This is part one of two on understanding Pseudoaddiction versus Addiction. There are many questions to be addressed when treating someone who has chronic pain and coexisting substance use disorders.  I start most of my Addiction-Free Pain Management® trainings with three questions:

1.  Are we managing pain but fueling the addiction?

2.  Are we treating the addiction but sabotaging the pain management?

3.  Is it addiction or pseudoaddiction?

The term pseudoaddiction is fairly new to the addiction treatment field but has been used in pain management for quite a while now.  I’ve worked with many patients who where labeled as prescription drug addicts when in fact it was pseudoaddiction.  One patient, Sharon is a great example of how damaging a misdiagnosis can be.  Sharon was in her early forties and came from a fairly normal and religious upbringing.  She had never used alcohol or any other drugs and up until a few years ago she had never used any psychoactive prescription medications either.

About three years ago Sharon began having infrequent migraine headaches.  She went to her general practitioner and was given Vicodin to help her cope.  This worked for her at the time, but we now know that she would have been better off on migraine specific medication.  Although barbiturates and opioids are sometimes considered effective for short-term migraine relief, many doctors recommend against prescribing them for long-term use because of the potential for dependence and abuse and the very real danger of developing medication overuse headaches (this is sometimes called pain rebound).

Sharon’s migraines started coming more frequently and she eventually needed to take more and more to get any relief.  As the dose increased her family and then her doctor became concerned that she had become “addicted” to the Vicodin.  Her doctor told her he couldn’t help her anymore unless she went into an addiction treatment program.  Her family found a program that advertised treating pain and prescription drug addiction.  That’s when Sharon’s nightmare began.  As she was detoxing from the Vicodin, the treatment center made her stand up in front of groups and identify herself as a drug addict.  They wouldn’t even let her say she was a prescription drug addict, which was humiliating for this very conservative woman. 

Unfortunately her migraines kept coming back after she was off all her medications.  To add insult to injury, when she asked for help they said she was just “drug seeking” and needed to “turn it over” and work the steps.  Even though I’m a big advocate of 12-Step support for people with addictive disorders, it can be dangerous for support groups, or treatment programs based in the 12-Step program to either label or advise chronic pain patients. 

Sharon was discharged from this program and with a letter to her doctor stating she was an addict and shouldn’t be given opiates anymore.  She became extremely depressed and near suicidal.  That’s when her family entered her into the pain clinic I was consulting for.  I met with Sharon several times and assessed her case.  I discovered her diagnosis never was an addictive disorder; she suffered from pseudoaddiction.

To better understand the importance of overcoming obstacles to effective chronic pain management please check out my article, Overcoming Obstacles for Effective Pain Management, 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 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.

People in chronic pain pay a high price.  That price tag involves both money and human misery.  Up until very recently people in this country had no idea how expensive and wide spread the “silent” epidemic of chronic pain really was.  In 1999 I joined the International Association for the Study of Pain (IASP) to begin researching the true extent of the problem.  In the Untied States alone it was estimated that over 83 million people were living and suffering with chronic pain.  Other interesting statistics jumped out at me.  For example the United States spent over $70 billion dollars between treatments for chronic pain and lost productivity because of it.  Other research indicated the costs to be much higher.

As we fast forward to 2005 that cost rose to over $120 billion dollars for treatment and lost productivity – and that was for just four types of chronic pain: (1) Carpal Tunnel Syndrome; (2) Low Back Pain; (3) Migraine; and (4) Osteoarthritis.  As future research will no doubt demonstrate, the costs continue to rise.  In 2008 many people with chronic pain will not receive adequate treatment and will develop secondary coexisting problems because of mismanaged or under treated chronic pain.

The “cost” for people with chronic pain is not only measured in lost productivity in the marketplace, or in lost salaries, but it also impacts families, friends, jobs, mental health and even their lives.  People can become so depressed that they see no other alternative except suicide.  Many significant others who become primary caregivers want to be helpful, but as the pain lingers they burn out and feel frustrated, and even hopeless.

