12 Personal Action Steps for Chronic Pain & Medication Management

Posted on Wednesday, August the 5th at 3:06am

By: Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II

First of all, I want to emphasize that the information that follows can be used by anyone who wants to avoid prescription medication abuse or addiction problems, not just those already in recovery. Nonetheless, during my work with people over the past 27, I have seen far too many relapse because of poor medication management plans.

If someone wants to avoid medication abuse or addiction they need a very specific type of primary treatment that addresses coexisting psychological disorders including addiction, as well as relapse prevention protocols that include effective medication management. This type of treatment has always been needed but not really addressed, which is why early in my career I started to develop the Addiction-Free Pain Management® System and since then have taught it to healthcare professionals throughout the United States and Canada.

The following chronic pain and medication management suggestions and tips address not only medication but other chronic pain interventions that are the result of many years of study, researching literature on outcome based treatment, and my own personal experience. Along with a friend and colleague, Sheila Thares, I originally published a pamphlet for people in recovery from any type of chemical dependency who are living with chronic pain or facing an invasive surgical procedure (medical or dental) that could entail the use of psychoactive medication.  Last year we updated the pamphlet and added it into the new Addiction-Free Pain Management ® Module Four: a Guide for Managing Pain Medication in Recovery.

An important part of developing an effective chronic pain management plan is to develop an understanding of what an effective plan looks like.  I believe it requires a three part approach: (1) A medication management plan which includes a medication management agreement; (2) A cognitive-behavioral treatment plan that addresses pain versus suffering by learning how to managing thoughts and feelings, as well as changing self-defeating behaviors and problematic social/family reactions; and (3) A nonpharmacological (non-medication) pain management plan which supports the development of safer ways to manage pain.

Guidelines for More Effective Chronic Pain Management

Directions: As you read each of the guidelines below please ask yourself how you would rate each of the following areas on a 0 to 10 scale. On this scale 0 means this is something I can’t see doing and I don’t think is important to have on my chronic pain management plan to 10 meaning this is something I can see is crucial and extremely important for my ongoing effective chronic pain management and I am willing to make it part of my plan.

1. When under stress or emotional crisis you need to postpone non-urgent dental work (except preventative or restorative) as well as elective surgical procedures requiring additional psychoactive (mood/mind altering) medications. When you need to be on medication, learn all you can about how to take it safely.
   
2. If you need to be on potentially addictive medication, have a significant other, or an appropriate support person, hold and dispense the medication.  Learn as much as you can about any medication you are prescribed and don’t be afraid to ask your prescriber (doctor) questions—be an informed consumer.
   
3. Consult with a trusted doctor or prescriber about using opiates and other mood/mind altering medications or even non-addictive medications such as anti-inflammatory or other over-the-counter analgesics—always be open for second opinions.
   
4. Explore ALL non mood altering chronic pain management medication and other modalities, including over the counter and prescriptions. Some people find the COX – 2 inhibitor non-steroidal anti-inflammatory medications such as Celebrex which does not impede platelets to be helpful. Some of the more common nonpharmacological interventions are acupuncture, chiropractic, physical therapy, massage therapy, and hydrotherapy. If you have neuropathic (nerve) pain, ask your doctor about either Cymbalta or Lyrica. In addition, identifying and managing uncomfortable emotions may decrease your pain significantly.
   
5. Be aware of your stress levels and have a stress management program already in place such as meditation, exercise, relaxation, music, plenty of rest, hydration, etc, and relaxation techniques specific to what works for you. If you lower your stress, you will usually lower your pain—or your perception of pain—as a result. When you experience a pain flare up your body’s automatic response often includes a reflexive tensing response.  This problem leads to your being unable to relax the locus of the pain problems, which leads to increased muscle tension in these areas.  You need to practice to consciously relax the affected muscles, enabling them to modulate your pain levels and bring the pain under your control without needing to increase your medication.
   
6. Take personal responsibility to augment your social support in order to decrease isolation.  Take extra precautions about who you share your chronic pain management recovery plan with – not everyone will be supportive of your choices and may even tend to shame you for your choices. Some people find it helpful to join chronic pain management support groups that are available in most communities.
   
7. The more you focus on your pain the more you actually intensify your experience of the pain.  You need to learn to shift and manipulate your focus of attention in a positive way, which will minimize your experience of the pain. This can be accomplished by changing how you think and feel about your pain.  You can then find pleasant activities or tasks to take your focus off of your pain. 
   
8. When you are experiencing intense uncomfortable emotions—especially about being in pain—your pain levels actually intensify.  Your emotions become like an amplifier circuit that increases the “volume” of your pain.  You need to practice specific methods of reducing this automatic process that occurs in the face of stressful triggers.  You also need to realize that you may not be able to eliminate these problematic emotional triggers but what you can learn are some different methods of reacting and managing your feelings.
   
9. Decline “helpful” offers to use someone else’s prescriptions. It is crucial to take only your medication as well as taking it exactly as prescribed. Part of an effective medication management plan is to have a system in place to make sure you take your medications at the right time and the right dose.  Some people find the plastic pill dispensing boxes you can get at most pharmacies to be quite helpful.
   
10. As depression is common for people with chronic pain, consider the possibility of taking appropriate antidepressants if needed. This involves getting a referral to an appropriate mental health professional. The research literature is clear that the best treatment for moderate to severe depression is a combination of appropriate antidepressant medication combined with cognitive behavioral therapy.
    
11. Understand the importance of proper exercise as a vital part of chronic pain management. Another problem is that many people experiencing pain flare ups become very sedentary, with strong avoidance tendencies for many types of activities.  The two primary reasons for this are the pain itself, and your own predictions regarding the negative impact of activity.  Therefore, it is crucial to return to more normal levels of activities and slowly increase your stamina for physical activities.  The primary goal here is to extinguish conditioned avoidance patterns. Implement a stretching program, slowly at first, then structure progressive walking at least once or twice a day if necessary to complete the designated distance. Increase the distance as you are able. Add strengthening exercises if cleared by your MD/NP/PT or other appropriate health care provider.
    
12. Explore your past beliefs and role models from childhood regarding pain and pain management. Look for healthy role models who are effectively managing their chronic pain management condition.  Take what you learned from looking at your history and develop an action plan for moving forward towards more effective chronic pain management.

To get the most out of this article, take time to develop your own personal chronic pain management plan that addresses the three components discussed above: (1) Medication Management Plan; (2) Psychological (thoughts/feelings) Management Plan; and (3) Nonpharmacological (non-medication) Management Plan. 

You can use any of the above 12 suggested steps as your starting point. To begin, personalize at least three action steps for each of the three areas.  This is one instance where more is definitely going to be better. Chronic pain management research is clear — people with the best treatment outcomes are active and knowledgeable participants.