Nine Sleep Hygiene Tips for More Effective Chronic Pain Management

I’m often asked by patients and people at my trainings "when someone has chronic pain and addiction, what can they do for sleep problems because they can’t safely take many of the sleep medications." Well first of all I don’t think it’s a good idea for anyone to become dependent on sleeping pills. If you look at the patient education information on most sleep medications you will see that it tells you that they are not intended for chronic use.

So what do you do when you live with chronic pain and need to sleep? Do you give in and use potentially dangerous sleep medications or just suffer? Most authorities recommend practicing good sleep hygiene, along with becoming very familiar with their sleep deprivation problem (i.e. understanding the cause). Sleep hygiene refers to the habits, environmental factors, and practices that may influence the length and quality of your sleep. These include bedtime, nighttime rituals, and disruptions to one's sleep. These are typically represented by simple guidelines meant to effectively promote a good night's rest.

If sleep problems persist after implementing sleep hygiene practices, it may then be the time to seek medical help. But what is sleep hygiene? Below I’m putting 9 sleep tips that I found on About.com , a website devoted to educating people about back and neck pain. If you want to see more about sleep hygiene please go to that website and type in “Sleep Hygiene.”

1. Relax before bedtime


2. Make sure your bedroom is quiet, dark, cool, and comfortable


3. Make sleep a priority: don’t sacrifice sleep to do daytime activities


4. Get up and go to bed at the same time every day, even on weekends


5. Avoid caffeine and other stimulants


6. Don’t smoke - in bed or at all


7. Exercise every day, but avoid doing it 4 hours before bedtime


8. Bedrooms are for sleeping and sex, not for watching television or doing work


9. Don’t take naps

I’ve been helping people with this problem for a long time and have actually used most of interventions listed above. One of the tools I also recommend for many of my patients is to use headphones with relaxation techniques, soothing sounds or music to help them to sleep. I also teach people relaxation response techniques that take about 7-10 minutes and one of the positive side effects is a reduction in their sensation of pain.

If you want more information on chronic pain management and sleep problems please go to our website and check out my article Chronic Pain Management and the Role of Sleep Disturbances , that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you or a loved one is undergoing chronic pain management, especially if you're in recovery or believe you may have a medication or other mental health problem and you want to learn more effective chronic pain management tools, please go to our Publications page and check out my books; especially the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

To listen to a radio interview I did conducted by Mary Woods for her program One Hour at a Time please Click Here to go to this interview.

Chronic Pain Management and Addictive Disorders

According to researched published in Pain Physician Journal as recently as 2006, 90 percent of people in the US receiving treatment for pain management were prescribed opiate medication. Of that number 9 percent to 41 percent had opiate abuse/addiction problems. The research also stated that 16 percent of pain management patients experienced illicit drug use along with their prescribed medication, and as high as 34 percent in other research they reviewed. These numbers give a picture of the overall problem of chronic pain abuse/addiction problems in the general population. What is harder to quantify is the extent of this problem in the recovering community.

Whenever I asked the following question at trainings, “How many of you know someone in long-term recovery who has relapsed over pain management issues?” most of the audience raises their hands. The reasons vary, but more often than not they either take the wrong medication or too much. Others try to tough the pain out and end up relapsing back to their original drug of choice.

Living with chronic pain is difficult for anyone, but especially for someone with coexisting abuse, addiction or other psychological disorders. They can become severely depressed and discouraged. Healthcare providers often become confused and frustrated when their treatment interventions are ineffective and frequently blame their patients. The problem of managing pain and medication in recovery continues to grow and healthcare professionals are left with the challenge of how to effective address it. Given the biopsychosocial nature of addiction and chronic pain, it is imperative to understand both conditions and implement a multidisciplinary treatment plan.

To learn more about the need for teamwork for effective chronic pain management check out my article The Need for Multidisciplinary Chronic Pain Management that you can download for free on our Article page

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders; including depression, addiction and other coexisting psychological disorders effectively; please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Chronic Pain Management and Addictive Disorders

People with chronic pain who develop substance use disorders due to taking medication present a difficult challenge to treatment professionals. Many health care providers see no difference in treatment outcomes when these people are treated either in a pain clinic for their chronic pain condition or at an addiction treatment center for their substance use disorder issues.

In either case the prognosis ranges from poor to fair at best. However, I believe it is possible to increase the probability of a more successful treatment outcome by creatively combining existing chemical dependency and chronic pain treatment methods using a multidimensional, non-traditional approach I’ve named the Addiction-Free Pain Management® (APM) System.

The APM™ system is a treatment approach that uses a biopsychosocial model to integrate the most advanced pain management methods developed at the nation’s leading pain clinics, with the most effective treatment methods for addictive disorders developed at the nation’s leading chemical dependency treatment programs. The result is a unique integration of treatment methods that combine proper medication management with non-medication techniques to insure both chronic pain management and addiction treatment. This leads to relief of pain while lowering or eliminating the risk of addiction or relapse.

People with a chronic pain and addiction diagnosis have specific needs that are different from the typical chemically dependent person or the person who suffers only from a chronic pain condition; therefore, a specialized APM™ approach needs to be formulated and implemented. In addition to the pain and substance use, abuse and/or addiction screening, this approach assesses for the psychological issues present before any prescription medication abuse, new psychological problems arising from the pain and subsequent addiction, as well as finding innovative treatment modalities for this particular population.

To learn more about chronic pain management and denial please check out my article From Denial to Effective Pain Management that you can download for free on our Article page.

