A Fresh Take on Chronic Pain

I attended a conference on chronic pain last weekend which gave me a fresh perspective on the topic. It left me thinking about the prevalence of chronic pain, with 100 million Americans affected each year (about 1/3 of the population!) (Reuben et al., 2012). It also left me thinking about pain as relates to addiction and fear.

The first presenter of the day was a nurse who shared her personal experience with drug and alcohol addiction. She went through rehab twice and has been off of prescription pain medications for 13 years. What sticks with me most about her presentation is how she refers to herself as a person who has the disease of addiction and alcoholism, not as an alcoholic or an addict. She is a person first, as are other people who have the disease of addiction. Also, this distinction highlights the fact that addiction is a disease. There are neurological and genetic components to addiction as well as psychological, social, and spiritual aspects. People need help and this can come in the form of correct treatment, but also in the form of compassion.

Addiction is often overlooked when addressing chronic pain, but fear is another overlooked component: Fear of getting worse or living with the current pain forever, fear of changing or decreasing medications, and fear of trying something new, especially when current pain levels are finally at a manageable level. Fear is real, just as pain is real, and is a component of pain management that needs addressed.

Chronic pain is pervasive in our society, and has been approached from one direction for years. Oral opioids. (Codeine, hydrocodone/vicodin, morphine, oxycodone/percocet, hydromorphone/dilaudid, fentanyl/duragesic) Opioid therapy has good evidence for short term use (4-8 weeks), but little evidence for long term use (Manchikanti, L et al, 2012). Despite this fact, opioids are most commonly used long term. Other options for pain management exist. Herbs, homeopathy, physical medicine, massage, movement, topical medications, topical herbs, etc. can be used to great benefit. No one deserves to suffer, and with so many options for addressing different types of pain, why get stuck with opioids as the only option? This is not to say that opioids do not have a place in health care, but they are highly addictive, and overdose with opioids (prescription and heroin) led to 28,000 deaths in 2014. At least half of these were from prescription drugs. Since 1999 the number of opioid prescriptions written and the number of opioid related overdose deaths has nearly quadrupled (cdc.gov/drugoverdose/).

My goals for people with chronic pain are to decrease pain, moving toward a pain free life, and to address fears, addiction, and overprescribing by doing the following:

  • Determine and treat the underlying cause of pain
  • Address the neuroemotional, social, and psychological aspects of pain
  • Optimize overall health, and
  • Decrease or eliminate prescription drug use
1. Manchikanti L et al. (2012). American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part I –evidence assessment. Pain Physician, Jul;15(3Suppl):S1-65.
2. Reuben DB et al. (2015). National Institutes of Health Pathways to Prevention Workshop: the role of opioids in the treatment of chronic pain. Ann Intern Med, Feb 17;162(4):295-300.
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