In 1996 I began developing the first clinical skills training for Addiction Free Pain Management®.  I conducted research to see if I could find information about people who had chronic pain and co-existing addiction, but was unable to find much written at that time.  What I did find was a lot of data about people with addiction and an fairly equal amount of information about people who had chronic pain.  It was difficult to find research that addressed someone who suffered with both conditions so I decided to do my own research of addiction programs and pain clinics. 

When I surveyed addiction programs to find out what happened to people who had an addictive disorder and chronic pain, I discovered their entire focus was on the addictive disorder, and the patient’s pain was not adequately addressed.  Addiction programs struggled when someone with chronic pain came into their program. 

When I surveyed pain clinics to find out about people who had chronic pain and a co-existing addiction, I found that their entire focus was on the physiological pain.  Pain clinics found it difficult to deal with patients who were acting out with their addiction.  This was an important learning experience for me and realized that the focus needed to be on concurrent treatment for both the pain and the addiction.

Addiction treatment programs cover about a third of the problem (the Addictive Disorder Zone) when dealing with a chronic pain patient.  The pain clinics cover a different third of the problem (the Pain Disorder Zone).  When each of the above modalities is implemented independently they miss about two thirds of the problem.

Some progress is definitely made when addiction treatment centers recognize the need and refer a patient to a pain specialist, or when pain clinics refer a patient to an addiction specialist.  But still, only about two thirds of the patient’s needs are being addressed (both the Addictive Disorder Zone and the Pain Disorder Zone).  What about the third zone? 

The third zone in the diagram is what I coined the Addiction Pain Syndrome™ Zone which is a combination of the Pain Disorder Zone the Addiction Pain Syndrome Zone.  The addictive disorder leads to one universe of biopsychosocial problems, and the pain disorder leads to a different set of problems.  In the Addiction Pain Syndrome Zone negative consequences more than double.  1 + 1 no longer equals 2, rather 1+ 1 now equals 3 or more.  This is called synergism.

Addiction-Free Pain Management® (APM) is a synergistic treatment system.  APM™ concurrently addresses The Addictive Disorder Zone, the Pain Disorder Zone, and the Addiction Pain Syndrome Zone and teaches treatment providers how to more effectively deal with patients who have both conditions. 

If you want to learn more about the Addiction Pain Syndrome™ you can find my article Understanding the Addiction Pain Syndrome™ that you can download for free on our Ariticles page.

If you want to learn more about the Addiction-Free Pain Management® System please check out our website at www.addiction-free.com. To learn more about how to develop an effective chronic pain management plan please go to our Publications page and check out my book The Addiction-Free Pain Management® Recovery Guide. To look for my upcoming trainings please go to our Calendar page.

To read our latest Chronic Pain Solutions Newsletter please click here. To sign up for Chronic Pain Solutions, please click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.
 

Antidepressants may be indicated for several reasons; one is that many patients with chronic pain disorders become clinically depressed and a medication intervention may be necessary depending upon an assessment of their problem. The Addiction-Free Pain Management® approach always suggests that a full biopsychosocial evaluation be taken to determine the severity of the depression.

Some types of depression (situational) respond best to cognitive behavioral therapy. Other types (bipolar) may need a medical intervention in addition to therapy. There are many different types or classifications of antidepressants to choose from, therefore a healthcare practitioner who specializes in treating depressive disorders related to chronic pain should be consulted to determine the most effective medication for each patient.

Pain reduction is another key factor that may benefit from using an antidepressant. The use of tricyclic antidepressants has been an effective tool in pain management for years. For example, the tricyclic Elavil (amitriptyline) is frequently used to treat and help prevent migraine headaches. These antidepressants have been able to provide relief for nerve pain and often result in lowering the dose of opiate medications.

Another class of newer antidepressants is the SSRIs (selective serotonin reuptake inhibitors). Many pain management specialists utilize this type of medication for chronic pain treatment particularly for people who live with constant debilitating chronic pain, as their serotonin system becomes depleted. This type of medication is good for both depression as well as improving pain management.

