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Common Chronic Pain Conditions
Low Back Pain Neck Pain Upper Back Pain Arthritis Fibromyalgia TMJ Chron’s Disease Pain and Addiction CNCP and addiction frequently co-occur. They have shared neurophysiological patterns involving abnormal neural processing.
Effective CNCP management in patients with or in recovery from SUDs must address both conditions simultaneously.
Similarities– CNCP and SUD
Fluctuate in intensity over time and under different circumstances.
Require ongoing management.
Are neurobiological, with evidence of disordered CNS function.
Treatment of one condition can support or conflict with treatment for the other.
A medication appropriately prescribed for a particular chronic pain condition may be inappropriate, given the patient’s SUD history.
Are mediated by genetics and environment.
May have significant behavioral components.
May have serious harmful consequences if untreated. (What harmful consequences if chronic pain left untreated)
Often require multifaceted treatment.
Have similar physical, social, emotional, and economic effects on health and well-being.
Chronic Pain
Chronic pain often results from a process of neural sensitization following injury or illness in which: Thresholds are lowered. Responses are amplified (hyperalgesia) Normally non-noxious stimulation becomes painful (allodynia) Spontaneous neural discharges occur.
Effects of CNCP on Health
Contributes to a sense of exhaustion.
Can trigger emotional responses
Emotional responses can produce more pain.
Physiological and psychological sequelae of CNCP can be exacerbated by
Inactivity
Overuse of sedating drugs.
Risk Factors for Addiction
Genetics—Forty to sixty percent of a person’s vulnerability to addiction may be genetic.
Mental illness—A person may attempt to relieve depression or anxiety with substances.
Environmental factors—Examples include poverty, poor parental support, living in a community with high drug availability, and using substances at an early age.
Cycle of Pain and Addiction
CNCP provides both positive and negative reinforcement of substance use:
Positive reinforcement—A behavior is followed by a consequence that is desirable
Negative reinforcement—A behavior is followed by the elimination of a negative consequence (e.g., pain reduction from heroin use).
Assessment of CNCP should include documentation of the following:
Pain onset, quality, and severity; mitigating and exacerbating factors; and the results of investigations into etiology
Pain-related functional impairment
Assessing for Chronic Pain
Assessment of CNCP should include documentation of the following:
Emotional changes (e.g., anxiety, depression, anger) and sleep disturbances
Cognitive changes (e.g., attentional capacity, memory)
Common Co-Occurring DisordersAnxiety Depression Post-traumatic Stress Disorder Somatization Suicide
Assessing Ability to CopeThe concept of acceptance refers to the patient’s belief that: There is more to life than pain. Being completely free of pain is unrealistic. Activities should be pursued, even at the price of some increase in pain.
Impact of High Acceptance
Deciding that pain “is” and choosing not to focus/dwell on it leads to:
Lower pain intensity. Less pain-related anxiety and avoidance. Less depression. Less physical and psychosocial disability.
Discuss treatment goals that include: Reducing pain.Maximizing function. Improving quality of life. Addressing co-occurring mental disorders. Incorporating suitable nonpharmacologic and complementary therapies for symptom management.
Exercise and physical therapy Assist with homeostasisCan increase strength, aerobic capacity and flexibility. Can improve postureEnhance general well-being Can be an antidote to feelings of helplessness and personal fragility.
Summary
There are many similarities between CNCP and SUDs
Integrated, concurrent, biopsychosocial treatment is vital
Mood impacts Pain impacts Life Satisfaction
Recovery supporting realistic beliefs and identifying controllable factors outcomes
Patients with current SUD need treatment just as much (or more than) those without.
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