If you would like to see my upcoming trainings and especially to learn about my 20 hour (three days) Addiction-Free Pain Management® Certification Training on December 7-9, 2009 in Sacramento California designed to teach treatment strategies for people living with chronic pain and coexisting disorders including disorders including addiction please Click Here and scroll down to the December 7-9, 2009 for the description and how to sign up.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are working with people in chronic pain or are living with chronic pain and have any resistance or denial and want to learn how to develop a plan for helping to identify and manage denial please go to our Publications page and check out my book the Denial Management Counseling for Effective Pain Management Workbook. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

The Role of Phone Coaching in Chronic Pain Management

Today I would like to inform you about the telephone Addiction-Free Pain Management® (APM) Coaching services we offer. If you’re not sure if coaching is for you (or your clients) please go to our Coaching page and click on the Coaching Questionnaire link near the end of the page. If you’re interested in receiving free information and an overview of these services go our Contact page and send a request for this information. Below I want to cover why we believe APM™ Coaching works and the benefits you can receive from coaching.

Why APM™ Coaching Works

The main reason APM™ coaching works is that you’re hiring someone with greater experience than you in pain management and relapse prevention. Your APM™ Certified coach can quickly identify patterns that may not be clear to you. Then your coach can help you devise and implement solutions. When this works well, it’s a very high-leverage relationship. It’s one of the fastest ways to solve challenging problems. Similarly, a good coach will have superior knowledge and experience in the area(s) in which you want to improve.

A coach can use all of this expertise to help you solve specific problems efficiently. This is essentially a variation on the principle of overwhelming force. A pain management or relapse prevention problem that may seem daunting to you might be a fairly simple matter for an experienced APM™ coach.

The real challenge of APM™ coaching is for your coach to help you implement the solutions to your specific problems. Coming up with solutions is easy. Implementing those solutions is the hard part. That’s where good APM™ coaching really performs. Your APM™ coach can work as a guide to help you stay on track, leading you safely through the quagmire of mistakes, blind alleys, and delays.

Benefits of APM™ Coaching

Achievement means the delivery extraordinary results and individual goals achieved, strategies, projects and plans executed. It suggests effectiveness, creativity, and innovation. Effective APM™ coaching delivers achievement, which is sustainable. Because of the emphasis on learning and because your confidence is enhanced ('I worked it out for myself!') the increase in performance is typically sustained for a longer period and will impact on areas that were not directly the subject of coaching.

Fulfillment includes learning and development. To achieve the result is one thing, to achieve it in a way in which you learn and develop as part of the process has a greater value - to you and your coach, for it is the capacity to learn that ensures your going quality of life. Fulfillment also includes the notion that going through coaching you begin to identify goals that are intrinsically rewarding. With fulfillment comes an increase in motivation. That the APM™ coach respects you, your ideas and opinions, that you are doing your work in your own way, that you are pursuing your own goals and are responsible - all this makes you much more inspired and committed.

Joy. Enjoyment ensues when people are achieving their meaningful goals and when learning and developing is part of the process.

These three components – achievement, fulfillment, and joy – are synergistically interlinked and the absence of any one will impact and erode the others. Learning without achievement quickly exhausts your energy. Achievement without learning soon becomes boring. The absence of joy and fun erodes the human spirit.

To learn about the my views on quality treatment please go to my article The Right to Quality Chronic Pain Management that you can download for free on our Ariticles page.

If you would like to see my upcoming trainings and especially to learn about my 20 hour (three days) Addiction-Free Pain Management® Certification Training on December 7-9, 2009 in Sacramento California designed to teach treatment strategies for people living with chronic pain and coexisting disorders including disorders including addiction please Click Here and scroll down to the December 7-9, 2009 for the description and how to sign up.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders; including depression, addiction and other coexisting psychological disorders effectively; please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Chronic Pain Management and Neuroplasticity

A surprising consequence of neuroplasticity is that the brain activity associated with a given function can move to a different location as a consequence of normal experience or brain damage/recovery. In the case of chronic pain this can mean that pain signals keep occurring despite lack of a trigger or tissue damage.

According to research published in Annals of the New York Academy of Sciences (2001) titled Spinal Cord Neuroplasticity following Repeated Opioid Exposure and Its Relation to Pathological Pain; convincing evidence has accumulated that indicates there are neuroplastic changes within the spinal cord in response to repeated exposure to opioids. Such neuroplastic changes occur at both cellular and intracellular levels.

Unfortunately, most pain conditions in this country are treated with opiates—some research shows as high as 90 percent of people undergoing pain management are prescribed opiates. With so many people living with chronic pain and using opiates, these neuroplastic changes need to be better understood.

I like to use simple language and metaphors or visual images when educating my patients. Many people may not understand the term Neuroplasticity so I use the metaphor of the hijacked brain. I tell them the reality of neuroplasticity science is much more complex, but in essence what happens is that the brain forms pathways (called neuro-networks) that eventually become super highways—in other words the new neuro-network becomes more complex and elaborate. Another major problem is the deeper the trance goes the less obvious it becomes. In fact, our inner saboteur (AKA denial) often surfaces at this point and our problem can get even worse.

To learn more about neuroplasticity please go to our 2008 News and Research Archive and scroll down to the posting The Role of Neuroplasticity in Chronic Pain Management that you can download for free.

To learn about the inner saboteur and chronic pain management please check out my article From Denial to Effective Chronic Pain Management that you can download for free on our Article page.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are working with people in chronic pain or if you are someone living with chronic pain and think you may have any resistance or denial and want to learn how to develop a plan for identifying and managing denial please go to our Publications page and check out my book the Denial Management Counseling for Effective Pain Management Workbook. To purchase this book please Click Here.

To learn more about my upcoming trainings check out our Training News Update by Clicking Here. You can also go to our Training Calendar to sign up for any or all of these great training opportunities.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Resistance And Denial in Chronic Pain Management

For over 26 years I’ve worked with patients living with chronic pain who also developed coexisting psychological disorders, including addiction, as a result of living with debilitating chronic pain. One of the tools that I was able to adapt was Terence T. Gorski’s Denial Management Counseling for Addictive Disorders. I modified his denial management system to work with other coexisting disorders including chronic pain.

