Chronic Pain Management Needs More Than a Quick Fix

Posted on Wednesday, November the 4th at 4:24pm

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

If you watched any amount of TV the past few years you may have noticed a significant increase in commercials hyping prescription medication.  At the same time prescription drug abuse and addiction is on the rise.  We live in a quick fix society so when something goes wrong we look for the fastest way to remedy the situation.

The Problem: Better Living Through Chemistry

When someone has a headache they “pop a pill” and hopefully the headache goes away.  When their back starts hurting, finding a medication to deal with the pain is their primary concern.  The medical system in the United States is designed around crisis, or symptom management.  Rarely do people look for the reasons behind that headache or back pain.  Using a symptom management “Band-Aid” approach by taking a pill seems quicker, cheaper, and easier—but is it really?
What if the pain is long lasting or develops into a chronic condition?  In that instance using certain types of pain medication over long periods of time can cause serious problems.  One of the major over-the-counter pain medications used by millions of Americans today is Tylenol (acetaminophen).  We now know that a major problem with this medication is liver damage.  All medications have side effects, so determining a cost-benefit analysis is crucial.

According to research published in Pain Physician Journal (2006), 90 percent of people in the US receiving treatment for pain management are prescribed opiate medication. Of that number 9 percent to 41 percent had opiate abuse/addiction problems. In addition, prescriptions for medications like Vicodin and Percocet (both contain acetaminophen) have increased drastically in the past decade leading to significant medical problems for many people including addiction.
Seeking pain relief often leads people down the quick fix path or the “better living through chemistry” action plan. Pain is often seen as the enemy.  The truth is human beings need pain to survive.  Pain is the signal that says something is wrong; that we need to find out what is it, and then learn how to manage it. 

Sometimes it can be difficult if not impossible to pinpoint why we hurt, and human beings want to know why something is happening.  But when you are in pain the more important question becomes: What can I do, right now, to manage my pain in a healthy way that supports me physically, emotionally and spiritually?  The answer will be different for each person.  Unfortunately, many people turn to the pill bottle as a solution for everything.

When medication does not eliminate the pain or improve the lifestyle losses people are experiencing, the result is usually irrational thinking and uncomfortable emotions—in other words, suffering.  The anticipation of an expected pain level can influence the degree to which someone experiences pain.  When the self-talk is saying, this is horrible, awful, terrible, the brain then amplifies the pain signal.  When this occurs, the level of distress increases and people suffer thereby remaining a victim to their pain. This further increases the drive to use medications as the only solution for their pain problem.

The Solution: A Three Tiered Approach

The search for magical interventions and quick fixes for the treatment for chronic pain can be never-ending. The better option is address all the issues confronting someone living with chronic pain; this approach includes a combination of proven psychological treatment approaches in addition to effective and appropriate medication management as well as non-medication interventions.

Over the past several years organizations like the International Association for the Study of Pain, the American Academy of Pain Management, and the American Academy of Pain Medicine have all promoted better and safer ways to treat someone undergoing chronic pain management. In fact they have been advocating for many different pain initiatives designed to promote more effective and humane chronic pain management.

For the past 27 years I have been focused on assisting people undergoing chronic pain management who were also experiencing other coexisting psychological disorders including addiction. I have been very active in helping people in recovery from any addictive disorder to develop more effective—and safe—medication management plans to prevent relapse. I have also been focused on helping people who are living with chronic pain to develop effective medication management plans so they can avoid the risk of prescription medication abuse or addiction.

Finding the safest medication protocol possible cannot be overemphasized; when the narcotic medication is taken in increasingly larger doses due to tolerance, the side affects from the medication may become physically and/or psychologically damaging and in some cases even life-threatening. Undergoing chronic pain management is difficult for anyone, but especially for someone with coexisting medication abuse, addiction or other psychological disorders. They can become severely depressed and discouraged. Healthcare providers often become confused and frustrated when their treatment interventions are ineffective and frequently blame their patients.

The problem of managing pain and medication for people in recovery continues to grow and healthcare professionals are left with the challenge of how to effectively address it. Given the biopsychosoical nature of addiction and chronic pain, it is imperative to understand both conditions and implement a multidisciplinary chronic pain management treatment plan.
Knowledge is power.  To that end I have written several books and booklets as well as published many articles to get this information out to the people undergoing chronic pain management.  To effectively manage a pain condition, it is very important that people understand exactly what they are experiencing.  When people are in pain they experience both physical and psychological/emotional symptoms. 

The psychological symptoms include both thinking changes and emotional (or uncomfortable feelings) responses that lead to suffering.  Most people are not able to differentiate between the physical and psychological types of pain.  All they know is I hurt.  For effective pain management to occur people need to learn all they can about their pain.

The easiest way to understand pain is to recognize that every time someone feels pain, their body is attempting to tell them that something is wrong.  Pain sensations are critical to human survival.  Without pain people would have no way of knowing that something was wrong with their body and they would be unable to take action to correct the problem or situation that is causing the pain.  Whenever someone is experiencing pain, it’s helpful to ask themselves this question: What is my pain trying to tell me?

In some cases psychological treatment for chronic pain needs to supplement medication treatment, not replace it.  Emotional stress and negative thinking can actually increase the intensity of your pain, but the presence of psychological factors does not mean that your pain is imaginary.  Psychological treatment goals are designed to help you learn how to understand, predict, and manage the pain cycle, how to use coping skills to minimize pain, and how to maximize active involvement in positive life experiences despite the presence of chronic pain.

Additionally, psychological treatment for chronic pain focuses on the emotional toll someone experiences when living with pain on a daily basis.  Important factors such as disability, financial stress, or loss of work are also a part of the pain picture, and the psychological treatment plan is designed to address these and other relevant issues.

Although managing pain without pills may be a desirable goal, in some cases it may be impossible to achieve and an “appropriate” medication management plan must be put in place.  This plan should be a collaborative process with a professional who understands the biopsychosocial nature of pain and the very real risks of dependency or addiction.  In addition to the psychological treatment plan and the medication management plan there also needs to be non-medication approaches such as acupuncture, chiropractic, massage therapy, hydrotherapy, biofeedback, etc.