Pain and Addiction

People in chronic pain can be difficult to treat. Their pain is real and their need for relief is urgent. Because the typical treatment plan involves the use of very strong pain medications, many people are at high risk of becoming addicted to them. When treating addiction and chronic pain, there are a series of difficult questions that must be asked:

• What if the traditional medication management doesn't work?
• What if the person quickly develops tolerance to their painmedication and requires progressively larger doses to gain relief from the pain?
• What happens to people who consistently abuse their pain medication by using more than prescribed?
• How can you distinguish who legitimately needs more pain medications over a longer period of time, from those who are manipulating for more pain medications because they have become addicted to it?
• What can help a person who has a pain disorder and an addiction to their pain medication who feels helpless and hopeless and can see no way out without suffering?

Using my Addiction Free Pain Management^TM (APM) system as a guide, my focus here will be to explore the answers to these and other difficult questions that are routinely asked by treatment professionals and their patients who are suffering with chronic pain. In order for people to feel empowered instead of victimized by their pain, they must develop a pain management and addiction recovery plan which is the foundation of the APM^TM treatment approach. If a person with chronic pain and addiction is willing to do the work, they will find physical and emotional recovery as well as renewed hope for a better quality of life.

Before we can address these questions it's important to understand what really happens when chronic pain and addiction meet.

Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II

When I began working with people who had chronic pain and addiction in the late 1980's it was extremely challenging. I could also identify because I had been managing my own chronic pain condition for several years so when I was able to help someone in treatment it was very fulfilling. Over the next several years I began to discover that this group had very specific needs and issues that were not being appropriately addressed through the current "addiction" paradigm.

As a result, I began developing the foundation for what was to become the first Addiction Free Pain Management^TM clinical skills training I presented in 1996. I began looking for information about people who had chronic pain and co-existing addiction, but was unable to find much written at that time. I decided to survey addiction programs and pain clinics to find out what happened to people who entered treatment with both conditions.

I discovered that the entire focus at addiction programs was on the addictive disorder, but the patient's pain was not adequately addressed. Addiction programs struggled when someone with chronic pain came into their program. At pain clinics their entire focus was on the physiological pain. They found it difficult to deal with patients who were acting out with their addiction. This was an important learning experience for me and I realized that the focus needed to be on concurrent treatment for both the pain and the addiction.

In thinking about this further I saw that 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). When either of the above modalities is implemented alone it misses about two thirds of the problem.

Now what about the third zone? This is what I coined the Addiction Pain Syndrome Zone which is a combination of the Pain Disorder Zone the Addiction Pain Syndrome Zone. The addictive disorder leads to one universe of biopsychosocial problems, and the pain disorder leads to a different set of problems. In the Addiction Pain Syndrome Zone negative consequences more than double. 1 + 1 no longer equals 2, rather 1+ 1 now equals 3 or more. This is called synergism.

Synergism is a condition where the combined action is greater in total effect than the sum of the individual effects. A new universe of symptoms now occurs due to the synergistic effect. To have successful treatment outcomes this phenomenon must be addressed through a specialized treatment approach-a Synergistic Treatment System.

Addiction-Free Pain Management^TM (APM) is such a system. APM^TM concurrently addresses The Addictive Disorder Zone, the Pain Disorder Zone, and the Addiction Pain Syndrome Zone and teaches treatment providers how to more effectively deal with patients who have both conditions.

Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II

In my last submission I explained what happened when pain and addiction meet-the synergistic Addiction Pain Syndrome. To successfully manage this phenomenon it is crucial to develop a specialized treatment approach-a Synergistic Treatment System.

Addiction-Free Pain Management^TM (APM) is such a system. APM^TM concurrently addresses The Addictive Disorder Zone, the Pain Disorder Zone, and the Addiction Pain Syndrome Zone and helps you to more effectively deal with both conditions. In the several weeks I will cover more of what the problem is while also shifting toward a solution.

If you want more instant gratification you can go to my website http://www.addiction-free.com and go to the Articles page for free educational downloads. On the Publications page you can order my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management System.

I propose that effective treatment for someone with an addictive disorder and chronic pain requires a three part approach: (1) A medication management plan-in consultation with an addiction medicine specialist; (2) A cognitive-behavioral treatment plan-addressing the psychological/emotional components of pain and changing self-defeating behaviors; and (3) A nonpharmacological pain management plan-developing safer chemical-free ways to manage chronic pain and pain flare ups. The Addiction-Free Pain Management^TM System is a strategic combination of all three of these components working together, implementing a multidisciplinary integrated pain management approach.

Recovery and avoiding relapse is possible if you are willing to do the footwork and follow this type of plan using a collaborative multidisciplinary treatment team. With the proper treatment plan and positive support, you can experience successful pain management. You can become a proactive participant in your healing process instead of being a passive recipient (i.e., victim). This shift allows you to become empowered and experience a much better quality of life.

Over the past twenty-five years I have seen many people struggling with pain management use food as a comfort or coping tool. Some of these people had a coexisting addictive disorder that was in remission and were doing a good job with their pain management until they began using food compulsively or addictively. Many of them put on weight that sabotaged their pain management plan, which eventually led to inappropriate medication use once again. At some point they needed to make a decision to look at their relationship with eating.

It is very important when you are confronted with a decision to make a significant lifestyle change that you carefully weigh the benefits and disadvantages of making that transition. It is easy for many people who have been eating addictively to see the disadvantages or negative consequences of that behavior (i.e., obesity, heart problems, joint problems, etc.). Therefore, it is often difficult to admit that they mistakenly believe there is a benefit to eating addictively-it helps them cope with their chronic pain condition.

Some people use eating to dull the pain of uncomfortable emotions or to deal with the consequences of having poor social skills and lack of friendships. Others use eating to avoid intimacy by making food their best friend. There must be some benefits to your eating inappropriately or you wouldn't have started eating to cope instead of for fuel.

These benefits are sometimes called secondary gains. Being open to recognizing that this may be a problem is the first step toward change. Many of my patients have found some benefit from completing my Recovery and Relapse Prevention for Food Addiction Workbook, which you can review on my website http://www.addiction-free.com on the "Publications" page.