In my early pain management recovery I often set myself up for setbacks. I have the personality type of “more is better” and always pushed the envelope. It took me a while to see how this was self-defeating behavior. The first thing that often happened after my setback was a feeling of hopelessness and frustration—“I’m always going to be this way.” This second self-defeating mindset is one of the 12 common denial patterns—Strategic Hopelessness; AKA Diagnosing Myself as Beyond Hope.

Unfortunately, unrecognized denial can lead to severe consequences. For example the population I work with is people with chronic pain and many of them have coexisting additive disorders but are in denial about what the addiction is doing to them and those they love.

My first publication in this area is the Denial Management Counseling for Effective Pain Management Workbook. This workbook was designed for people who have experienced significant problems related to living with chronic pain, but who honestly don’t believe—or don’t want to believe—that their self-defeating decisions and behaviors are undermining what could be an effective pain management plan. This process is an important component of the Addiction-Free Pain Management® System.

To learn more about chronic pain management and denial please check out my article From Denial to Effective Pain Management that you can download for free on our Article page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people in chronic pain or are living with chronic pain and have any resistance or denial and want to learn how to develop a plan for helping to identify and manage denial please go to our Publications page and check out my book the Denial Management Counseling for Effective Pain Management Workbook. To purchase this book please Click Here.

If you would like to see my upcoming trainings and especially to learn about my 20 hour (three days) Addiction-Free Pain Management® Certification Training on December 7-9, 2009 in Sacramento California designed to teach treatment strategies for people living with chronic pain and coexisting disorders including disorders including addiction please Click Here and scroll down to the December 7-9, 2009 for the description and how to sign up.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Chronic Pain Management and the FDA Panel Recommendations

A Federal Drug Administration (FDA) panel voted narrowly (20 to 17) in June 2009 to recommend a ban on Percocet and Vicodin, two of the most popular prescription painkillers in the world, because of their effects on the liver.

I have mixed thoughts about the efficacy of this proposed ban. On one hand, I have seen the quality of life improve for many people who received adequate pain relief from this type of medication. But I have also worked with people who abused them. Understandably many healthcare providers don’t understand the logic behind banning a drug which, when taken as prescribed, won’t harm a patient.

The FDA's Drug Safety and Risk Management Advisory Committee said in their report that the agency should ban the two prescription painkillers, Percocet and Vicodin, due to their high levels of acetaminophen and the ease with which patients can become addicted to them. Acetaminophen is also combined with different narcotics in at least seven other prescription drugs, and all of these combination pills will be banned if the Food and Drug Administration heeds the advice of this panel.

One of the reasons I am taking this issue so seriously is the impact this proposed ban will have on pain management. Not just for acute pain situations like serious bone breaks, major dental procedures etc., but also in the chronic pain management arena. Many healthcare providers have traditionally prescribed medications like Vicodin and Percocet to address breakthrough pain for people undergoing cancer treatment or other serious types of chronic pain conditions.

Whatever the outcome from the FDA, I believe it is important that anyone undergoing chronic pain management should develop a safe and effective medication management plan if they are on any medications that have serious risk factors, as well as looking at the psychological factors that accompany a pain condition, and what non-medication approaches can be implemented.

I Recommend This Three Part Approach To Developing
An Effective Chronic Pain Management Plan

1. Medication Management which includes a medication management agreement;


2. Cognitive-Behavioral Treatment that addresses pain versus suffering by learning how to managing thoughts and feelings, as well as changing self-defeating behaviors and problematic social/family reactions; and


3. Nonpharmacological (non-medication) Interventions which supports the development of safer ways to manage pain.

To learn more about how to developing a medication management plan please check out my last month’s article 12 Personal Action Steps for Chronic Pain Management that you can download for free on our Ariticles page.

If you would like to see my upcoming trainings and especially to learn about my 20 hour (three days) Addiction-Free Pain Management® Certification Training on December 7-9, 2009 in Sacramento California designed to teach treatment strategies for people living with chronic pain and coexisting disorders including disorders including addiction please Click Here and scroll down to the December 7-9, 2009 for the description and how to sign up.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders; including depression, addiction and other coexisting psychological disorders effectively; please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Avoidance by Distraction in Chronic Pain Management

When necessary I have learned—and taught many other people—that avoidance by distracting myself will help take the focus off the unpleasant sensation of pain. Earlier this week I traveled to Palm Beach Florida to present at the Moment of Change Interventionist Conference and had a very long travel day due to mechanical problems and weather delays. I was only able to get four hours of sleep and then I woke up with the start of a migraine headache. I had to "practice what I preach" and used avoidance by distraction.

The pain didn’t magically "go away" but it was much less problematic when I focused on something more interesting and exciting for example. In this case I used being fully present to my workshop audience to take the focus off of my pain. When I’m out teaching or training people I can put my entire focus on them. At other times I shared with my friends there about what was going on with them. Then I went for a walk in by the beautiful beach right outside the conference center.

Dose this always work? Of course not. But it does help take the edge off while I implement other nonpharmacological pain management tools or take appropriately prescribed medication in rare instances. My pain management is not a rigid approach but it first and foremost must always protect my recovery. I’m always looking for new ways to live with pain flare ups because sometimes they come at the most inconvenient times.

A final word of caution: Using distracting or avoidance techniques should not be used until you are sure that it won’t make your overall situation worse. I’ve made that particular mistake many times and ended up causing myself more pain than I needed to have. Remember, pain is a signal that something is wrong and needs attention. Unfortunately though, sometimes pain signals get turned on or amplified when no actual damage or danger is present. Telling the difference is a very important part of ongoing chronic pain management.