SSRIs like Prozac, Effexor, Lexapro, or Celexa, improve mood as well as help relieve pain, reduce fatigue and improve sleep problems. There have been reports about SSRIs being helpful for some types of neuropathic pain symptoms. Some studies also suggest that using an SSRI and a tricyclic antidepressant (such as amitriptyline) together may be more successful at breaking the cycle of pain, depression, and sleep problems caused by fibromyalgia than using just either one alone.

In addition, there are three antidepressant medications that can also be very helpful; Cymbalta and Effexor, which block the reuptake of serotonin and norepenepherine and Wellbutrin, which alters the levels of norepenepherine and dopamine. Cymbalta is a versatile medication approved to treat depression and certain types of pain. Norepenepherine, serotonin, and dopamine are neurotransmitters that not only affect depression but also pain management. Many pain management specialists recognize that combining different medications creates a synergistic effect for both pain management and improving depression.

If you want to read more about depression and chronic pain management you can find my article The Role of Clinical Depression in Chronic Pain Management that you can download for free on our Ariticles page.

If you want to learn more about the Addiction-Free Pain Management® System please check out our website at www.addiction-free.com. To learn more about how to develop an effective chronic pain management plan please go to our Publications page and check out my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To look for my upcoming trainings please go to our Calendar page.

To read our latest Chronic Pain Solutions Newsletter please click here. To sign up for Chronic Pain Solutions, please click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Modern pain management systematically approaches chronic pain management at all three levels (bio-psycho-social) simultaneously.  This means using physical treatments to reduce the intensity of physical pain.  It also means using psychological treatments to identify and change the thoughts, feelings, and behaviors that are making the pain more intense and replacing them with positive thinking, as well as feeling and behavior management skills that can reduce the intensity of the pain. 

Finally, effective pain management must involve not only the pain patient, but also the significant people in their life who can help them to develop a social and cultural context in which to experience their pain in a way that will reduce suffering.

Biological pain is a signal that something is going wrong with the body.  The biological, or physical, pain sensations are critical to human survival. Without pain we would have no way of knowing that something was wrong with our body. So without pain we would be unable to take action to correct the problem or deal with the situation that is causing our pain.

Psychological Pain results from the meaning that the brain assigns to the pain signal.  The psychological symptoms include both cognitive (thinking changes) and emotional (uncomfortable feelings) that lead to suffering. Most people are not able to differentiate between the physical and psychological. All they know is “I hurt.” For effective pain management you need to learn all you can about your pain.

Social and Cultural Pain, results from the social and cultural meaning assigned by other people to the pain experience, and whether or not the pain is recognized as being severe enough to warrant a socially approved sick role.  These three components determine whether the signal from the body to the brain is interpreted as pain or suffering. 

Imagine the following vignette

Bob is his college’s star football player.  In last week’s homecoming game Bob scored the winning touchdown but broke his arm in the process.  This week Bob is sitting on the bench with a cast on his arm that everyone has signed.  This cast and how he earned it are seen as an honorable reason for him to be sitting on the bench.  In that same game Karl, a big hulking lineman, “tweaked” his back and was also sitting on the bench this week.  Unlike Bob, Karl doesn’t have an observable injury and people were asking him why he wasn’t out on the field helping his team.  Karl is much more apt than Bob to experience shame/guilt, which will probably amplify his pain symptoms.

If you want to read about the how the Addiction-Free Pain Management® System addresses the biopsychosocial areas you can find my article The Core Clinical Components of Addiction-Free Pain Management® that you can download for free on our Ariticles page.

If you want to learn more about the Addiction-Free Pain Management® System please check out our website at www.addiction-free.com. To learn more about how to develop an effective chronic pain management plan please go to our Publications page and check out my book The Addiction-Free Pain Management® Recovery Guide. To look for my upcoming trainings please go to our Calendar page.

To read our latest Chronic Pain Solutions Newsletter please click here. To sign up for Chronic Pain Solutions, please click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.