When I work with people undergoing chronic pain management one of the early questions I ask is what is your goal in working with me?  Over the years I’ve had many people say they wanted to be pain-free.  This is not a realistic expectation for many chronic pain management conditions, however; and I have to break this to them.  But what I can guarantee is this: if, and only if, you are willing to do the footwork you will never have to suffer with your pain again.  The old saying is true: Pain is inevitable; but suffering is optional.

Because you believe that you’re going to hurt, you can activate your physiological pain system just by thinking about doing something that you believe will cause you to hurt.  This is called anticipatory pain.  You anticipate that something will make you hurt, which in turn activates the physiological pain system.  You start hurting even before you begin doing whatever it is that you believe will cause you to hurt.  All you have to do is to start thinking about doing that thing. 

Once the physical pain system is activated, the anticipatory pain reaction can actually make the pain symptoms worse.  Whenever you feel the pain, you interpret it in a way that makes it worse.  You start thinking about the pain in a way that actually makes it worse.  You tell yourself that my pain is “awful and terrible,” and that “I can’t handle the pain.”  You convince yourself that “it’s hopeless, I’ll always hurt, and there’s nothing I can do about it.” 

This way of thinking causes you to develop emotional reactions that further intensify or amplify your pain response.  The increased perception of pain causes you to keep changing your behavior in ways that create even more unnecessary limitations and more emotional discomfort.  This can make you feel trapped in a progressive cycle of disability. 

My Pain Is Horrible, Awful, Terrible! AKA I’m Suffering!

Your expectations—what you believe it will be like when you experience pain—does affect your brain chemistry.  Your brain chemistry can either intensify or reduce the amount of physical pain that you experience.  What you think and how you manage your feelings in anticipation of feeling pain can make your pain either more severe or less severe.  In other words, you usually get the level of pain and dysfunction that you expect—a self-fulfilling prophecy.

You Get The Level Of Pain And Dysfunction That You Expect!

The anticipation of an expected pain level can influence the degree to which you experience pain.  When your self-talk is saying, “this is horrible, awful, terrible,” your brain tends to amplify the pain signals.  When this occurs, the level of distress increases—you suffer, remaining a victim to your pain.

Using A Two-Part Approach: Physiological & Psychological

Because of the two parts—pain and suffering—pain management must also have two components: physical and psychological.  The way you sense or experience pain—its intensity and duration—will affect how well you are able to manage it.  Anticipatory Pain (which was covered earlier article) is also a major psychological factor that must be addressed.  The research on recovery from chronic pain is very clear.  The people that are most likely to successfully manage their pain do so by becoming proactively involved in their own treatment process.  The chances of success go up as you start learning as much as possible about your pain and effective pain management.

Breaking the suffering pain cycle involves addressing the physiological as well as the psychological/emotional components of the pain.  Stress also plays a role in keeping a pain cycle going.  Stress causes muscle tension, which then leads to increased pain sensation.  At the same time your cognition (thinking) and emotions can also amplify this cycle.  Breaking this cycle requires concurrent treatment of the physiological and psychological/emotional condition. 

Using the Addiction-Free Pain Management® System

Because of the two parts—pain and suffering—pain management must also have two components: physical and psychological.  The way you sense or experience pain—its intensity and duration—will affect how well you are able to manage it.  The Addiction-Free Pain Management® System can help you if you’re living with chronic pain and want to better manage your pain; thus leading to a better quality of life. 

To learn more about anticipatory pain for better chronic pain management and freedom from suffering check out my article Moving Beyond Anticipatory Pain for Effective Chronic Pain Management that you can download for free on our Article page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you or a loved one is undergoing chronic pain management, especially if you’re in recovery or believe you may have a medication or other mental health problem and you want to learn more effective chronic pain management tools, please go to our Publications page and check out my books; especially the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, 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.

To see an online overview of Cognit delivering Addiction-Free Pain Management® please go to this Link for a free demo.

To learn about my upcoming trainings you can check out our Calendar page.

Subutex and Suboxone are the brand names that buprenorphine is being marketed as for the treatment of opiate dependence. Both medications contain the active ingredient Buprenorphine Hydrochloride, which works to reduce the symptoms of opiate dependence. Subutex contains only Buprenorphine Hydrochloride which was developed as the initial product.

The second medication, Suboxone contains an additional ingredient called Naloxone to guard against misuse or abuse. Subutex is usually given during the first few days of treatment, while Suboxone is used during the maintenance phase of treatment. Both medications come in 2 mg and 8 mg strengths as sublingual (placed under the tongue to dissolve) tablets.

Because Suboxone is a partial opiate agonist some dependence can result from long-term use. We are now actually seeing people starting to abuse Suboxone and often this is because they are only receiving the medication without counseling or therapeutic treatment.  Unfortunately many people are not offered programs that are specifically designed to help people transition from Suboxone to abstinence-based sobriety. 

I personally believe that in most cases Suboxone should be used as a transitional medication and eventually stopped. For some people this can be accomplished in a few weeks but in others several months to a year is needed.  But because the drug is an opiate agonist, the final Suboxone taper must occur slowly over the course of several weeks. If the drug is stopped abruptly, withdrawal symptoms similar to what was experienced at the time of induction can occur. During this phase there needs to be a slow decrease of the dose, being careful to do so in a manner that produces the fewest withdrawal symptoms or opiate cravings. The eventual goal of this phase is to stop Suboxone treatment altogether.