If you would like to see my upcoming trainings and especially to learn about my 20 hour (three days) Addiction-Free Pain Management® Certification Training on December 7-9, 2009 in Sacramento California designed to teach treatment strategies for people living with chronic pain and coexisting disorders including disorders including addiction please Click Here and scroll down to the December 7-9, 2009 for the description and how to sign up.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders; including depression, addiction and other coexisting psychological disorders effectively; please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Chronic Pain Management for Postherpetic Neuralgia

The past few months I have spoken with several people who had recent Shingles episodes. Shingles is a form of postherpetic neuralgia. Postherpetic neuralgia (PHN) is a painful condition affecting the nerve fibers and skin. Postherpetic neuralgia is a complication of shingles, a second outbreak of the varicella-zoster virus, which initially causes chickenpox.

During an initial infection of chickenpox, some of the virus remains in the body, lying dormant inside nerve cells. Years later, the virus may reactivate, causing shingles. Once reactivated, the virus travels along nerve fibers, causing pain. When the virus reaches the skin, it produces a rash and blisters. A case of shingles (herpes zoster) usually heals within a month. But some people continue to feel pain long after the rash and blisters heal — a pain called PHN.

Current treatment of the disease is not completely satisfactory, and many patients suffering from PHN must deal with pain for months or even years after the initial lesions have disappeared. Antiviral agents such as acyclovir (the prescription medication Zovirax) are associated with absence or reduced duration of PHN if they are started within 72 hours of appearance of the lesions.

However, many patients are not diagnosed within this period. In addition, some acyclovir studies show no improvement in PHN even if started within the 72 hour period. Other treatments such as narcotics, antidepressants, and antiepileptics offer symptomatic control in some patients, but the pain control is frequently inadequate and side effects, such as dizziness, drowsiness, and constipation, limit their use. The limited efficacy of current treatments prompted a search for alternative approaches.

Postherpetic neuralgia (PHN) is difficult to treat. Once PHN develops, a patient may need a multidisciplinary approach that involves a pain specialist, psychiatrist, primary care physician, and other health care providers.

To learn more about the importance of using a team approach in chronic pain management please check out my article The Need for Multidisciplinary Chronic Pain Management that you can download for free on our Ariticles page.

If you would like to see my upcoming trainings and especially to learn about my 20 hour (three days) Addiction-Free Pain Management® Certification Training on December 7-9, 2009 in Sacramento California designed to teach treatment strategies for people living with chronic pain and coexisting disorders including disorders including addiction please Click Here and scroll down to the December 7-9, 2009 for the description and how to sign up.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you or a loved one is undergoing chronic pain management, especially if you're in recovery or believe you may have a medication or other mental health problem and you want to learn more effective chronic pain management tools, please go to our Publications page and check out my books; especially the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Chronic Pain Management Medication Abuse

One of the most frequent questions I get at my trainings is “what are the major reasons people abuse their pain medication?” In my opinion under-treated (or mis-treated) or mis-diagnosed pain is right up there, especially when we’re talking about a chronic pain condition. For many of the chronic pain patients I’ve worked with, either they or their doctors were too afraid to prescribe opiate medication—opioid-phobia—or they wouldn’t prescribe a high enough dose.

Now I know caution must be used when prescribing this type of medication, especially for someone with a history, or family history, of alcoholism or other addiction. But even for this population under-medicating my actually cause more damage bio-psycho-socially than using the medication, and for someone in addiction recovery it could lead to a relapse.

A big reason other chronic pain patients eventually get in trouble is due to too conservative treatment and being able to access effective pain management interventions. For example many of the injured workers who were on Workers Compensation Coverage weren’t given adequate treatment early on. In fact many times relatively inexpensive treatments were denied and later on it cost much more in the long run.

Another big reason people develop substance use disorders when taking pain medication is they don’t do anything else for pain management. They become passive pill-taking recipients instead of proactive participants in their pain management. Most of the research on best practice treatment for chronic pain recommends an integrated multidisciplinary approach—treating the whole person. Unfortunately, due to HMOs Managed Care and lack of insurance, pills are often the quick fix.

Some people abuse their pain medication because they don’t know any better. Today many pain management specialists take precautions to educate their patients when they are going to be prescribed opiate medications. Part of this education includes information about drug-interactions. For example many people still drink alcohol even when the medication label gives a warning. In fact some people see a warning such as “Alcohol may intensify the effects” as an indication that drinking with the medication will give them better pain management. They don’t realize the synergistic effect on the liver and how the medication is not being metabolized like it should be. This can be lethal.

The best way to help people not abuse pain medication is to help them access safe and effective pain management and educate them about how to use pain medications when they are a necessary component of treatment. In APM™ Module Four: A Guide for Managing Pain Medication in Recovery you can learn to explore how you can use pain medication using a recovery oriented approach.

In APM Module Four you can look at some misunderstood terms, then you will be asked to list the benefits and disadvantages of using pain medication. Next you’ll write your pain history story and then be shown how to develop your own effective pain medication management plan. The final step is to review a Recovery/Relapse Indicator Checklist and complete a final call to action.

For a brief overview of some of the information in this module please check out my article Managing Pain Medication in Recovery that you can download for free on our Ariticles page.

For an additional resource regarding medication management please go to our Publications page and check out my Addiction-Free Pain Management® Module Two: Examining Your Potential Medication Management Problems. To purchase APM™ Module Four please Click Here.

If you would like to see my upcoming trainings and especially to learn about my 20 hour (three days) Addiction-Free Pain Management® Certification Training on December 7-9, 2009 in Sacramento California designed to teach treatment strategies for people living with chronic pain and coexisting disorders including disorders including addiction please Click Here and scroll down to the December 7-9, 2009 for the description and how to sign up.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

The FDA and Chronic Pain Management

A Federal Drug Administration (FDA) panel voted narrowly (20 to 17) in June 2009 to recommend a ban on Percocet and Vicodin, two of the most popular prescription painkillers in the world, because of their effects on the liver. Having seen people abuse both of these medications I have mixed thoughts about the efficacy of this proposed ban. I’m conflicted because I have also seen the improved quality of life of many others who received adequate pain relief from this type of medication. Many healthcare providers also don’t understand the logic behind banning a drug which, when taken as prescribed, won’t harm a patient.

