Pain is the reason many people start using potentially addictive substances. Mary is an example of what can happen when a pain condition is not managed appropriately and treatment depends only on medication.
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Physical pain symptoms
We know that regular use of psychoactive medication plus a genetic or environmental susceptibility can lead from pain relief to increased tolerance. Both of Mary’s parents were alcoholics and she was in an abusive marriage. She then developed a chronic pain condition and was prescribed narcotic medication to treat her pain. Mary soon discovered that her pain medication also helped her escape from painful childhood memories and the trauma of an abusive relationship.
Eventually Mary’s medication no longer helped her physical pain symptoms or emotional distress, so she started taking much more than was prescribed. She eventually went to several different doctors to get the amount she believed she needed, but her pain continued to get worse. In fact, Mary’s medication actually started increasing or amplifying her pain signals—this is called the pain-rebound effect.
The end result for Mary was an addiction to her medication that increased her pain and created problems in every area of her life; physically, psychologically, and socially (Biopsychosocial). Because Mary was experiencing both chronic pain and substance dependency problems she needed a specialized concurrent treatment protocol for both conditions.
Historically, pain disorders and addictive disorders have been treated as separate issues. Pain clinics have had great success in treating chronic pain conditions. Chemical dependency treatment centers have had success in treating addictive disorders. However, both of these treatment centers struggle when the person is suffering from both conditions.
When dealing with a person in chronic pain, chemical dependency recovery or treatment programs cover about a third of the problem, which we call the Addictive Disorder zone. The pain clinics cover a different third of the problem, called the Pain Disorder zone. Each of the above modalities misses about two thirds of the problem.
Sometimes chemical dependency treatment programs recognize the need to refer a patient to a pain specialist or the pain clinics might refer a pain patient to a chemical dependency specialist. This is definitely an improvement. Now about two thirds of the person’s needs are being addressed within both the Addictive Disorder zone and the Pain Disorder zone. But what about the third zone—that I call the Addiction Pain Syndrome zone?
When addictive disorders and pain disorders coexist, their negative impact more than doubles. Addictive disorders lead to one set of biopsychosocial problems, and the pain disorders lead to another set of problems. 1 + 1 no longer equal 2, rather 1+ 1 now equals 3 or more. This is called synergism.
When Mary’s negative consequences from the Addictive Disorder Zone and her Pain Disorder Zone were added together she experienced not only the problems of both zones but also additional problems from the new zone—the Addiction Pain Syndrome Zone. Her synergistic symptoms occurred due to the combined effect.
To have successful treatment outcomes this phenomenon must be addressed through a specialized treatment approach—a Synergistic Treatment System. That is why people developed the Addiction-Free Pain Management (APM) system. APM addresses the addictive disorder, the pain disorder, and the addiction pain syndrome.
Treatment protocol for chronic pain
An effective synergistic treatment protocol for Mary’s chronic pain and substance dependency issues needed to include the following components: Medication Management Components, Core Clinical Processes, and Holistic Treatment Processes.
Part One Medication Management Components
For this component to be effective it is important to find a doctor that is addiction medicine certified—a call to a local drug treatment program may be necessary to find this person. Mary’s medication management plan included collaborating with an addiction medicine practitioner/specialist to make sure that her medication was needed and was the right type, as well as the appropriate quantity and frequency, so it would not trigger relapse or end up with Mary abusing her medication again.
Part Two Core Clinical Processes
Mary also needed to deal with her irrational thinking, uncomfortable emotions, and self-defeating urges and behaviors as well as the isolation tendencies that come about with pain and addiction. This required a cognitive behavioral therapy approach using the eight clinical processes in the Addiction-Free Pain Management Workbook as a starting point. This process worked well for Mary because her health care provider was experienced in the concurrent treatment of chronic pain and substance dependency.
Part Three Holistic Treatment Processes
This process included Mary searching out alternative non-pharmacological/holistic pain management modalities such as hydrotherapy, physical therapy, acupuncture, chiropractic, prayer, meditation, hypnosis, self-hypnosis, etc. Also, reading “Managing Pain Before it Manages You,” a book by Margaret Caudill, was very helpful for Mary. Mary also got connected with both a 12-Step group and a chronic pain support group, which greatly enhanced her recovery.
Knowledge is power
Developing an effective treatment plan also required knowing which stage of the problem Mary was in. It was important for her to know how much damage had been done by her inappropriate use of pain medication and which stage of the addiction process she was at. As Mary moved into recovery it was also essential to understand which stage of the developmental recovery process she was in so she could implement appropriate treatment interventions.
As you can see, the road to recovery is a difficult one for someone with both chronic pain and chemical dependency. However, most of the chronic pain research I have reviewed over the past two decades has been very clear about treatment outcomes. The best prognosis is when people are proactive in their own treatment and recovery process. One way they can do this is to learn as much about their pain and effective pain management as they can.
Once people know what is really going on with their body and mind they can start to take action to effectively manage their pain. In fact, they need to stop seeing pain as their enemy and see it as their friend. I know this is much easier said than done.
Mary looked at me like I was crazy when I told her must make peace with her pain and that pain is her friend. She even told me—very strongly—she couldn’t buy that, but nevertheless it is true. It was very important for Mary to move out of victim mode and empower herself by developing a pain management and chemical dependency recovery program. Fortunately, Mary adhered to her APM treatment plan and remains clean and sober as well as effectively managing her chronic pain.
