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.