In July of this year the FDA announced it would place only a warning label on propoxyphene (Darvon), which also includes acetaminophen, leaving many healthcare providers hopeful that the FDA will go against its advisory board and also keep Vicodin and Percocet on the market. The same FDA panel also voted 36-1 that if the Percocet and Vicodin are not banned from the market; they should be given a black box warning, the FDA's most severe warning label.

One of the reasons I am taking this issue so seriously is the serious impact this proposed ban will have on pain management. Not just for acute pain situations like serious bone breaks, major dental procedures etc., but also in the chronic pain management arena. Many healthcare providers have traditionally used medications like Vicodin and Percocet for breakthrough pain for people undergoing cancer treatment or other serious types of chronic pain conditions.
I also believe that anyone undergoing chronic pain management should develop a safe and effective medication management plan if they are on any medications that have serious risk factors. An important part of developing an effective chronic pain management plan is to develop an understanding of what an effective plan looks like.

I recommend that this type of plan requires a three part approach:

(1) A medication management plan which includes a medication management agreement;

(2) A cognitive-behavioral treatment plan that addresses pain versus suffering by learning how to managing thoughts and feelings, as well as changing self-defeating behaviors and problematic social/family reactions; and

(3) A nonpharmacological (non-medication) pain management plan which supports the development of safer ways to manage pain.


To learn more about developing a medication management plan please check out my last month’s article 12 Personal Action Steps for Chronic Pain Medication Management that you can download for free on our Ariticles page.

If you would like to see my upcoming trainings and especially to learn about my 20 hour (three days) Addiction-Free Pain Management® Certification Training on December 7-9, 2009 in Sacramento California designed to teach treatment strategies for people living with chronic pain and coexisting disorders including disorders including addiction please Click Here and scroll down to the December 7-9, 2009 for the description and how to sign up.


You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are living with chronic pain, especially if you're in recovery or believe you may have a medication or other mental health problem and want to learn how to develop a plan for managing your pain and medication effectively, please go to our Publications page and check out my book the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here. To listen to a radio interview I did conducted by Mary Woods for her program One Hour at a Time please Click Here to go to this interview.To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

It Takes A Team for Effective Chronic Pain Management

Many people undergoing chronic pain management who also have coexisting disorders often become depressed and feel a deep sense of hopelessness. Healthcare providers often become confused and frustrated when their treatment interventions are ineffective, and often blame the patient (you). Given the biopsychosocial nature of chronic pain I believe that it is imperative to utilize a multidisciplinary treatment plan.

For over 26 years I’ve helped people who were mislead by some unscrupulous healthcare providers who told them they could handle all of their chronic pain management needs. In many cases what they offered was a wide spectrum of medication that led many of these people into bad problems. Other alternative healthcare providers promised miracle treatment interventions; usually at a very high cost.

True multidisciplinary pain management involves a host of interventions such as physical therapy, massage, medication management, counseling or therapy, biofeedback, occupational therapy, exercise physiology, an addiction medicine specialist, an anesthesiologist or pharmacologist, and a case manager. It may also include some type of movement therapy such as Tai Chi, classes on spiritual wellness, yoga or meditation.

To learn more about teamwork for chronic pain management please check out my article The Need for Multidisciplinary Chronic Pain Management that you can download for free on our Ariticles page.

To learn about my upcoming trainings you can check out our Calendar page.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are working with people in chronic pain or living with chronic pain yourself and want to learn how to develop a plan for managing the pain and coexisting psychological disorders including PTSD or addiction effectively please go to our Publications page and check out my book the Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To listen to a radio interview I did conducted by Mary Woods for her program One Hour at a Time please Click Here to go to this interview.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Is Medical Marijuana Effecttive for Chronic Pain Management?

First of all I must own a bias that I do not think smoked marijuana is an effective chronic pain management medication even though it is legal in California. There are too many risk factors associated with marijuana, especially smoked marijuana, that must be considered not only in terms of immediate adverse effects on the lung; e.g., bronchi and alveoli, but also long-term effects in people with chronic diseases and those with a poor immune status. Another major problem I have with someone smoking marijuana as a medicine is the inability to regulate the dosage and, even more important the delivery system.

The level of THC varies so greatly in the marijuana that is currently available, that coming up with a therapeutic dose for smoked marijuana is extremely difficult. In addition, marijuana has other ingredients that may have problematic side effects. Then there is the dangerous delivery system—the issue of smoking it. The components of the smoke are hazardous, especially in the immuno-compromised patient. No other medication we have is administered that way because of the potential dangers.

Several years ago (about 2000) I wrote an article titeled The Mecical Marijuana Controversy. This January I posted a new article on our Aricle Page that you can download for free; my new article is titled 2009 Medical Marijuana Update (below you will find a link to download that article). Since my original article in 2000 there has been significant research on THC and other cannabinoids that do show promise for chronic pain management that you can learn about in my new article.

To learn more about medical marijuana and chronic pain management please check out my article 2009 Medical Marijuana Update that you can download for free on our Article page.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are working with people in chronic pain management or are living with chronic pain yourself and have any resistance or denial and want to learn how to develop a plan for helping to identify and manage denial please go to our Publications page and check out my book the Denial Management Counseling for Effective Pain Management Workbook. To purchase this book please Click Here.

To learn about my upcoming trainings you can check out our Calendar page.

To listen to a radio interview I did conducted by Mary Woods for her program One Hour at a Time please Click Here to go to this interview.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

The Pros and Cons of Rx Medication in Chronic Pain Management

It’s important to remember that any psychoactive medication could be problematic for people with a genetic or personal history of an addictive disorder. Unfortunately, there may be times when opiate (or opioid) medication management is needed, but there are risks. I think it’s important to be aware of both the benefits and potential consequences of using opiate medications for chronic pain management.

Efficacy and Risks of Opioid Medication Management

• Opioids have been shown to effectively reduce cancer and acute pain conditions and they can also share a role in the management of chronic pain.


