Chronic Pain Management

Therapists Overview
COPING WITH ADDICTION AND CHRONIC PAIN
GOALS OF THE EXERCISE

1. 2. 3. Practice a program of recovery, including 12-Step program participation and use of pain management skills. Develop healthy options to cope with chronic pain. Reduce daily suffering from pain and substance abuse.
ADDITIONAL PROBLEMS FOR WHICH THIS EXERCISE MAY BE USEFUL

Medical Issues Opioid Dependence Substance Abuse/Dependence
SUGGESTIONS FOR PROCESSING THIS EXERCISE WITH CLIENT

The Coping with Addiction and Chronic Pain activity is designed for clients who, as the title indicates, suffer from both addictions and severe and persistent pain. It addresses the perceived dilemma many clients face of reconciling participation in 12-Step recovery programs with the need to use prescribed medications that have a high potential for addiction, as well as noting other sources of emotional and practical support. Follow-up can include referral to appropriate medical professionals and to one or more of the chronic pain support groups cited in the exercise. It is helpful for the psychotherapist to coordinate work on this issue with any other health care providers from whom the client is receiving services, after ensuring that you and the other providers have each received the clients consent to share treatment information.
EXERCISE IX.B
COPING WITH ADDICTION AND CHRONIC PAIN
Some people suffer from both substance abuse problems and severe or chronic pain. This puts them in a dilemmathe usual treatments for pain are narcotics or other strong medications with potential for abuse and addiction. Often, the pain led these people to begin using addictive drugs. On the other hand, many professionals are reluctant to prescribe strong pain medications, for fear of their patients getting addicted. So if youre in this situation, how can you achieve and maintain a life free of both addiction and ongoing pain? Fortunately, there are solutions. This exercise will help you understand the problem more completely and find some of those solutions. 1. How does chronic pain impact your daily life? Describe the relationship between your addiction and pain management.
2. Do your medical providers have specialized knowledge in pain management and addictions? If not, can the doctor or other professional with whom youre working give you a referral to a pain management specialist? As part of this exercise, please check on this and let your therapist know. Also, have you talked with them about your addiction history? If not, what keeps you from sharing that information?
3. In recent years the medical profession has found that even drugs that are otherwise highly addictive do not result in physical addiction for pain patients if they are taken in appropriate amounts (i.e., no more than is needed), and for no longer than needed, to control the pain. If you and your
doctor
plan
to
manage
your
pain
EXERCISE IX.B
this way, what is your plan to avoid taking more than you need and to stop taking the medications (probably by switching to something safer and not so strong) as soon as appropriate, to avoid getting hooked?
4. Another discovery that is changing how pain medications are used: When the medication is taken before pain gets severe, it takes less to block the pain and keep the patient comfortable. This is why hospitals sometimes put people on a regular schedule for their pain medications and give them the medications even when they arent too uncomfortable. Have you and your doctor talked about this, and if so, whats your plan and how do you feel about it?
5. A danger to watch out for: Many alcoholics and other addicts have found that when they used narcotics or equivalent drugs, although they didnt get addicted to those drugs, their judgment and inhibitions were affected and they relapsed into drinking or using other drugs, because they forgot why it was important to stay clean and sober. How will you avoid this trap?
6. Medical professionals have a central part in pain treatment, but other people also have key roles to play in helping you manage this situation (e.g., your sponsor if youre in a recovery program, family, and friends). How can they help you avoid falling into addictive thinking and behaviors when youre using potentially habit-forming drugs to manage your pain?
7. If you are participating in a 12-Step program, do you know your programs philosophy about the use of prescribed medications? The position of Alcoholics Anonymous is that if your doctor knows your history and is experienced working with people with addictions, and youre taking the medications as prescribed, youre doing what you need to do to stay sober. Other programs have similar views. If others in your group challenge this, they dont know their program well enough. If you have questions, check
the official literature.
EXERCISE IX.B
8. Do you know others in 12-Step programs that have had to take powerful prescribed medications? How have they avoided falling into the trap of substance abuse?
9. In addition to 12-Step or other recovery programs focusing on addictions, you may find help from support groups specifically for chronic pain sufferers. These groups include local organizations, which you may be able to find through your local media (many newspapers publish lists of support groups of all kinds). You may also want to investigate the following online groups, which you can reach through their web sites (please keep in mind that as time passes, these sites may disappear and others appearto get current info, we recommend using an Internet search engine such as Google.com). a. American Chronic Pain Association: www.theacpa.org b. Back Pain Support Group: www.backpainsupportgroup.com c. Chronic Pain Support Group: www.chronicpainsupport.org d. National Chronic Pain Outreach Association, Inc.: www.chronicpain.org e. Out of Pain: www.outofpain.com 10. Have you had any contact with any of these groups, either local or online? If so, please identify the groups and briefly write about your experiences with them. If not, please explore the web sites listed and talk with your therapist about what you learn.
11. Please describe the tools, methods, and resources you will use to cope with the combined challenges of addiction and chronic pain.
Be sure to bring this handout back to your next session with your therapist, and be prepared to talk about your thoughts and feelings about the exercise.

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Therapists Overview

COPING WITH ADDICTION AND CHRONIC PAIN

GOALS OF THE EXERCISE

ADDITIONAL PROBLEMS FOR WHICH THIS EXERCISE MAY BE USEFUL

SUGGESTIONS FOR PROCESSING THIS EXERCISE WITH CLIENT

COPING WITH ADDICTION AND CHRONIC PAIN

the official literature.

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