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Looking at Pseudoaddiction in Chronic Pain Management

February 22nd, 2010

The term pseudoaddiction is fairly new to the addiction treatment field but has been used in chronic pain management for quite some time now. What is important to remember is that even though pseudoaddiction looks like addiction, it is actually caused by an undertreated or mistreated chronic pain condition. 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, sometimes slowly.

In 2004 the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine collaborated on defining pseudoaddiction: Behaviors that may occur when pain is undertreated.  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.

To read my newest article on this topic please check out Differentiating Between Addiction and Pseudoaddiction 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.

Do you Want to Avoid Suffering in Chronic Pain Management?

February 17th, 2010

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 as Transitional Interventions

February 16th, 2010

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.


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