Buprenorphine is also being used very effectively by some pain management physicians for people living with chronic pain.  It is important to remember that medication is only one modality for effective chronic pain management.  It is also crucial to develop non-medication based treatment interventions as well as learning to treat the psychological/emotional components of chronic pain.  A multidisciplinary team approach always gives the best treatment outcomes.

To learn more about effective chronic pain management check out my article The Need for Multidisciplinary Chronic Pain Management that you can download for free on our Articles page.

You can learn about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders; including depression, addiction and other coexisting psychological disorders effectively; please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please click here. If you want to sign up for the newsletter, 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.

To see an online overview of Cognit delivering Addiction-Free Pain Management® please go to this Link for a free demo.

To learn about my upcoming trainings you can check out our Calendar page.

Question One: Are We Managing Pain or Fueling Addiction?

This first question of managing pain or fueling addiction concerns what can happen when people are over-medicated or put on a medication that can be a problem for them.  One of my former patients, Jason, is a perfect example of what happens when addiction issues are not factored in to pain management. 

Jason first came to me for pre-marital therapy where he and his soon to be wife accomplished all of our treatment goals and we successfully terminated therapy.  I next heard from Jason about a year later and he was in trouble.  You see Jason had been in recovery for alcohol and methamphetamine addiction for over 12 years.  About six months after we stopped working together Jason got injured in a skiing accident and at first he was very conservative and used only over the counter  medication and physical therapy. 

As his pain continued to get worse Jason accepted a prescription for Vicodin from his doctor.  At first he only took 3-4 tablets per day but in a few months he was taking 15-18 per day from two different doctors.  Fortunately, we worked together with a different doctor and got him off the Vicodin and onto more appropriate pain management modalities.  Jason’s addiction was re-ignited and fueled by the Vicodin.

Question Two: Are We Treating Addiction But Sabotaging Pain Management?

This second question addresses what happens to a lot of people who become addicted to their pain medication and as a result end up in an addiction treatment program. In most cases the addiction program only focuses on one third of the problem—the addiction—and the pain condition does not get adequately addressed. 

Another patient of mine named Sharon is a perfect example of pain management being sabotaged by a well meaning treatment program.  When I first met her, Sharon was a 43 year old married mother of three grown children.  Sharon had never used alcohol or any other drugs including nicotine until at age 42 she started developing periodic migraines.  She went to her primary care physician and was given opiates for the pain.

At first Sharon was experiencing 2-3 episodes per month but after about nine months she was experiencing migraines 3-4 times a week.  In addition, over that period of time the type, strength, and frequency of her medication also increased dramatically.  She went from 5-10 Vicodin tablets per month to taking 4-6 80mg OxyContin tablets per day plus 5-6 Vicodin tablets per day for “breakthrough” pain. 

Her doctor finally became alarmed and told her she was an addict and needed to go to an addiction treatment program.  The program he recommended said they treated prescription drug addicted pain patients—unfortunately, they really didn’t address Sharon’s pain management needs at all. In fact, when she experienced migraines while in treatment she was told she was drug seeking and needed to learn to live with it. 

Sharon was finally discharged and sent home to a family system that now saw her as “one of those addicts.” Sharon became very depressed and suicidal and actually attempted to kill herself and as a result was hospitalized and that’s when she was referred to me. I’ll tell you the rest of her story in the next question.

Question Three: Is it Addiction or Pseudoaddiction?

The third question is about the phenomenon of pseudoaddiction.  After Sharon’s suicide attempt she was treated in a psychiatric hospital and they referred her to my private practice.  As I worked with her and gathered information I determined that Sharon was misdiagnosed as an addict.  Sharon suffered from pseudoaddiction, which is really mistreated or undertreated chronic pain. 

In 2004 the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine collaborated on defining misunderstood terms in chronic pain management. One term was pseudoaddiction and this is their definition: Behaviors that may occur when pain is under treated.  Patients with unrelieved pain may become focused on obtaining medications, may “clock watch,” and may otherwise seem inappropriately “drug seeking.”  Even behaviors such as illicit drug use and deception can occur in the patient’s efforts to obtain relief.

The main point to remember here is that while pseudoaddiction looks an awful lot like addiction it is caused by an under treated or mistreated chronic pain condition.  I do want to make one important point however; my treatment plan for pseudoaddiction and addiction is identical.  The major danger of pseudoaddiction is that if it is not adequately addressed it will turn into full blown addiction—sometimes quickly and sometimes slowly.

In Sharon’s case she never should have been prescribed opiates for her migraines.  The research is very clear that opiates can lead to rebound or transfer migraine episodes.  In other words it was the heavy opiate use that led her from going from 2-3 migraine episodes per month to 3 to 4 per week.  Once Sharon was placed on an appropriate migraine medication management plan along with cognitive behavioral therapy her quality of life improved dramatically and her migraine episodes lessened both in frequency and intensity.

To learn more about effective chronic pain management check out my article The Need for Multidisciplinary Chronic Pain Management that you can download for free on our Article page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you or a loved one is undergoing chronic pain management, especially if you’re in recovery or believe you may have a medication or other mental health problem and you want to learn more effective chronic pain management tools, please go to our Publications page and check out my books; especially the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, 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.

To see an online overview of Cognit delivering Addiction-Free Pain Management® please go to this Link for a free demo.

To learn about my upcoming trainings you can check out our Calendar page.