About 10 percent of people taking mood-altering medication for chronic pain will develop substance use disorders including abuse, dependence, pseudoaddiction, and addiction.  When they go into a pain management program the focus is on the physical pain, but those programs don’t know what to do when patients act out from an addiction and often discharge them.  If a person goes into an addiction treatment program, the entire focus is on the addictive disorder and often the pain is not adequately addressed.  Collaborative multidisciplinary treatment interventions are a must for this population.

I believe that anyone with chronic pain and other disorders deserves effective and compassionate treatment.  It does not matter whether they have an addictive disorder or other psychological problems—they need and should get help.  I’ve spent almost a quarter of a century studying and working with people with chronic pain and coexisting disorders and I’m here to tell you that effective, concurrent treatment is possible.  That’s why I developed the Addiction-Free Pain Management® System, published books on the subject, and continue to train healthcare providers on effective ways to deliver a collaborative integrated pain management approach.

For a number of years the focus has been to blame the patient or the physician, as the expanding war on pain management prescription drugs attests to.  If we start demanding effective, multidisciplinary pain management for people living with chronic pain, we can begin to lower the financial and human-misery price tag.  We all know someone; a loved one, friend, colleague or an acquaintance who has had some kind of mismanaged chronic pain and suffered because of it. 

Are you willing to join me in lobbying our representatives to push for better treatment and urge them to stop the war on pain management that the DEA is currently waging?  Please write letters or make phone calls and let your voices be heard.

To learn more about the importance and prerogative of obtaining effective chronic pain management please check out my article The right to Quality Chronic Pain Management 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.

Many people undergoing chronic pain management frequently become depressed due to living with under-treated or mistreated pain symptoms. This process starts when thinking and emotions become problematic. By problematic I mean that the thinking process becomes irrational or dysfunctional and they start to mismanage their feelings; they often have urges to indulge in self-defeating impulsive or compulsive behaviors to cope with depression surrounding their chronic pain management. This in turn affects all the relationships in their lives.

There are several types of clinical depression that involve disturbances in mood, concentration, self-confidence, sleep, appetite, activity and behavior as well as disruptions in friendships, family, work and/or school. A clinical depression is different than the experiences of sadness, disappointment and grief that are familiar to everyone. Because of this it can be difficult to determine when professional help is necessary.

Feeling Down versus Being Depressed

A period of depressed mood that lasts for several days or a few weeks is often just a normal part of life and is not necessarily a cause for concern. Although these feelings are often referred to as depression, they typically do not constitute a clinical depression because the symptoms are relatively mild and only last for a short period of time. Moreover, milder periods of depression are often related to specific stressful life events and improvement frequently coincides with the reduction or elimination of the stressor.

If a person is experiencing clinical depression, however, they would be experiencing substantial changes in mood, thinking, behaviors, activities and self-perceptions. If they are depressed, they often have difficulty making decisions.  Even the day-to-day tasks of paying bills, attending classes, reading assignments, and returning phone calls may seem overwhelming.

If depressed a person may also dwell on negative thoughts, focus on unpleasant experiences, describe themselves as a failure, believe that things are hopeless, and feel as though they are a burden to others. The changes in mood brought on by depression frequently result in feelings of sadness, irritability, anger, emptiness, and/or anxiety.

There are different types of depression, including Bipolar Disorder, in which depressive episodes alternate with mania (extremely elevated mood, energy, and unusual thought patterns) or hypomania (generally a less destructive state than full mania) episodes which may include feelings of agitation and euphoria. A severe or long-term depressive episode can substantially wear down self-esteem and may result in thoughts of death and even attempts at suicide.

To better understand the importance of addressing depression in chronic pain management please check out my latest article, Depression Management with the Chronic Pain Patient, 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 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 listen to a radio interview I did conducted by Mary Woods for her program One Hour at a Time please Click Here to go to this interview.