5 principles of treating both chronic pain and addiction
Addiction happens. Chronic pain happens. When pain and addiction collide in the same person, that person can end up in a hellish place where the diseases destroy their life and the lives of loved ones. This combination can make a person feel powerless and overwhelmed by circumstances that seem unmanageable. If someone you know is at this terrible intersection, the basic principles below could help save a life.
Provide chemical stability
When people are on a chemical roller coaster ride, their ability to contemplate change, participate in therapies, and make better choices is impaired. Whether the problem is opioids, alcohol, cocaine, methamphetamine, marijuana, sugar, or any combination of brain-altering chemicals, the first treatment priority is to establish chemical stability in the brain.
Stability starts with abstinence or rational pharmacotherapy, that is, using medications that help with the stabilization process. An example of rational pharmacotherapy is switching from taking short-acting hydrocodone around the clock to a long-acting transdermal buprenorphine patch. This switch transforms the crazy chemical roller coaster to a calmer merry-goround. However it is achieved, chemical stability is an essential component for successful recovery.
Motivate for change
Change happens in phases. First, people become aware of the need for change. Next, they begin to build confidence in their ability to make change. This encourages them to develop an action plan and finally, to begin taking steps toward the change they seek.
When someone is struggling with pain and addiction, change needs to happen in many aspects of life—one change feeding another. Each stage of change is a key steppingstone in a successful treatment plan; success builds on success. Ambivalence will kill most chances of managing pain and addiction together.
Relieve suffering
The common theme shared by both chronic pain and addiction is suffering. Both cause fear, social isolation, a sense of overwhelm, and the belief that life is out of control and always will be. 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 developed to replace the unhealthy interests. By identifying sources of suffering and finding ways to circumvent them, suffering can be relieved in the presence of both pain and addiction.
Infuse resiliency
People afflicted with addiction or chronic pain have one priority: to survive. Surviving the disease, surviving setbacks, surviving change, surviving stress, surviving pressure are best 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 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, and eventually thrive in life.
Improve health
Finally, saving someone's life must include a plan to improve health. Poor mental and/or physical health can undermine the best efforts to treat pain and addiction. And what better way to improve health than starting with a complete nutrition make-over?
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,” which means that a person's addictive behavior can be reinstated with a different substance. 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, such as exercise, sleep, and lifestyle habits, should also be evaluated as part of a comprehensive treatment plan.
These five principles of treating both pain and addiction in the same person provide a foundation for recovery, a foundation from which lives can be transformed. With all five in place, recovery can happen.
Dr. Christina Lasich specializes in pain management at MCHC Health Centers, a community-based and patient-directed organization that serves Mendocino and Lake Counties, providing comprehensive primary healthcare services as well as supportive services such as education and translation that promote access to healthcare. Learn more at mchcinc. org.