Chronic pain is an issue recently at the forefront of addiction treatment. As America’s opioid epidemic increased and got worse, government and public health officials began to call for greater scrutiny on prescribing practices, especially the prescribing of dangerous opioids. Overtime, prescribing methods began to catch up with the overprescribing of opioids, with less and less opioids prescribed for patients dealing with acute medical conditions and alternative methods considered for patients that could avoid the prescribing of opioids. However, it seems that an unintended consequence of trying to get America’s arms around the opioid crisis was that chronic pain patients, having been prescribed opioids for many years, were seemingly cut off from medications they had been taking for a long time, and thrown into the grips of dealing with the physical dependency and tolerance they had built up for many years.
Recently, the CDC issued updated guidance on the prescribing of opioids, looking to try to rectify issues around chronic pain patients and what seemed like a lack of access to necessary medications. However, in that updated guidance, the CDC continued to recommend prescribing opioids only when absolutely necessary and continued to suggest doctors and nurses look at alternatives to opioids when prescribing for individuals in pain.
So, what is chronic pain, how can it be appropriately treated, and how can rehabs and addiction treatment professionals best support chronic pain patients that suffer from substance use disorder and need to find sobriety and recovery? Let’s take a look.
What is Chronic Pain?
Chronic pain is considered pain that an individual has that lasts for over three months and can be pain that lasts for years or decades. Chronic pain is also considered pain that can be constant (meaning pain that is present all the time) or it can be intermittent (meaning pain that comes and goes.) There is no specific area of region of the body for chronic pain, as it can occur anywhere within the body of the individual sufferer. This is different than acute pain, which is the type of pain that occurs when someone gets hurt or injured. Acute pain is a type of pain that doesn’t last long and ends when the body heals from whatever caused the acute pain. The most common forms of chronic pain are arthritis or joint pain, back pain, neck pain, nerve pain, cancer pain (often occurring near a tumor), scar tissue pain, muscle pain, or migraines.
How is Chronic Pain Treated?
The treatment for chronic pain would come from diagnosis and then a treatment plan created by the treating doctor or attending physician. The diagnosis can come from a number of different tests, or sometimes a battery of tests, that can include blood tests, imaging such as X-rays or MRIs, nerve conduction studies, spinal fluid tests, urine tests, reflex and balance testing, or muscle tests such as an electromyography. The treatment for chronic pain will depend on the type of chronic pain the individual is experiencing, the cause of the pain, and the individual’s age, physical activity, and overall medical and health condition. Often, treatment will include at least one approach, but usually multiple approaches. This can include physical therapy, stretching exercises, physical activity and fitness, medical treatments such as transcutaneous electrical nerve stimulation (TENS), nerve blocks, epidural steroid injections, or other types of injections, and/or medications. While opioids are the most well-known medications for chronic pain, the latest research demonstrates that opioids are also the most dangerous medications used for chronic pain, the medication with the most side effects (such as physical dependency or addiction), and that opioids are much better suited for short-term acute pain than for chronic pain. Other medications often prescribed for individuals suffering from chronic pain are anticonvulsants, antidepressants, corticosteroids, steroids, muscle relaxers, anti-inflammatory drugs, topical products that contain pain relivers, and OTC (Over the Counter) drugs like Tylenol, Motrin, or Aleve. There is some more recent research and studies that medical marijuana may also be effective to help treat chronic pain.
Treating Chronic Pain in Individuals with Substance Use Disorder
For patients that suffer from chronic pain, medical professionals and addiction treatment facilities can face difficulties in offering treatment. No one wants to be in chronic pain, and medical professionals do not want to allow patients to suffer from chronic pain. However, it is important for medical professionals to appropriately navigate treating chronic pain in a patient that also has a substance use disorder or a patient with chronic pain that has developed an addiction due to the prescribing of medication to treat the chronic pain. There are also many chronic pain patients that have issues with drugs and alcohol unrelated to opioids, such as a chronic pain patient suffering from alcoholism or a patient appropriately using medication to help with chronic pain, that also may be using or misusing cocaine or methamphetamines.
First, it is important to make sure a patient is separated from harmful substances through a medical detox. Then the medical professionals can determine a baseline for the individual’s chronic pain, as many chronic pain sufferers find that after stopping the use of drugs and alcohol, the pain was not as bad as they thought. Then, alternative chronic pain treatments can be used, as described above. Often, there are multiple approaches in chronic pain treatment used, that can be effective and less dangerous that opioids. Other options include the use of medication such as Suboxone in the form of Medication Assisted Treatment (MAT) along with other treatment approaches. Additionally, there are four major lifestyle factors that can affect someone’s chronic pain and when effective approaches used in these four areas, help to minimize chronic pain. Healthcare providers sometimes refer to these four areas as the four pillars of chronic pain. They are:
If a chronic pain patient can focus on ways to improve these four areas, they can help minimize the chronic pain they are dealing with on a daily basis. There are also outside-the-box alternative treatments and approaches that have been shown to help with chronic pain. They include some types of therapy or counseling, acupuncture, aromatherapy, biofeedback, hypnotherapy, mindfulness practices and exercises, music or art therapy, Reiki, massage, guided imagery, yoga, and meditation practices. Many individuals are surprised at the many different methods of treating chronic pain.
For an individual suffering from chronic pain but also addiction, it is vital to be honest with the doctor or addiction treatment center regarding their pain, their past attempts to manage it, and be open-minded in looking at alternative ways to help treat and manage the chronic pain moving forward. For individuals in chronic pain, just like anyone suffering from addiction, they often feel isolated, alone, and like they are the only person in the world dealing with this issue. This is untrue. There are millions of people suffering from addiction and chronic pain, and there are also millions of people that have overcome these issues or learned to manage them to achieve a high quality of life. It is important that chronic pain patients receive what they need in order to manage their pain, while also receiving what they need to overcome their addiction, find recovery, and a life worth living.
If you or someone you know needs help for addiction or co-occurring disorders, please give us a call. Innovo Detox offers the latest in evidence-based medical, psychiatric, and clinical care for those in need of detox and medical stabilization in Pennsylvania. Helping clients from Delaware County, Chester County, Dauphin County, Montgomery County and the surrounding Mid-Atlantic area. If we aren’t the best fit for you or a loved one, we will take the necessary time to work with you to find a detox, rehab, treatment center or provider that better fits your needs. Please give us a call at (717) 619-3260 or email our team at [email protected]. For more information on our company or services, please visit our website at www.innovodetox.com.