• Opioids may be inappropriate for patients with substance use disorders or a history of those problems. If any psychoactive medications are used, providers must take special precautions.


• Concerns about side effects, such as functional impairment and physical inactivity, as well as concerns about physical or psychological dependence, must be taken into consideration when using opioids for chronic pain management.


• Physical dependence is a physiological adaptation to a substance, defined by a growing tolerance for its effects and/or withdrawal symptoms when use is reduced or ends.


• Psychological dependence (often called addiction) is a primary, chronic, neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestations.


• Psychological dependence may occur with or without physical dependence and is conceptually characterized by impaired control over drug use, compulsive use, continued use despite harm, and craving for the psychic effects of the drug.


• What appears to be psychological dependence may be due to pain that is under treated. This is also known as pseudoaddiction.

Some pain disorders require pharmacological (prescription drug) interventions. Other conditions may respond to over-the-counter medications like aspirin or ibuprofen. Still other conditions may need a combination of both. However, some pain disorders can be effectively treated without any chemical interventions at all.

To learn more about the benefits and risks of prescription medication in chronic pain management check out my article titled America in Pain: Turning to Prescription Drugs - a Blessing or a Curse, that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you or a loved one is undergoing chronic pain management, especially if you're in recovery or believe you may have a medication or other mental health problem and you want to learn more effective chronic pain management tools, please go to our Publications page and check out my books; especially the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

To learn about my upcoming trainings you can check out our Calendar page.

An Important Chronic Pain Management Question

What is Effective Chronic Pain Management?

Today, chronic pain is one of the most critical healthcare issues in the world. In the United States alone, more than 100 million people suffer with some type of chronic pain—affecting as many as 1 in 5 Americans. Chronic pain takes its toll on personal lives, healthcare resources, and the economy—more than $100 billion in medical expenses and more than $70 billion each year in lost productivity, unsafe working conditions and increased absenteeism in this country alone.

There has been a lot of controversy not only in the United States but also internationally on what is the best approach for long-term chronic pain management. Unfortunately, due to cost constraints, HMOs and Managed Care, many people undergoing chronic pain management treatment are not getting their needs adequately addressed.

Living with chronic pain is very difficult. If a person also has a coexisting addiction it becomes even harder. Many people who have chronic pain and addiction become very depressed and start feeling hopeless. They have often lost their self-esteem and eventually lose the support of their significant others. Healthcare providers often become confused and frustrated when none of their treatment interventions seem to work.

The Addiction-Free Pain Management® (APM) System was developed to address the specific needs of this under-served population. Historically, addictive disorders and pain disorders have been treated as separate issues. However, to effectively implement an APM approach, both the addictive disorder and the pain disorder must be adequately addressed at the same time. In addition, the physical, psychological, and social implications of these disorders must also be dealt with.

To learn more about effective chronic pain management—especially when other coexisting disorders are present—please check out my article The Need for Multidisciplinary Chronic Pain Management, that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders including depression, addiction and other coexisting psychological disorders effectively please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To learn about my upcoming trainings you can check out our Calendar page.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Seeking Relief in Chronic Pain Management

But They Call It Drug Seeking Behavior

If you’ve been around any healthcare settings that treat people with chronic pain one term that comes up a lot is “drug seeking” or “med seeking.” When it’s brought up it’s usually in a pejorative way. For example “there’s another of those drug seeking addicts.” Unfortunately, many people who are living with chronic pain are not getting their pain managed effectively. In some cases it’s because the medical professionals are afraid.

I have a lot of compassion for healthcare providers who treat chronic pain patients in California. On one hand the DEA is playing big brother and their war on drugs has now moved to a war on pain management. The alternative is when a medical professional takes a conservative track and under-prescribes; then they are at risk for litigation.

The other big problem is most medical professionals don’t realize that being opiate tolerant does not automatically mean that they are addicted. Anyone who is on prolonged opiate maintenance will have built up tolerance and needs periodic increase in the dose. Unfortunately, some people can also develop a condition called pain rebound or even hyperalgesia and now the medication has become—at least in part—the pain generator.

I invite people to eliminate the phrase “drug seeking” or “med seeking” from their vocabulary. What people are really seeking is RELIEF. They want the pain to stop. They want to have some relief from their suffering. They often; however, mistakenly believe that the only way to get that relief is by taking more medication. In fact some pain conditions do not respond well to traditional mono opiate medication management.

If you want read more about my views on this topic please go to my article War on Drugs - War on Pain Management that you can download for free on our Article page.

To check out my upcoming trainings you can check out our Calendar page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders; including depression, addiction and other coexisting psychological disorders effectively; please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Developing an Attitude of Gratitude for Better Chronic Pain Management

Many years ago I learned the value of showing up as a contribution instead of a complaint. When life gets rough many of us start complaining; at least I know I do. One day I was going on and on to a good friend of mine who, after listening for awhile, asked me if I would be willing to make a list of all the things in my life I was grateful for instead of just complaining.

I was very surprised as I went through this exercise and had about 50 things I was grateful for. I thought it was a great list. My friend didn’t. He asked me to triple that list. At first I couldn’t understand how I could find that many things to be grateful for, but with his support and coaching I finally did it. I was amazed and the problems I had been complaining about no longer seemed so bad. He even gave me a bumper sticker that said “Attitude of Gratitude.”

About ten years later I ran across a book Simple Abundance Journal of Gratitude by Sara Ban Breathnach. The journal asked readers to write down at least five things each day that they were grateful for and at the end of the month summarize the results. The first time I did it I made sure to complete an entire year. Then I pulled away for a few more years.

I started writing another gratitude list because I caught myself complaining and remembered my old friend’s advice. I wrote my lists for just over a year and then stopped again. Almost two years ago I ran across one of my old Gratitude Journals and decided that I want this to be an ongoing part of my life. I started listing five to ten things a day I was grateful for and at the end of the month I listed my top twenty for the month. At the end of the year I put my entire top twenty for each month in the same document. I then choose my top twenty for the entire year after reviewing every single entry I wrote that year.

