Treating People In Chronic Pain

Posted on Friday, December the 28th at 7:52pm

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

People with chronic pain who become addicted to their medication present a difficult challenge to therapists and other treatment professionals. Pain clinics often fail with these people because their addiction disrupts the treatment of the pain disorder. Addiction treatment programs often fail because the pain disorder disrupts the addiction treatment process.

People in chronic pain often seek treatment as a result of a complex combination of physical, psychological, and social problems. The pain disorder is usually complicated by other serious issues that need to be addressed in order to successfully manage the pain disorder.

People in chronic pain can be difficult to treat. Their pain is real. They are at high risk of becoming addicted to their pain medications. Their need for relief is urgent. The typical treatment involves the use of pain killing medications. When treating addicted chronic pain patients, health care professionals are forced to answer a series of difficult questions.

· What if the traditional medication management doesn’t work?

· What if the patient quickly develops tolerance to their pain medication and requires progressively larger doses to gain relief from the pain?

· What do you do with patients who consistently abuse their pain medication by using more than prescribed?

· How can you distinguish the patient who legitimately needs more pain medications over a longer period of time from those patients who are manipulating for more pain medications because they have become addicted to it?

· How do you approach an addicted patient with a pain disorder who feels helpless and hopeless because they are addicted to their pain medications and can see no way out?

The Addiction Free Pain Management (APM) system provides a way to answer these and many more difficult questions that are routinely asked by treatment professionals treating chronic pain patients. The APM system is a treatment approach that uses the GORSKI-CENAPS^® model. It integrates the most advanced pain management methods, developed at the nation’s leading pain clinics with the most effective treatment methods for addiction developed at the nation’s leading chemical dependency treatment programs. The result is a unique integration of treatment methods that combine proper medication management with non-medical techniques. This leads to a patients pain relief, while lowering or eliminating their risk of addiction or relapse.

We need to look at the term addiction free. To understand addiction free, we need to recognize the difference between addiction and dependency. We also need to understand the addictive disorder, which includes biological rewards, craving cycle, loss of control, and negative consequences.

Many chronic pain patients are physically dependent on their medication, but they do not exhibit addictive biopsychosocial tendencies—this is physical dependency. To be considered addiction free a patient must be free of inappropriate psychoactive chemicals and using other treatment modalities to manage their pain, such as the ones described later in this chapter.

In some instances addiction free may mean that a person must take mood altering medication and they are able to do so exactly as prescribed. They use the medication for pain relief, but do not use the medication to achieve a state of euphoria or mood alteration. They do not obsess about the medication, or become compulsive about taking it, and they do not experience negative consequences from using it. This is a fairly simple description of addiction free pain management, which is explained in greater detail in Managing Pain and Coexisting Disorders.

Managing Pain and Coexisting Disorders explores and explains separate elements of APM by using two actual case study examples and by discussing the exercises in the Addiction Free Pain Management Workbook. This book uses two patients, Dean and Jean, to illustrate the various APM methods that were used in their treatment.

The APM Professional Guide explores and explains separate elements of APM by using two actual case study examples and by discussing the exercises in the Addiction Free Pain Management Workbook. The APM Professional Guide uses two patients, Donna and Matt, to illustrate the various APM methods that were used in their treatment.