Overcoming Obstacles for Effective Pain Management

Posted on Sunday, December the 14th at 12:30pm

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

The Problem

Before looking at ways to overcome the obstacles to effective pain management, it’s important to explore what those obstacles are in order to develop the best plan possible. Managing a pain condition is often very challenging, and it becomes even more so when a coexisting disorder is also present. In fact, one of the biggest problems is not identifying coexisting psychological disorders which includes addiction. 

Coexisting Disorders

Historically pain, psychological and addictive disorders have been treated as separate issues. Pain clinics have had great success in treating chronic pain conditions. Addiction treatment programs have had success in treating addictive disorders. If the addiction program also treats co-existing disorders their success rate with the coexisting psychological disorders increases as well. However, the effectiveness the pain clinics or addiction treatment programs often fail when the person is suffering with both chronic pain and other coexisting conditions.

Within addiction and/or mental health treatment centers, specific issues need to be addressed in order to obtain positive treatment outcomes for those disorders. The same holds true for pain clinics when striving for effective pain management. But for people who are dealing with coexisting disorders, finding appropriate treatment can be difficult as well as frustrating for them and their healthcare providers—unless their unique treatment needs are adequately addressed.

The Denial Blindfold

When someone is not aware they have a problem, finding a solution may seem impossible. Many people have a mistaken belief that "I can’t be addicted because I’m in pain and besides, my doctor gave me the medication."  This can be a type of denial, especially when they have been abusing or have become addicted to their medication. Eventually they will begin to experience life-damaging consequences. If they are in denial, they are unable to see those problems.

The Depression and Isolation Pit

Many people with chronic pain frequently become depressed due to living with under-treated or mistreated pain symptoms. This process starts when their thinking and emotions begin to become problematic. When their thinking becomes irrational or dysfunctional they start mismanaging their feelings, then 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 caretaking by others may be enabling the depressed patient 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 includes cognitive behavioral therapy and possibly an antidepressant medication.

Working Towards a Solution

The important thing to remember is that people with chronic pain and co-existing disorders need to be able to recognize and admit they have a problem before they can work on an effective solution. Typically they need help—a support network for instance—to work through any denial or depression issues in order to develop an effective recovery and pain management program. In acute cases, and due to the nature of coexisting disorders, they also need a multidisciplinary team to effectively assess, diagnose and provide treatment. In any case, a major task for the individual or a treatment team is education regarding the diagnosis and how to effectively participate in a treatment plan.

Knowledge Is Power

To effectively manage a chronic pain condition it’s important for people to understand exactly what is going on with their body. When in pain, they experience both physical and psychological symptoms. To understand the language of pain, they must learn to listen to how the pain echoes and reverberates between the physical, psychological, and social dimensions of the human condition. Pain is truly a total human experience that affects all aspects of human functioning.

When people are in pain for a long period of time, they can feel victimized by that pain. They may hate their pain. They may want to escape from their pain. They may even become willing to do anything to get relief, but unfortunately that relief often results in self-defeating behaviors, including pain medication abuse.

The research on recovery from chronic pain is very clear; the people who successfully manage their pain are those who become actively involved in their own treatment. Their chances of success go up as they continue learning everything they can about their pain and effective pain management strategies.

Once people understand what is really going on with their body and mind, they can take action to effectively manage their pain. In fact, the most successful people are those who stop believing pain is their enemy and begin to embrace it as their friend. Many of the people I work with have a difficult time with the idea of making peace with their pain and accepting that pain is their friend. They tell themselves, and me, they can’t buy it, but nevertheless it is true.

Pain is Our Friend—Not Our Enemy

Fortunately, people can learn how to change their anticipatory response to pain. They can decrease their perception of pain by changing what they believe and what they think will happen when they start to hurt. They can change their thinking—their self-talk—and learn how to better manage their emotions. They can learn new ways of responding to old situations that cause or intensify pain. As they come to believe that they really can do things that will make their pain sensations bearable and manageable, the brain responds by influencing special neurons that reduce the intensity of the pain. The brain becomes less responsive to an incoming pain signal. 

There are things that people can do which make them habitually less responsive to incoming pain signals. In any event, both ascending (pain signals coming from the point of injury to the brain) and descending nerve pathways (signals from the brain to the point of injury) will influence or modify the effects of pain on the body.

Treating the Bio-Psycho-Social Components of Pain

Pain is a total biopsychosocial experience. A person hurts physically. They psychologically respond to the pain by thinking, feeling, and acting. They think about the pain and try to figure out what is causing it and why they are hurting. They experience emotional reactions to the pain and may get angry, frightened, or frustrated. They talk about their pain with family, friends, and coworkers who help them to develop a social and cultural context for assigning meaning to their personal pain experience, which leads to taking appropriate action.

Once again, it’s important for a person with chronic pain and coexisting disorders to avail themselves of a multidisciplinary team to help them effectively develop a biopsychosocial treatment plan. Successful pain management systematically approaches the treatment of pain at all three levels simultaneously. This means using physical treatments—including appropriate and safe medication management—to reduce the intensity of the physical pain. 

Effective chronic pain management also means using psychological, or cognitive behavioral, treatment approaches to identify and change the thoughts, feelings, and behaviors that are making the pain more intense or distressing and replacing them with positive thinking, as well as feeling and behavior management skills that can reduce the intensity of the pain. This includes dealing with the anticipatory pain mentioned earlier.

Successful chronic pain management must also involve not only healthcare providers and the person living with a chronic pain condition, but also their significant others who can help them develop a social and cultural context in which to experience pain in a way that reduces their suffering.  

The Addiction-Free Pain Management® System

The Addiction Free Pain Management® (APM) System provides a way to deal with the problem of chronic pain and co-existing disorders and succeed in providing people with effective chronic pain management so they can lead a higher quality of life.  The APM™ system is a treatment approach that is based in part on the GORSKI-CENAPS^® Biopsychosocial Developmental Model of Recovery.  It also integrates the most advanced pain management methods, developed at the nation’s leading pain management programs with the most effective treatment methods for addiction developed at the nation’s leading addiction treatment programs. 

The result is a unique integration of treatment methods that combine proper medication management and cognitive behavioral interventions along with nonpharmacological (non-medication based) modalities.  The APM™ approach leads to patients obtaining pain relief, while lowering or eliminating their risk of addiction or relapse as well as reducing or eliminating problems from other mismanaged coexisting disorders.