Not everyone with chronic pain and depression will need antidepressant medications.  However, this class of medication may be indicated for several reasons; one is that many people living with chronic pain disorders become clinically depressed.  The Addiction-Free Pain Management® System suggests a full biopsychosocial evaluation to determine the severity of the problem before any medications are prescribed.

Situational depression responds best to cognitive behavioral therapy and in those cases medications are not necessary.  Other types (bipolar) may need a medical intervention in addition to psychotherapy.  There are many different types or classifications of antidepressants to choose from, therefore a specialist should be consulted to determine the most effective medication for each person.

Pain reduction is another key factor to consider using an antidepressant.  For example the use of tricyclic antidepressants has been an effective tool in pain management for years.  The tricyclic medication 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.  Since sleep disturbances often accompany both chronic pain and depression some healthcare providers use this type of medication as a sleep aid.

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, these three antidepressant medications 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 that is FDA approved to treat depression and certain types of neuropathic 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.

The good news is that there are many different management and treatment options for depression.  Try to remember that overcoming depression can take time and someone living with chronic pain and depression will need to stay strong and focused when faced with tough pain days.  They will also need to reach out for support to keep them from becoming isolated.  The important thing to remember is that overcoming depression is achievable with the right team and the right plan!

To learn more about the importance of identifying and treating depression for more effectivce chronic pain management please check out my article Depression Management with the Chronic Pain Patient that you can download for free on our Article page.

If you’d like to receive training for helping people with relapse prevention, I’m very excited to announce that the Gorski-CENAPS Corporation is presenting The Relapse Prevention Therapy44 Hour Certification Training in Ft. Lauderdale October 18-22, 2010. To learn more about this 5 day 44 hour training you can check out our Calendar 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.

An important part of developing an effective chronic pain management plan is obtaining an accurate understanding of what effective chronic pain management really means.  I believe that effective pain management requires a three part approach:

(1) A medication management plan—developing an effective medication management agreement;

(2) A cognitive-behavioral treatment plan—addressing pain versus suffering by better managing your thinking and feelings as well as changing any self-defeating behaviors and problematic social/family reactions; and

(3) A non-pharmacological (non-medication) pain management plan—developing safer ways to manage pain. 

An effective chronic pain management plan starts with an accurate assessment of your presenting problems, your strengths, weaknesses, support system, as well as any obstacles that could sabotage your pain management.  This usually requires a multi-disciplinary approach that includes an in-depth medical History and Physical by your doctor followed by appropriate diagnostic testing. 

One of the first treatment decisions needs to be whether or not modification to your medication plan is necessary.  If it is needed then you need to determine whether inpatient medical assist is necessary or you can do it on an outpatient basis with your doctor’s guidance.  If modifications to your medications are made you may need some craving management tools to help you adhere to your new plan and ways, in addition to your medication, to handle pain flare ups. 

The next step is to determine whether your pain is more Physiological vs. Psychological/Emotional.  This is very important as you get into pain flare up management and prevention, so you implement the right type of interventions to help you at that point.  Also you want to learn to identify and manage any resistance and denial issues regarding pain management and any payoffs for not having effective chronic pain management. 

You need to develop and implement non-pharmacological pain management interventions.  As you continue with your chronic pain management planning it is important to continue learning even more nonpharmacological, holistic pain management tools.  Then you need to develop an initial relapse prevention plan that will help you identify your high-risk situations for ineffective pain management or self-sabotage.  It is crucial to have a relapse prevention plan in place that addresses both your high risk pain situations as well as any core psychological or other coexisting issues such as depression.

To learn why not going to any lengths for effectivce chronic pain management is a big problem please check out my article Chronic Pain Management Needs More Than a Quick Fix that you can download for free on our Article page.

If you’d like to receive training for helping people with relapse prevention, I’m very excited to announce that the Gorski-CENAPS Corporation is presenting The Relapse Prevention Therapy44 Hour Certification Training in Ft. Lauderdale October 18-22, 2010. To learn more about this 5 day 44 hour training you can check out our Calendar 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.

Physical pain is the reason many people start using potentially addictive substances.  Chronic medication use plus genetic or environmental susceptibility can lead to increased tolerance as a result of searching for pain relief.  Eventually the addictive substance no longer manages the pain symptoms.  In fact, it often increases or amplifies the pain signals—a condition called opiate-induced hyperalgesia (an extreme sensitivity to pain) can also develop.  The end result is severe biopsychosocial pain and problems.

Historically, pain disorders and addictive disorders have been treated as separate issues.  Pain clinics have had great success in treating chronic pain conditions.  Chemical dependency (addiction) treatment centers have also had success in treating addictive disorders.  However, both modalities often struggle when the patient is suffering from both conditions.

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).  Each of the above modalities when implemented independently misses about two thirds of the problem.

Sometimes addiction treatment centers recognize the need to refer a patient to a pain specialist or the pain clinics refer a patient to an addiction specialist.  This is definitely an improvement.  Now about two thirds of the patient’s needs are being addressed (both the Addictive Disorder Zone and the Pain Disorder Zone).  But what about the third zone?

The center area in the diagram is the Addiction Pain Syndrome Zone.  This is why I developed the Addiction-Free Pain Management® (APM) system.  APM™ concurrently addresses the addictive disorder, the pain disorder, and the addiction pain syndrome.  All three zones are addressed—The Addictive Disorder Zone, the Pain Disorder Zone, and the Addiction Pain Syndrome™ Zone.

To learn how the Addiction-Pain Syndrome™ impacted one of my former patients please check out my article Understanding the Addiction-Pain Syndrome™ that you can download for free on our Article page.

If you’d like to receive training for helping people with relapse prevention, I’m very excited to announce that the Gorski-CENAPS Corporation is presenting The Relapse Prevention Therapy44 Hour Certification Training in Ft. Lauderdale October 18-22, 2010. To learn more about this 5 day 44 hour training you can check out our Calendar 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.