Dan Mager, MSW Senior Staff Writer, Central Recovery Press Pain brings more people into contact with medical providers than any other presenting problem. Chronic pain conditions affect approximately 100 million adults in the US, at a cost of $560-635 billion annually in direct medical treatment costs and lost productivity. Although there is no reliable research to substantiate the use of opioids for long-term use for chronic pain not caused by cancer, opioids continue to be the most common and first line treatment for chronic pain. In the last twelve to eighteen months, the overuse and abuse of and addiction to prescription opioid pain medications have received a tremendous amount of attention. The abuse of these medications in the US is epidemic. In the last several years, rates of emergency room admissions and deaths related to opioid overdoses have escalated so dramatically that in an increasing number of communities first responders are now authorized to carry Narcan—an opioid overdose antidote. However, opioids are not the only prescription drugs driving increasing rates of addiction and death by overdose. Benzodiazepines—anti-anxiety medications once known as “tranquilizers,” such as Xanax and Valium (often referred to as benzos), and sedative hypnotics—medications used to induce or maintain sleep, such as Ambien and Lunesta, are also highly addictive medications that are frequently prescribed along with opioids for chronic pain. Xanax and Valium are prescribed to ease the anxiety commonly experienced by chronic pain sufferers. What is generally unacknowledged however, is that over time opioid use can lead to and worsen anxiety. Further, anxiety often increases even as the current dose of opioid pain medication wears off—this is a form of micro-withdrawal that creates physiological stress and discomfort. When combined with opioids and benzos have a synergistic effect that enhances the  euphoric qualities of both drugs. Although, initially chronic pain sufferers may not know of or seek that euphoria, when they experience it they can grow to desire it. Ambien and Lunesta are prescribed to treat the sleep difficulties that regularly accompany chronic pain. Of course, the opioids prescribed for chronic pain also often have a negative impact on the quantity and quality of people’s sleep. A recent online article in a workers compensation publication highlighted the possible risks—including addiction and death—to chronic pain sufferers prescribed multiple drugs with potentially hazardous interactions that are neither recommended in combinations nor for long term use. Among the issues of concern presented was that the use opioids in combination with benzodiazepines and/or sedative hypnotics has received inadequate study. This article quoted our own Mel Pohl, MD, FASAM, LVRC Medical Director. As Dr. Pohl put it, “I don’t know that people are as aware of the potential dangers of benzodiazepines and sedatives as they are of the dangers of opioids,” yet “I don’t think I ever admit a work comp patient who is not on a habit forming sedative.” “If you are addressing opioid dependence, in my opinion, you have to address benzo and sedative dependence. To just take people off opioids and leave them on their sedatives and anti anxiety drugs is not good care.” Ironically, as it relates to opioids, benzodiazepines, and sedative hypnotics, the prescribed “solution” often contributes to the problem. In the same way that the long-term use of opioids ultimately makes people more sensitive to pain, often resulting in the experience of increased pain levels, the long-term use of benzos usually results in higher levels of anxiety, and the long-term use of sedative hypnotics only adds to difficulties falling and staying asleep. There are no magic bullets to eliminate chronic pain or the anxiety and varying degrees of insomnia that frequently walk hand-in-hand with it. However, as the LVRC Pain Recovery program has successfully demonstrated with hundreds of clients, there are many approaches and practices that are helpful and healing. These include:

• meditation and other mindfulness practices
• along with attention to exercise appropriate to one’s physical capability
• as well as to diet
• and sleep hygiene
• as well as the use of complementary and alternative medicine treatment modalities, such as acupuncture, chiropractic, massage, Chi Kung, and yoga, among others

These approaches and practices can make a profound positive difference in the quality of people’s lives—helping dramatically reduce their suffering and significantly increase their level of functioning.