Pain Recovery. Robert Hunter

have the beginning of the answer to chronic pain. Please don’t underestimate the significance of this!

       A lot of the work you will be doing in this book will be to help you notice your pain, but notice it in a very different way. It will require that you be open to changing the experience, and you will be amazed at the differences in how your pain “feels.”

       These techniques cannot help but help—a little for some, a remarkable amount for others—and a lot depends on your openness, willingness, and tenacity in applying yourself to these ways of changing your thinking about your pain.

      RECOMMENDED READING

      A Day without Pain by Mel Pohl, MD, FASAM; Central Recovery Press.

2 Chronic Pain and Addiction: Double Trouble

       According to a 2006 study, 90 percent of all people in the US receiving treatment for pain management receive prescriptions for opioid medication. These medications carry with them a risk of dependency and addiction. For those with chronic pain who become addicted when they take opioids for pain relief, the two conditions exacerbate each other, making both worse than either would be alone. Many professionals believe the benefits of opioid treatment far outweigh the risk of developing addiction, but people who do become addicted find themselves in a conundrum: They need opioids to treat pain, but when they take them, they experience horrible consequences.

       Given the complex and multifaceted nature of chronic pain and addiction, it is essential to address all the aspects of the condition—the physical, mental, emotional, and spiritual components—in order for the individual to recover. First, let’s look at addiction in some detail.

       Addiction Explained

      Addiction is a complex brain disease. The symptoms of addiction include physical, emotional, spiritual, and thought disturbances with manifestations that affect behaviors and relationships. Use of drugs over time induces changes in the structure and function of the brain that can be long-lasting and produce a host of harmful effects. Studies have shown that in drug-addicted individuals, the areas of the brain that undergo physical changes are critical to judgment, decision making, emotion, memory, and behavior control. This may help explain the destructive behaviors of addiction. As the disease progresses, a person becomes increasingly unable to control his or her drug seeking and use even in the face of terrible consequences.

      There is no way to predict with certainty whether a person will become addicted to drugs, but there are several known risk factors. These include:

      

Genes: It is estimated that genetics accounts for 40 to 60 percent of a person’s vulnerability to addiction.

      

Environment: Frequent exposure to drug use in home, work, school, or social life can influence a person’s use of drugs, which may become problematic.

      

Early use of drugs: The earlier a person starts using drugs, the more likely he or she is to develop problems with abuse and addiction.

      

Mental illness: Anxiety, depression, and other mood disorders are commonly associated with addiction.

      

Traumatic childhood experiences: Abuse, neglect, dysfunction in the family, or other trauma can leave a child more susceptible to addiction later in life.

      TERMINOLOGY OVERVIEW

      Addiction is a chronic, relapsing brain disease characterized by compulsive drug seeking and use, despite harmful consequences. At one time, addiction was a pharmacologic term that referred to a person’s using enough drugs to cause tolerance and physical dependence. In fact, we now know a person can have addiction without developing tolerance or physical dependence.

      Tolerance means that more of the drug is needed over time to experience the same effect, and it commonly occurs with long-term use of opioids.

      Physical dependence is characterized by being unable to stop using the drug without feeling terrible and developing a syndrome known as withdrawal.

      Drug dependence is a synonym for addiction and is a set of behaviors involving problematic use of mood-altering substances over a continuous period of time.

      Symptoms a person might display include:

      • Having problems with controlling use, and thus having an unpredictable outcome once he or she begins using a substance.

      • Trying to cut down or stop, but being unable to “stay stopped.”

      • Being preoccupied with the drug and continuing to use it even though it is causing problems.

      • Not doing the things he or she used to do and “chasing the high”— spending time and energy getting the drug and using it.

      With addiction, the problem exists not so much with the drug itself, but with the way that drug works in the brain and nervous system. Some of you are destined to develop addiction because of how “well” the drug works—both physically and emotionally.

      You were probably wired differently from birth, and with continued exposure to a drug, particularly an opioid (whether you started taking it for pain or not), you eventually became addicted.

      Some people develop tolerance and physical dependence. These phenomena occur with continued exposure to certain substances over time. With increased use of certain drugs (e.g., an opioid), the body reacts by decreasing the effect of the drug, in this case, pain relief. This is tolerance. Consequently, in order to achieve pain relief, you increase the dose of the drug. This adjustment works temporarily, but eventually the need for still-increased doses will occur. Eventually, the drug seems not to work any longer, which results in using stronger, more potent drugs in an escalating upward spiral.

      If you become tolerant to the drug, this indicates that your body is “normalized” in the presence of the drug. In fact, you may become so used to the drug that you need the drug to feel normal. Without it, you feel terrible. This is physical dependence.

      When the drug is discontinued abruptly, you will feel withdrawal—in effect, the opposite feelings that the drug caused. So if opioids cause decreased pain and some amount of calm and well-being, then withdrawal consists of increased pain and anxiety, body aches, stomach and muscle cramps, diarrhea, nausea, vomiting, insomnia, and agitation. This outcome is one of the main reasons some of you will feel the need to continue the opioid, since, when you try to stop or even reduce the dose, you feel terrible.

      So what is the solution to this awful problem? You feel that you have to take the drug to feel any level of pain relief, even though it barely works. In fact, as you’ll learn, it actually may be making the pain worse due to a phenomenon known as opioid-induced hyperalgesia. You might consider cutting down the dose of the opioid; however, that presents the immediate problem of withdrawal. In the short run, cutting down or stopping will make you feel much worse. This is because the withdrawal of the opioid from your system inevitably causes a temporary increase in symptoms, including pain. This effect makes the process of coming off opioids