The most interesting thing about my end of year process was that I was feeling very sad and grieving the recent death of my father. As I started going back over the year I noticed many of my gratitudes were about my relationship with my father and how we were much closer than any other time in my life. My mood and energy started shifting the more I read. By the time I made my top twenty list for 2007 I was again centered, peaceful and happy.

Starting this year I make it a practice to write at least 10 things I'm grateful for each day and at the end of the month pick my top 30 biggest hits. At the end of the year I plan to make a top 30 list for the year.

I have worked with many pain patients over the years that I taught the "attitude of gratitude" process. Those who wrote daily gratitude lists reported that it was impossible for them to be in gratitude and suffering at the same time—most of the time they chose gratitude. I would like to encourage those of you reading this blog to try writing daily gratitude lists for at least a couple of months and see what happens for you. I would love to hear about your experience.

To check out my upcoming trainings you can check out our Calendar page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people in chronic pain or are living with chronic pain and have any resistance or denial and want to learn how to develop a plan for helping to identify and manage denial please go to our Publications page and check out my book the Denial Management Counseling for Effective Pain Management Workbook. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Looking at the Biopsychosocial Components of Chronic Pain Management

Bio-Psycho-Social Components of Pain

In order to understand chronic pain management you need to first understand the concept of pain. Pain is a signal from the body to the brain that tells you something is wrong. There are three components of pain—biological, psychological, and social/cultural.

Pain is a signal from the body to the brain that tells you something is wrong

Pain is a total biopsychosocial experience. You hurt physically. You psychologically respond to the pain by thinking, feeling, and acting. You think about the pain and try to figure out what is causing it and why you’re hurting. You experience emotional reactions to the pain. You may get angry, frightened, or frustrated by your pain. You talk about your pain with family, friends, and coworkers who help you to develop a social and cultural context for assigning meaning to your personal pain experience and taking appropriate action.

Three Essential Levels of Chronic Pain Management

Modern pain management systematically approaches the treatment of pain at all three levels (bio-psycho-social) simultaneously. This means using physical treatments to reduce the intensity of your physical pain. It also means using psychological treatments to identify and change your thoughts, feelings, and behaviors that are making your pain more intense and replacing them with positive thinking, as well as feeling and behavior management skills that can reduce the intensity of your pain.

Finally, effective pain management must involve not only you, but also the significant people in your life who can help you to develop a social and cultural context in which to experience your pain in a way that will reduce suffering.

Biological Pain is a signal that something is going wrong with your body. The biological, or physical, pain sensations are critical to human survival. Without pain we would have no way of knowing that something was wrong with our body. So without pain we would be unable to take action to correct the problem or deal with the situation that is causing our pain.

Psychological Pain results from the meaning that you assign to the pain signal. The psychological symptoms include both cognitive (thinking changes) and emotional (uncomfortable feelings) that lead to suffering. Most people are not able to differentiate between the physical and psychological. All they know is “I hurt.” For effective pain management you need to learn all you can about your pain.

Social and Cultural Pain, results from the social and cultural meaning assigned by other people to the pain you are experiencing, and whether or not the pain is recognized as being severe enough to warrant a socially approved sick role. These three components determine whether the signal from your body to your brain is interpreted as pain or suffering.

To learn more about effective chronic pain management please check out my article The Need for Multidisciplinary Chronic Pain Management, that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders; including depression, addiction and other coexisting psychological disorders effectively; please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To learn about my upcoming trainings you can check out our Calendar page.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Chronic Pain Management and the Role of Smoking

You see it in the media all the time now—the “evils” of smoking. If you review research from credible sources e.g., The American Heart Association, The Food and Drug Administration, or maybe WebMD you will find information that states—“Tobacco addiction, the second-leading cause of death in the world, is a culprit for approximately 5 million deaths each year or 1 in 10 adult deaths.” For many who smoke it is much more than “just a habit.”

You can also go to the National Institute on Drug Abuse and check out their Research Report Series: Tobacco Addiction and review current scientific up-to-date research about the true nature of nicotine addiction.

What I haven’t seen very much concerns how smoking impacts chronic pain management. Today I ran across a Blog site “Skills for Healthy Living: A Blog for Health Providers.” One posting I saw was titled “Smoking and Pain” that was posted on June 19, 2008 by adiemusfree. I want to include a few excerpts from that posting. If you want to read the entire posting go to Smoking and Pain.

A large national study published in 2006, specifically looking at tobacco smoking and pain in the general population - quite different from our hospital patients, or those directly seeking treatment. Quoting directly from the abstract: “Former and current heavy smokers had higher odds for greater numbers of pain locations and for moderate and intense pain than never smokers after adjustment for analgesic medicament use and behavior-related risk factors.”

The findings suggest that former and current heavy smokers are more likely to report more pain locations and more intense pain than never smokers. Well, that’s quite high odds! And sadly, it doesn’t seem to make a lot of difference whether you’ve stopped smoking or continue to smoke - the odds are still high.

Curious - some very strong pointers that smoking increases the risk of persistent pain and poorer recovery from acute pain, yet I’m not sure that I’ve ever heard that in public health messages about smoking, and I’ve not yet heard of quitting smoking efforts targeting people with chronic pain. Time for action? I think so.

To read more about my views about smoking please go to my article Smoking and Recovery Just Don't Mix that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders; including depression, addiction and other coexisting psychological disorders effectively; please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To learn about my upcoming trainings you can check out our Calendar page.

Effective Chronic Pain Management and Depression Issues

Psychological problems can develop as a direct result of living with chronic pain and/or long-term pain medication treatment. These problems are serious and often sabotage peoples’ ability to receive adequate pain management treatment.

