I’m often asked when someone has chronic pain and addiction, which condition do we treat first?  Many people think it’s one or the other.  But it’s really not that simple.  Patients who need in-patient treatment and have chronic pain and coexisting addiction, need to be treated for both conditions at the same time, in the same place, by the same treatment team. 

For example if you have an arbitrary 100 units of treatment available, it doesn’t mean you use 50 for pain and 50 for addiction.  Instead a multidisciplinary assessment is necessary in order to see which condition needs the most intervention first; but you never ignore the other condition.  Sometimes that means 80-90 percent of the treatment focus is on pain management, but you still pay attention to the addiction with the remaining 10-20 percent of your effort—it can also be the other way. 

The most important part of the treatment process is conducting a multidisciplinary assessment—in real world treatment you would be assessing both pain and addiction concurrently.  This would be the time to implement a medication detoxification or taper as well as other safer interventions if needed. 

Effective treatment means that patients learn how to differentiate between the physical and psychological-emotional symptoms of pain which is described in the first exercise of my Addiction-Free Pain Management® (APM) Workbook.  To learn more about this workbook or to purchase it please Click Here.

The patient must also understand what denial is and be taught how to identify and manage it.  They need to see how it undermines an effective chronic pain management program, as well as supporting them to look at the payoffs or secondary gains they may have for being in pain.  Now is the time to begin teaching them non-pharmacological pain management interventions. 

The APM™ System supports patients to build their nonpharmacological pain management plan—in fact this is an ongoing process, after which they develop relapse and pain flare up plans for pain management.  In the real world this happens concurrently with the addiction relapse intervention plan.  This plan plan also includes craving management to help ensure that the patient adheres to their medication management agreement.

It’s also important to make sure patients resolve any grief caused by their chronic pain management condition and are moving into acceptance—and beginning to reintegrate back into their life.  At this point the person should be able to say, and mean it, “today my life is better than ever—it may be different, but it is better and I have hope where before I had none.” 

Another important component is reviewing and refining the patients’ activity pacing plan.  Some people are at one end of a spectrum where they have been immobilized and need to be speeded up; while others are major over-achievers and need to be slowed down.

To learn more about concurent Addiction-Free Pain Management® treatment please check out my article The Stages and Phases of Concurent Treatment that you can download for free on our Ariticles page.

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

We all know how important it is to manage stress.  But if you’re living with chronic pain management like I am, it’s crucial because increased stress leads to increased pain.  In this blog I want to give you a brief overview of five simple steps for managing stress associated with chronic pain management: Understanding Stress; Using Positive Affirmations; Breath Work; Muscle Relaxation; & Meditation.

Step One Understanding Stress: It’s important to learn about stress and understand the stress scale.  It’s essential to recognize that stress can either be a positive influence or make your life overly difficult.  When looking at stress on a 1 to 10 scale, with 1 meaning you are very relaxed and 10 meaning you can’t function or you shut down, the danger zone begins at level 7 —stress overload!  From levels seven to ten you will experience disruptive symptoms.  It depends on how you interpret this distress whether you face the situation with confidence or helplessness.  At this point, you could shift into survival mode—fight, flight or freeze.  Any of those three modes will amplify your pain levels.  The fight mode leads to anger and attacking others; the flight mode leads to fear and hiding; and the freeze mode leads to depression and immobilization.

Step Two Stress-Reducing Self Talk or Positive Affirmations: The premise here is if you change the way you think you will automatically start changing the way you feel. You really can talk yourself into feeling better no matter what’s happening around you or to you.

Step Three Autogenic Breathing or Breath Self-Regulation: This is a systematic daily practice of breathing sessions that last around 15 minutes, usually in the morning, at lunch time, and in the evening.  One simple exercise is to breath in deeply to the count of five hold for seven counts and slowly exhale starting from nine to zero.  You might consider adding this breath exercise to the next stress tip and practice both three times a day.

Step Four Progressive Muscle Relaxation: One way to do this is to start by taking slow deep breaths then hold your breath while tensing up one muscle group at a time and when you exhale let the muscle group relax.  Then add the next group and keep going until you are tensing and releasing all the muscle groups in your body.

Step Five Meditation: There are literally hundreds if not thousands of types of meditation.  One way to start is to select a consistent time and a quiet place, either early morning and/or evening. Wear loose comfortable fitting clothing and a comfortable position that you can stay in for at least 30 minutes.  Do deep breathing for a minute or two to help relax the body.  Close your eyes and then focus on the point between your eyebrows to help increase your concentration.  If your mind wanders be gentle with yourself and just refocus. When you first start; meditate for 5-7 minutes then slowly increase your time.

These five steps are just a starting point and I encourage you to learn as many stress management tools as you can.

If you want more information on stress and chronic pain management please go to our website and check out my article The Stress Pain Connection , that you can download for free on our Ariticles page. This article also shows you Terence Gorski’s Stress Thermometer to help clarify levels of stress.

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.

Pseudoaddiction is a term which has been used to describe patient behaviors that may occur when pain is under-treated.  Patients with unrelieved pain may become focused on obtaining medications, clock watch, or otherwise seem to be inappropriately drug seeking.  Even such behaviors as illicit drug use and deception can occur in the patient’s efforts to obtain relief.  Pseudoaddiction can be distinguished from true addiction in that the behaviors will resolve when the pain is effectively treated.

This was the case for Sharon. The clinic decided to use migraine specific medications as opiates are contra indicated for ongoing migraine treatment.  There are seven triptans (Imitrex, Maxalt, Zomig, Amerge, Axert, Frova, and Relpax) that were developed for and FDA approved as migraine abortive (management) medications. These medications work to actually stop the Migrainous process in the brain and stop the Migraine attack and its associated symptoms. 

Sharon responded well to Maxalt, but she also was put on preventative medication.  Ergotamine medications (used as vasoconstrictors for migraine prevention and are sometimes mixed with caffeine) such as DHE and Migranal; they are also FDA approved for Migraine treatment as is Midrin (a combination of acetaminophen, dichloralphenazone, and isometheptene).  Sharon was also prescribed Migranal.  Because of these two medications, her migraines were now being effectively managed.

Sharon was also prescribed an SSRI antidepressant as I implemented a cognitive behavioral therapy plan for the depression and pain-focused psychotherapy for pain management. Today Sharon is once again experiencing a great quality of life but still has nightmares about being in the treatment program.

I want to add that it is crucial to conduct multidisciplinary assessments and keep an open mind to discover whether a patient is experiencing addiction or pseudoaddiction.  Going back to my original three questions; Sharon’s general practitioner was at risk of fueling addiction and the addiction treatment program definitely sabotaged her pain management.  Sharon was experiencing pseudoaddiction—not addiction as everyone thought.  All of her addiction symptoms disappeared when she followed an appropriate and effective medication management plan, which enabled her to manage her migraines appropriately.

Another problem many people experience that leads to either pseudoaddiction or addiction is suffering.  To learn about the difference between pain and suffering please check out my article Pain is Inevitable but Suffering is Optional when Living with Chronic Pain that you can download for free on our Ariticles page.

You can learn more 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.  Also, please check out my Addiction-Free Pain Management® Workbook. To purchase this workbook 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 learn about my upcoming trainings you can check out our Calendar page.