People living with chronic pain and coexisting disorders experience many obstacles that are often quite challenging for their healthcare providers.  These people have a tremendous amount of grief and loss around their previous level of functioning in addition to a host of other problems that lower their quality of life.  Some of the roadblocks include high levels of denial and resistance to treatment, as well as the attitudes and approaches used by their treatment providers.

To help overcome these obstacles and for healing to occur they must feel listened to, understood, taken seriously and affirmed as human beings.  This is the starting point for them to overcome their treatment resistance and denial.  To do this requires a respect-centered approach utilizing a denial management interactional approach.

This is why I make an effort in my trainings to teach clinicians what I call the Formula for Success which is a process that helps overcome a client’s resistance and denial.  But before I explain the Formula for Success I want to first tell you about the Formula for Disaster.

The formula for disaster starts when a healthcare provider is unaware of a bias or prejudgment they have about their patient.  In their mind they know what the patient needs even before they tell their story.  Often they use what I call a cookie-cutter approach or a one size fits all treatment strategy.  If there is a coexisting addictive disorder, a negative bias or stigma is often involved; after all they’re just an addict. 

This prejudgment is often followed by insensitivity; especially if the clinician is overwhelmed or overworked.  Many times they talk at and work on their patients instead of talking with them and working with them, instead of on them.  Added to this pre-judgment and insensitivity, many clinicians resort to confrontation in order to get their patients to do what they want; this is the “my way or the highway phenomenon.”  This combination almost always leads to a power struggle. 

When I ask people in my trainings who they think usually wins this power struggle, many of them believe it’s the patient, others say the provider. The patient may feel they win because they’re not going to let you put one over on them.  And the provider may feel like they win because they knock the patient into compliance—but it’s usually a malicious compliance.  Some training participants get it right away, nobody really wins.

I believe it’s vitally important to change this dynamic by implementing the formula for success which starts with the provider recognizing, then replacing pre-judgments with understanding.  The best way I know to gain this understanding is to really listen to what the patient is actually saying.  To do this a clinician must use empathic and active listening to make sure they are receiving what the patient is sending.  The next step is to replace insensitivity with compassion and empathy—not sympathy.  Instead of confrontation it is important to use positive strength based challenge.  Sometimes this challenge is a tough love approach; but always with respect and in the best interest of the patient. 

When we pull all of these pieces together we get collaboration instead of power struggles.  This collaboration is the crucial first step for effective healing to occur. That is why the Formula for success is an integral component of the Addiction-Free Pain Management® System. 

To learn more about chronic pain management please check out our website at www.addiction-free.com and go to our Publications page and check out my latest book The Addiction-Free Pain Management® Recovery Guide: Second Edition. To look for my upcoming trainings please go to our Calendar page.  If you want to learn more about respectful treatment for chronic pain management you can find my article The Right to Quality Chronic Pain Management that you can download for free on our Ariticles page.

To read our latest Chronic Pain Solutions Newsletter please click here.  

Over the past twenty-five years I have seen many people struggling with pain management who use food as a comfort or coping tool. Some of these people had a coexisting addictive disorder that they put into remission and were doing a good job with their pain management until they crossed over into using food compulsively or addictively. Many of them would put on weight and that would start sabotaging their pain management, which would eventually lead to inappropriate medication use once again. At some point they needed to make a decision to look at their relationship with eating.

It is very important when you are confronted with a decision to make a significant lifestyle change that you carefully weigh the pros and cons (i.e., benefits and disadvantages) of making that transition. It is easy for many people who have been eating addictively to see the disadvantages or negative consequences of that behavior (i.e., obesity, heart problems, joint problems, etc.). Therefore, it is often difficult to admit that they mistakenly believe there is a benefit to eating addictively—in this case to help cope with their chronic pain condition.
 
Some people use eating to cope with uncomfortable emotions or to deal with the consequences of having poor social skills and lack of friendships. Others use eating to avoid intimacy by making food their best friend. There must be some benefits to your eating inappropriately or you wouldn’t have started eating to cope instead of for fuel. These benefits are sometimes called secondary gains. Being open to seeing that this may be a problem is the first step toward change. That is why I published the Food Addiction Recovery and Relapse Prevention Workbook in 2000 to help people with these problems.

