Relapse Prevention and Chronic Pain Management

Posted on Monday, May the 12th at 5:43pm

I’ve been certified in advanced relapse prevention therapy and working with patients with chronic relapse episodes since 1991.  In addition to an addictive disorder most of these people were also living with chronic pain as well as other coexisting psychological disorders.  There continues to be confusion and misunderstanding about what relapse is and how it happens.  I want to attempt to clarify my definition of relapse, how it happens and most important how to prevent people from entering the relapse cycle.What does the term Relapse mean? 

If you ask someone in recovery from an addictive disorder they most likely will say relapse is taking a going back to using the target substance.  When you ask someone in pain management they might say they quit working an effective pain management program. For someone with both an addictive disorder and chronic pain it can be either or both explanations.

The most common meaning of relapse is that a person goes back to their addiction or ineffective pain management.  While that definition is partially correct, the full explanation of relapse is much more complex.What many people don’t realize is that the chemical use or self-defeating pain management strategies is the final stage of a relapse process—not the beginning.  In addition, relapse is a common symptom of chemical dependency, and between one-third to two-thirds of all recovering alcoholics/addicts relapse despite their best intentions not to do so.  For people in pain management this can be even higher because pain flare ups can become a relapse justification. Fortunately, this stunning statistic can be lowered if recovering people are exposed to education and training about relapse prevention and nonpharmacological pain flare up planning.  Prevention is much easier than crisis management.  I believe relapse education must start with a new definition of relapse.  The definition I like to use is: Relapse is a progressive series of events that takes someone from stable recovery to a state of becoming dysfunctional in their recovery.  When someone starts on the slide to relapse they undergo many changes.  The first change is a return to denial that at first has nothing to do with substance use or ineffective pain management.  This leads to thinking problems. 

Now instead of responsible recovery-prone positive thinking the person starts experiencing relapse-prone negative thinking and even euphoric recall.  Euphoric recall is remembering how good the pain medication used to work and how awful it is that I can’t have those pain meds now.  This negative thinking leads to a person experiencing uncomfortable and/or painful emotions.  These feelings produce self-defeating urges which are often followed by self-destructive behaviors.  Inappropriate medication useincluding alcohol or other drugs—may  not be an option in the early stages of relapse, but the negative behaviors often set up the person to experience more problems.

One of the biggest relapse triggers for someone in early addiction recovery is their inability to recognize and/or cope with the serious symptoms of protracted or post-acute withdrawal (PAW).  PAW is a series of biological and psychological symptoms that everyone in chemical recovery goes through.  The brain chemistry is adapting and healing from the long term toxic affects of psychoactive substance use.  There are six major symptoms of PAW: (1) Thinking changes (2) Emotional changes (3) Sleep disturbances (4) Short-term and long-term memory problems (5) Coordination problems and (6) A sensitivity to stress.When a person is trying to move into recovery they need to learn new tools to move from an addiction centered life-style to a recovery-centered one.  In the same way, when someone is trying to remain in recovery they need to learn all they can about the sobriety-based symptoms of an addictive disorder and to develop new tools.  One way to develop a new tool kit is through education.  One of the most informational books that a recovering person can read to avoid relapse is, Passages Through Recovery, written by Terrence T. Gorski.  His book describes the developmental stages of recovery, the symptoms of PAW, and the progressive nature of relapse.If you don’t want to do a lot of reading there are some simple steps available to help improve the quality of your sobriety and lessen the risk of relapse.  For someone who is also living with chronic pain this is even more crucial.  Fortunately, the steps for managing PAW will also be very useful for improving pain management.  For example stress management is a crucial component of a PAW treatment plan. 

We also know that if people living with chronic pain can lower their stress levels it will also decrease their pain symptoms.People in recovery need to develop a healthy balanced life-style.  This includes things like eating healthy, exercising on a regular basis, identifying and managing uncomfortable emotions, challenging negative thinking, avoiding high risk people, places, and things, and developing a healthy spiritual connection. 

Another important task for ongoing recovery is the ability to identify high risk situations and relapse warning signs as well as developing a relapse prevention network for both the addictive disorder and pain condition.  Often this can be done with the  help of a 12-Step support group and/or a chronic pain support group, but sometimes it is very important to consult with a relapse prevention specialist who is also knowledgeable about chronic pain in order to increase the chances of life-long sobriety and quality pain management.Like many other things in recovery, relapse prevention is simple—but not easy. And although relapse prevention is an inside job, that does not mean you have to do it alone.  Help is out there for those who want it.