Chronic Pain Interventions

Pain is an important sensation that adaptively signals our bodies that something is wrong. Fortunately, for most it is brief and when necessary is relatively easily controlled until the inciting condition is resolved. Unlike acute pain, which signals the nervous system that something is wrong or needs attention and is relieved once the cause of pain has been addressed, chronic pain persists.

Chronic pain is defined as pain that persists for more than six months. Often there is a mystery as to the actual cause of chronic pain. For example, two individuals can both have terrible back x-rays, riddled with collapsed vertebrae and arthritis, and one has chronic pain and the other has none. The pathology often does not correlate well with the symptoms. This is very frustrating and discouraging for patients and makes treatment confusing. It’s important for patients to know that chronic pain is a disease, in an of itself, and the pain is real.

Prescribing pain medications for chronic pain, usually opioids (relatives of opium), has become a “quick fix” that, for some, can turn into a nightmare. For these unfortunate individuals the medications actually cause a worsening of the pain, or hyperalgesia, due to hypersensitization of the nervous system. In other words a vicious cycle occurs because the pain meds actually affect the nerves such that there is a lowering of the threshold for pain and an increase in the sensitivity to pain.

Recent data is accumulating regarding this paradoxical physical effect: “the more opiate, the worse it hurts, followed by stronger and stronger medication.” The patient feels trapped and miserable and all they know to do, and frequently all their doctors know to do, is to further increase the pain meds. As this progresses there can be a progressive worsening in function. The patient can become so distraught and confused that it’s hard to differentiate their emotional pain from their physical pain. Eventually they only feel relief when they cannot feel at all.

The mystery of why pain-suppressing medicines that initially offered pain relief, can turn and become part of the problem is not well understood. What is known is that when this happens, and it usually happens quite subtly, the chronic pain patient is trapped within a hopeless cycle of chaos caused by drug dependence, even though they may be taking the medications exactly as prescribed by a pain management specialist. Because of this phenomenon there are many patients under pharmacological management who have poorly controlled pain.

If you receive large doses of opioids with no significant decrease in pain and no improvement in function or things are becoming worse, then you should seek assistance aimed toward carefully stopping the medications. The pain has engulfed your life, and the search for relief has created an addiction to drugs.or at least problematic use of addictive medications.

How Chronic Pain Interventions are Different

If you or a loved one suffer from chronic pain it is common to believe there is no hope. Chronic pain patients see themselves as “different” because it’s true. Our experience has shown there are differences in the needs of a chronic pain patients with drug dependence compared to the needs of addicts and alcoholics. After many encounters with healthcare providers, pain patients and family members end up feeling extremely hopeless following countless unsuccessful attempts to manage the problem. Drug therapy has become ineffective and a tolerance to drugs prescribed for pain has developed, but to stop the medications seems incomprehensible. Medical treatment has failed and the quality of life for these patients and their loved ones has become intolerable.

There is hope!

It’s convenient to describe three basic types of pain: acute pain, chronic malignant pain, and chronic nonmalignant pain. Our workshop is designed to focus on chronic nonmalignant pain. This is the least predictable and most difficult type of pain to treat. Studies have shown that in order to effectively manage chronic nonmalignant pain a multidisciplinary approach is necessary. We have found that three key areas must be addressed concurrently in order to achieve a successful outcome. These focused areas of treatment are the addictive disease, chronic pain, and the addiction-pain syndrome. The addiction-pain syndrome consists of the physical and emotional components of problems associated with both addiction and chronic pain, and develops a life of its own.

Our workshop is designed to focus on family education. With the entire family, including the pain patient, together hearing the same information at the same time, it is much easier to develop a consensus as to what path to take. Too often, part of the problem is that everyone has a different opinion derived from many different sources

The suffering in the families of chronic pain patients with dependency issues is profound. In an addicted family system it takes a sophisticated cast of enablers for the addictive behavior to continue and if the family commits to change the addictive behavior is difficult to sustain. The same is true with the families of chronic pain patients, except that the suffering is usually more profound. Families feel trapped because their loved one has a legitimate medical problem and their doctors have told them that the medications are necessary. They witness unwanted drug effects and believe that the effects are unavoidable and preferable to unrelieved suffering. The result is often massive malignant co-dependency and enabling. Family member’s lives end up being controlled by someone else’s illness. They feel obligated to give, give, give and receive little. They can feel intense guilt and self blame and at the same time feel intense resentment. Eventually, they feel helpless and depressed and their own lives become unmanageable. Family discord becomes a major source of stress for both the family and the pain patient and the entire systems spirals downward.

Recent studies have demonstrated that in the presence of solicitous (doting and overprotecting) family members the pain patient actually experiences heightened pain. This is extremely difficult for family members to comprehend, that their presence can actually worsen their loved one’s pain. Enabling is a major roadblock to recovery in any addicted family system.

Family education and involvement in the treatment process is critical for success. Education helps reduce the mystery and uncertainty about the nature of chronic pain. Learning about the causes and effective treatment of the chronic pain syndrome begins to help reduce the enabling. This is important so that well meaning family members do not promote unwarranted regression. Family members need to learn which activities are helpful and which are harmful. Paradoxically, the worst treatment is rest and activity is beneficial.

For the best outcomes the family and the patient need continual reinforcement to stay on track. Regression by any family member to old behavior places the entire system at substantial risk. When each family member commits to change the likelihood of a successful outcome is greatly increased.

Good treatment for chronic pain is difficult to find. We will help find the best facility that can best match each family’s unique situation.