There are four major areas that tend to impact chronic pain patients the most:

Depression

Irrational thinking patterns and the resultant uncomfortable emotions

Anxiety and Trauma Disorders

Sleep Disorders

Of these four the one that causes the biggest problems for the most people—and sometimes gets under-diagnosed and/or under-treated—is Clinical Depression. Therefore is important to focus on understanding and managing depression to obtain effective chronic pain management.

Hitting the Wall Called Depression

There are several types of clinical depression that involve disturbances in mood, concentration, self-confidence, sleep, appetite, activity and behavior as well as disruptions in friendships, family, work and/or school. A clinical depression is different than the experiences of sadness, disappointment and grief familiar to everyone, which makes it difficult to determine when professional help is necessary.

To learn more about the role of depression in chronic pain management please check out my article The Role of Clinical Depression in Chronic Pain Management that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are in recovery and want to learn how to develop a plan for managing your pain and medication effectively go to our Publications page and check out my book the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

To learn about my upcoming trainings you can check out our Calendar page.

Chronic Pain Management for Neuropathic Symptoms

One of the more challenging types of chronic pain involves neuropathic (burning, tingling, shooting, etc, nerve pain) symptoms that opiates do NOT adequately address. A report came out in October 2007 published by Science Daily that discussed why painkillers don't work for neuropathic pain from fibromyalgia and states in part: "When the painkillers cannot bind to the receptors, they cannot alleviate the patient's pain as effectively, Harris says. The reduced availability of the receptors could result from a reduced number of opioid receptors, enhanced release of endogenous opioids (opioids, such as endorphins, that are produced naturally by the body), or both, Harris says." To read the complete report, please Click Here.

Neuropathic pain is frequent for diabetics, fibromyalgia, and shingles. Many pain management providers have tried alternative (“off-label”) medications such as Neurontin (Gabapentin) with varying degrees of success. Unfortunately, this medication sometimes causes significant side effects for many people. Fortunately, there are other medication choices such as pregabalin (Lyrica).

For example, I just came across a report presented at the American Society of Anesthesiologists (ASA) 2008 Annual Meeting regarding the Perioperative (the time period surrounding a patient's surgical procedure; this commonly includes ward admission, anesthesia, surgery, and recovery) administration of pregabalin significantly decreases the incidence of neuropathic pain at 3 and 6 months after total knee arthroplasty (TKA), according to research. The report concluded that this procedure significantly reduced the patients’ pain. To see the entire report please Click Here.

In June of 2008 the Food and Drug Administration (FDA) approved duloxetine HCl delayed-release capsules (Cymbalta) for the management of fibromyalgia. Previously, only pregabalin (Lyrica; Pfizer, Inc) was approved to treat this painful condition. Some see this as a major victory in validating fibromyalgia as a legitimate diagnosis while others see this as a greed-driven pharmaceutical ploy. Having worked with many patients who were diagnosed and living with the pain and problems of fibromyalgia I am firmly in the first camp.

To read more about this topic please go to our 2008 Research Archive and scroll down to the Cymbalta posting. Also, near the end of the page is a posting titled Neuropathic Pain Management.

To learn more about effective chronic pain management check out my article The Right to Quality Chronic Pain Management that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are in recovery and want to learn how to develop a plan for managing your pain and medication effectively go to our Publications page and check out my book the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

To check out my upcoming trainings you can check out our Calendar page.

Problems with Chronic Pain Management and Prescription Medication

Chronic pain managemebt is a serious health crisis facing many people. They can be under-medicated, over-medicated or sometimes just misdiagnosed. They may also have co-existing disorders such as an addiction that must be taken into account. No matter what a person decides regarding the question of whether or not to use prescription drugs to manage their pain, they must look at the whole picture – not just the use of pain meds. In my experience people who look at the biological, psychological and social aspects of their pain condition, and address each area, have much more favorable treatment outcomes.

Unfortunately, we live in a quick fix society. When something goes wrong we look for the fastest way to remedy the situation. When we have a headache we “pop a pill” and the problem is solved. If you watched any amount of TV the past few years you may have noticed a significant increase in commercials hyping prescription medication. Many people are demanding specific medications that they saw on TV with the mistaken belief that—if it’s advertised on TV it much be safe; for example the commercials advertising Lunesta, a sleep medication. After all how can such a cute butterfly be dangerous?

So it’s not surprising when our back starts hurting again using medication to escape from the pain is our primary concern. Our medical system is designed for crisis, or symptom management. Rarely do we look for the underlying reasons for our headache or back pain. Using the “Band-Aid” approach of taking a pill seems quicker, cheaper, and easier—but is it really?

People undergoing chronic pain management experience three major types of pain:

(a) physical or biological;
(b) psychological, which includes thinking and emotions; and
(c) the social and cultural, which influence the perception of pain.

Medication is only effective for physical or biological pain. When people use medication for the other aspects of pain, it can often lead to addiction.

I want to introduce the idea sometimes it is possible to treat a chronic pain management condition without taking medications. It’s important to remember that if a person has a condition where they need to take appropriate chronic pain management medication that they still need to incorporate nonpharmacological interventions that are appropriate for them. The main point I want to make here is that there are as many types of pain interventions as your imagination will allow, and your mind is open to.

Although managing pain without pills can be a very desirable goal, in some cases there needs to be an “appropriate” medication chronic pain management plan. This plan should be a collaborative process with a professional who understands the biopsychosocial nature of pain and the very real risks of dependency or addiction. In addition to the psychological treatment plan and the medication management plan we need to explore non-pharmacological modalities such as acupuncture, chiropractic, massage therapy, hydrotherapy, biofeedback, etc. As you can see this is anything but a “quick fix.”

To learn more about effective chronic pain management—especially when other coexisting disorders are present—please check out my article The Need for Multidisciplinary Chronic Pain Management, that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders including depression, addiction and other coexisting psychological disorders effectively please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To learn about my upcoming trainings you can check out our Calendar page.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.