Five Principles for Treating Both Pain and Addiction
Addiction happens. Pain happens. And sometimes they happen in the same person. Addiction starts before the pain or pain can lead a person down a pathway of addiction. Either way, both roads end up in a hellish place where both diseases destroy someone’s life, destroy a family and consume everything in their path. At the point where chronic pain and addiction collide, there are some basic principles to saving a person’s life.
- _Provide Chemical Stability: _ The first treatment priority is to establish chemical stability in the brain. A chemical roller coaster ride that may involve opioids or alcohol or cocaine or methamphetamine or marijuana or sugar or any combination of brain altering chemicals will impair a person’s ability to contemplate change, to participate in therapies, or make better choices. The constant ups and downs sensitize the alarm system, the central nervous system, to the point that pain, anxiety and insomnia spiral out of control. Establishing chemical stability in the brain starts with abstinence or rational pharmacotherapy. An example of rational pharmacotherapy is switching from taking hydrocodone around-the-clock to transdermal buprenorphine patch. However it is achieved, chemical stability is absolutely necessary before proceeding to the other principles of treatment.
- _Motivate for Change _: Change happens in various stages. First there is a pre-contemplation stage when one will begin to become aware of the need for change. Next is the contemplation stage when confidence in ability to change will grow. This is followed by the development of an action plan and taking steps towards making the change occur. When someone is struggling with pain and addiction, change needs to happen in many aspects of life. For example, cutting back on smoking is an excellent example of someone contemplating change because he/she knows that tobacco use is not helping the chronic back pain. All stages of change are a key stepping stones of a successful treatment plan because ambivalence will kill all chances of managing pain and addiction together.
- _Relieve Suffering _: The common theme shared by both chronic pain and addiction is suffering. Both cause life to feel out of control, both are overwhelming, both can appear to have no end in sight, both can lead to social isolation, and both cause fear. Pain and addiction collide in a place called suffering. In order to leave that hellish place, certain strategies can be used like living in the present so that the fear of the future is eliminated. Another strategy to relieve suffering is to be flexible so that new interests in life can be gained in order to replace the unhealthy interests or interests that can no longer be done. Suffering can be relieved in the presence of both pain and addiction.
- _Infuse Resiliency _: A person that is afflicted with both pain and addiction has one thing to do: survive. Surviving the disease, surviving setbacks, surviving change, surviving stress, surviving pressure are all accomplished with a resiliency response. Resiliency is the ability to cope well, bounce back, overcome, change, and do no harm. Teaching resiliency skills can be as simple as helping a person rediscover a childlike curiosity in order to learn new skills, hobbies, and lessons. Yes, a person with pain and addiction can learn their way out of difficult times. Curiosity is just one way to infuse resiliency into someone who needs to survive both pain and addiction.
- _Improve Health: _ Finally, saving someone’s life must include a plan to improve health. Poor mental and/or physical health can completely undermine the best efforts to treat pain and addiction. And what better way to improve health than starting with a complete nutrition make-over. For example, sugar is the ultimate enemy to someone with both pain and addiction. Sugar can worsen a painful condition by promoting inflammation. Sugar can also prime the brain’s reward center for a chemical abuse relapse because of a concept called "cross-addiction". Eliminating sugar can improve a person’s health to the point where pain and addiction can both be managed more effectively. Other aspects of health like exercise, sleep, and habits also need to be evaluated in the comprehensive treatment plan.
These five principles of treating pain and addiction in the same person provide a foundation of recovery, recovery from the pain and recovery from the addiction. Chemical stability, motivation for change, relief of suffering, resiliency and health are all necessary to save a life from being consumed by both pain and addiction. With all five in place, recovery can happen.
Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.