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.