady, confident, calm, and know that I can do things again." Mindfulness includes directing attention to the present moment without judgment. There are many ways to practice mindfulness: mindful breathing, body-based practices, practices using the mind, and more. MSU Extension's mindfulness program explains the concepts and practices to help you experience the benefits of mindfulness. Sleep is incredibly important to our overall health and pain management. Many processes happen in the body during sleep, such as gene expression, muscle repair, and clearing out harmful waste products from the brain. This program introduces sleep basics, sleep hygiene, stimulus control therapy, mindfulness for sleep, physical activity, and sleep myths. Combined with Tai Chi or mindfulness, SLEEP provides tools to improve how we feel. The MSU Extension Mindfulness for Better Living webpage has mindfulness content and a Tai Chi warm-up video for you to explore. There's also extra content available on the Mindfulness for Better Living YouTube channel and Spotify podcast channel. Next, let's explore how to sign up for a program. You can visit Extension's homepage by going to www.extension.msu.edu. Here you can scroll down and click on the "Food & Health" button. This will take you to the Food & Health homepage, which has more information about our food and health programming. You can also sign up for our digest, which will be sent out as a quarterly newsletter. By navigating back to the top of the page, you can click on the Learn More/Refer To Our Programs button This will take you to our Health Programs page. You can also navigate to this page by typing in extension.msu.edu/healthprograms. This page provides a list of different classes and programs we offer, along with links to those program pages to find more information. Scrolling down, you can see the Health Program Referral Form. You can fill out this referral form for yourself, a family member or friend, or for a patient if you are a health care provider. You can provide contact information, and then check off boxes next to the programs you are interested in signing up for or learning more information about. You can also let us know how you found out about MSU Extension's health classes and submit the form. After you submit the form, a health educator will be in contact with you to let you know more about upcoming programs and how to register. You can also find more upcoming programs on our Virtual Health Programs Calendar. You can navigate to this page by typing in extension.msu.edu/virtualcalendar or clicking the button from the Health Programs page. You can also send an email to MSU Extension's Health Referral Team at ReferMSU@msu.edu. On the Virtual Health Programs Calendar, you can see a list of upcoming programs that are offered online or via telephone. Let's find a program to register for. Let's choose this Mindfulness for Better SLEEP program as an example. Here we can see how long the program runs, when the registration deadline is, and that it is being offered online via Zoom. We can review information about the program and note that this program has an orientation video to watch before the class begins. We can click the registration button right here to take us to the registration page. Next, we can click Register Online and fill out our registration information. After registering, an Educator will reach out to you, confirming your registration and providing you with Zoom links to join the class as well as any handouts. Thank you for watching and we hope to see you at a program soon. This work is supported by the Rural Health and Safety Education Program from the U.S. Department of Agriculture's National Institute of Food and Agriculture. [Music]
