America in Pain: Turning to Prescription Drugs—A Blessing or a Curse

Posted on Friday, December the 28th at 7:40pm

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

             In 1999 there were approximately 86 million Americans suffering from chronic pain.  In 2003 the number increased to over 117 million adults living with pain at least a level 4 on a 0 to 10 pain scale—about a 35% increase.  Surprisingly 18 to 34 year-olds were as likely to have a chronic pain condition as older Baby Boomers.  The overwhelming majority of these people believe that their pain will never go away.  We also know that at least 70 billion dollars is spent for pain relief in the United States each year.

While the vast majority of people with chronic pain may safely use pain medication, what may not be evident is that as many as 8.6 million to 11.7 million people taking prescription drugs also suffer from coexisting abuse or addiction problems.  Unfortunately, this addiction problem only comes to the public’s awareness when a nationally recognized personality is “caught” in the pain/addiction trap.

Living with chronic pain is very difficult.  If a person also has a coexisting addiction it becomes even harder.  Many people who have chronic pain and addiction become very depressed and start feeling hopeless. They have often lost their self-esteem and eventually lose the support of their significant others. Healthcare providers often become confused and frustrated when none of their treatment interventions seem to work.

The Addiction-Free Pain Management (APM) System was developed to address the specific needs of this under-served population.  Historically, addictive disorders and pain disorders have been treated as separate issues.  However, to effectively implement an APM approach, both the addictive disorder and the pain disorder must be adequately addressed at the same time.  In addition, the physical, psychological, and social implications of these disorders must also be dealt with.

Another major obstacle to effective treatment for this population is the patient’s denial system.  If patients don’t know they have a problem it can be extremely difficult to find a solution.  Many people I have worked with have a mistaken belief that “I can’t be addicted because I’m in pain and a doctor gave me the medication.”  This can be a type of denial if in fact they have been abusing or are addicted to their medication and experiencing life-damaging consequences.

There are four levels of denial.  The first is a lack of information about addiction.  The above example shows this first level.  The solution here is for you to be open to education and information about addiction.  It is important to learn as much as possible about chemical dependency and effective pain management.

The second level of denial is conscious defensiveness.  You know that something is wrong but you don’t want to look at the problem and face the pain of knowing.  The solution for this level is to recognize that there is an inner conflict occurring where one part of you knows there’s a problem, but another part doesn’t want to admit it.  To resolve this conflict you must be willing to listen to the part that knows the truth and take action.  The old saying “the truth will set you free” is certainly relevant in this case. 

The third level is denial as an unconscious defense mechanism.  You get to this level when you have stayed in the inner conflict, mentioned above, and the defensive voice keeps winning.  Once this happens denial then becomes an unconscious defense mechanism.  The solution is much more difficult.  It usually takes outside interventions or what is called a motivational crisis to break through this defense and allow you to know the truth and start addressing the problem.  For some of my patients this motivational crisis was generated when their treating physicians became concerned about their use/abuse of pain medication.  For others it was family members intervening and urging them to seek help.

The fourth level is denial as a delusional system, which is the toughest level to address.  Terence Gorski describes this delusion as “a mistaken belief that is firmly held true despite convincing evidence that it is not true.” People at this level of denial usually need psychotherapy to resolve their delusional system.

Many people with chronic pain frequently become depressed due to living with under-treated or mistreated pain symptoms.  This process starts when people’s thinking and emotions begin to become problematic.  When thinking becomes irrational or dysfunctional and people start mismanaging their feelings, they often have urges to indulge in self-defeating, impulsive or compulsive behaviors to cope with their depression.  This in turn affects their relationships with others. 

Some people may become isolated and believe they can handle life without any help, or they may become increasingly dependent on others to take care of them.  Either style can worsen their depression.  This care taking by others may be enabling the depressed person to continue ineffective behaviors and maintaining his or her role as a victim.  Some people may need to have treatment for depression.  An effective depression management treatment plan should include cognitive behavioral therapy and possibly an antidepressant medication. 

            Once we identify and start overcoming these obstacles we need to implement a multi-disciplinary treatment plan.  Effective pain management for someone with an addictive disorder and chronic pain requires a three part approach: (1) A medication management plan—in consultation with an addiction medicine specialist; (2) A cognitive-behavioral treatment plan—addressing pain versus suffering and changing behaviors; and (3) A non-pharmacological pain management plan—developing safer drug-free ways to manage pain.  Recovery and avoiding relapse is possible if someone is willing to do the footwork and follow this plan using a collaborative multi-disciplinary treatment team.