Magazine article Addiction Professional

Shared Responsibility Equals Sound Pain Management

Magazine article Addiction Professional

Shared Responsibility Equals Sound Pain Management

Article excerpt

The connections between opioid use for chronic pain management and addiction are well-known, and prescription pain medications are now the most abused drugs in certain regions of the country. Addiction treatment facilities have been seeing an increase in the number of patients presenting with both chronic pain and substance use disorders. Such patients often have other co-occurring problems as well, including depression and anxiety.

While an addiction treatment program likely will address the substance use disorder, the chronic pain that caused the need for medication in the first place might still be present. For these patients, the two main post-treatment goals are the management of pain and the prevention of relapse. The danger of relapse means that opioid analgesics should generally be avoided (which makes pain management more difficult), but the existence of chronic pain can increase the desire to self-medicate in unsafe ways.

Three entities contribute to meeting goals successfully: the addiction treatment provider, the patient; and other medical professionals.

Providers need to talk pain

Addiction treatment professionals work with patients both during the detox/ inpatient phase of treatment and the posttreatment period. In addition to treating addiction, they must educate their patients on pain management techniques.

Kevin Holbert, MD, medical chief of staff at the Lakeview Health addiction treatment facility in northern Florida, explains that the detox process itself can contribute to a reduction in pain.

"Opioid-induced hyperalgesia can cause patients to assess their baseline pain incorrectly," Holbert says. "This, in turn, can lead to increased prescription of medication, which will-ironically-increase the hyperalgesia."

Following detox, patients sometimes find that their pain is more tolerable than they had expected.

A variety of pain management techniques should be discussed with patients. A switch to non-opioid analgesics can lessen the pain, although nonsteroidal anti-inflammatory drugs (NSAIDs) are often less effective in treating chronic pain. Various psychological strategies also can help. In particular, recent research has shown that pain acceptance can not only reduce the perception of pain but also can lessen other problems, such as depression.

When patients do not expect to live pain-free, their acceptance of a certain level of pain as the "new normal" can lead to decreased pain and stress, because they are less focused on the prevention of pain. Meditation and mindfulness also can contribute to both sobriety and pain management.

Physical activity also plays a role. The pain-fear avoidance cycle can lead patients not to engage in activities associated with pain. When a patient avoids pain by not engaging in movements that have caused pain in the past, a feedback loop can be created that causes them to continue to avoid pain. This can contribute to a lack of physical fitness, which then exacerbates the pain and can ultimately lead to disability. Health and wellness strategies are increasingly being incorporated into addiction treatment programs, and their role in pain management should be emphasized.

Patients' support options

In the post-treatment phase, patients have primary responsibility for their continued recovery. A willingness to participate in activities that contribute to sobriety and pain management is necessary for success-assuming that patients have been made aware of such techniques during their inpatient stay. …

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