In early 2008 I decided that the focus and name of the original relapse prevention protocol needed to be changed. I asked a colleague, Dr. Shari Stillman-Corbitt the Clinical Director of Sierra Tucson, to collaborate with me on a new project—The Eating Addiction Relapse Prevention Workbook—that will be published by the Fall of 2008.  Please go to our Contact Page to sign up for our free Addiction-Free Pain Management® Chronic Pain Solutions E-Newsletter that will announce when this book is available.

Although the primary purpose of this new workbook is to help this population develop a recovery and relapse prevention plan and create a schedule of activities to assist that goal, Dr. Corbitt and I believe that patients must first develop a definition of abstinence that can work for them. It is also critical to develop an effective recovery plan or what we call a Healthy Living Plan, which is life enhancing. Therefore, The Eating Addiction Relapse Prevention Workbook is designed to increase patients’ knowledge and understanding of the nature of eating addiction.

To learn more about chronic pain management please check out our website at www.addiction-free.com and go to our Publications page and check out my latest book The Addiction-Free Pain Management® Recovery Guide: Second Edition. If you want to learn about coping with coexisting disorders to avoid relapse you can find my article Relapse Prevention and Chronic Pain Management that you can download for free on our Ariticles page.

To check out our July Chronic Pain Solutions Newsletter please click here.

Today I want to give you an overview of what happens when someone has chronic pain and a coexisting addictive disorder.  But before I get into that I want to give you some background information so you can better understand this overview.  In 1996 there were about 80 million people living with chronic pain in the United States.  Today, there are over 100 million people.  Current research estimates that 90% of people receiving medical treatment for chronic pain are prescribed opiates.  About 10% of these people develop substance use disorders.  That means that today there are over 10 million people experiencing prescription drug abuse or addiction.

In 1996 I conducted research to begin developing the first clinical skills training for Addiction Free Pain Management®.  What I looked for was information on people who had chronic pain and co-existing addiction.  What I found was disturbing.  There was nothing there!  What I did find was a large amount of data on people with addiction and an abundance of information about people who had chronic pain.  But I couldn’t find anything that addressed someone who suffered with both conditions.  During my research I surveyed addiction and pain programs to find out what happened to these people when they tried to seek help.
 
What I discovered was when they went into an addiction treatment program; the entire focus was on the addictive disorder.  Unfortunately, their pain was not adequately addressed.  The addiction programs really struggled with what to do about the chronic pain. Now if that same person went into a pain clinic, the entire focus was on the chronic pain, the physiological pain.  On the other hand, the pain clinics struggled with what to do when people were acting out with the addiction.  I realized that the focus needs to be on concurrent treatment for both pain and addiction.  That is why I developed the Addiction Free Pain Management® System so treatment providers can learn how to effectively deal with both conditions concurrently.
 
What I also uncovered during my research, was that when the person had both conditions, there was an amplification, or a synergism, of their symptoms present that I coined the Addiction Pain Syndrome™. This syndrome has three zones—the addictive disorder zone, the pain disorder zone and a third zone I’ll discuss a little later. 

The addictive disorder zone contains all the symptoms, problems, or consequences people experience when living with addiction.  Someone in the pain disorder zone has a different set of problems, symptoms, or consequences.  When a person has both conditions a synergistic effect happens and now we have the third zone the addiction pain syndrome zone.
 
The problem is that if the person goes into an addiction program 1/3 of the problem is dealt with and if they go to a pain clinic a different 1/3 of the problem is covered.  Many of these programs cross-refer; which is great because now we are treating 2/3 of the problem.  I developed the Addiction Free Pain Management System to treat all three zones concurrently using a collaborative, multidisciplinary approach. 

To learn more about chronic pain management please check out our website at www.addiction-free.com and go to our Publications page and check out my latest book The Addiction-Free Pain Management® Recovery Guide: Second Edition. 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.

To check out our July Chronic Pain Solutions Newsletter please click here.