One of a patient with chronic pain’s most persistent fears is that others will believe that their pain is exaggerated, not real, or “all in their heads”. For the patient with both pain and addiction, this fear is often magnified. Here at CeDAR, we know that patients with pain often struggle with the idea that “I’m a person with chronic pain that is out of control . . .I’m not an addict”.
Working as a team, CeDAR’s addiction and pain management professionals support this individual’s treatment needs using an interdisciplinary approach that includes safe detoxification from problematic and addictive substances, prescribing evidenced-based effective medications and utilizing a variety of non-pharmacologic methods of pain control and coping skills.
For some individuals, use of prescribed opiates such as Vicodin or Percocet may be involved in their road to addiction. One patient recounted “it felt like a blanket had put on my emotional pain when I took my pain medicine for my knee injury”. Unwittingly, this individual’s chronic unhappiness and a history of childhood neglect felt somehow “better” when he took his pain medication. He described not only less knee pain, but less life-pain.
For others in recovery from addiction, an opiate may be prescribed following a surgery or serious painful injury. If the recovering individual is unprepared or uninformed, the neural pathways in the brain’s reward system can reawaken the addictive process.
At CeDAR, our patient’s learn safeguards to prevent the catastrophic spiral into addiction accompanying an acute painful illness.
Some of these are:
1. Contact your sponsor and inform your trusted support group – perhaps even having them accompany you on your medical visits
2. Inform your addiction team of all medications that you are prescribed and inform full communications among your providers
3. Have a trusted individual hold the prescriptions for you so you are not tempted to overmedicate
4. Try non-drug therapies after consultation with your treatment provider (i.e. relaxation techniques, thermal treatments, physical therapy, acupuncture, etc.)
Without these safeguards, things quickly get out of control and what the patient believed would be a short-term use of post-op medications turns into frequent early requested refills, reports of “lost prescriptions”, having a few cocktails with the prescription to enhance the effect of the prescription effect, and finally the physician refuses to refill the opiates, fearing that the patient has developed an addiction to them. These patients then sometimes turn to street drugs, with heroin being the cheapest replacement for their opiate prescription.
In our gender-specific pain management groups, we address:
- How irrational thought patterns may be woven into the pain narrative
- Utilizing imagery for comfort
- Pain and the relationship of: interpersonal boundaries, activity pacing, and sleep
- Medications that can safely be used for pain without harming recovery
- Developing a pro-active plan for “just in case” (aka “how do I stay in recovery if I have to have surgery or am in a car wreck?”)
- Identifying your pain management resources