The focus of last month’s digest was to take a closer look at the relationship between pain and addiction. This month, we would like to compare and contrast two approaches to pain treatment—pain recovery and pain management.
The primary goal of pain management is to control, if not eliminate, chronic pain. Pain management involves prescribing pain medications and physical interventions that range from less invasive to more invasive, such as physical therapy, steroid injections, and surgeries in order to prevent or decrease pain. Opiates or painkillers, as they are often called, are the primary medications used to treat chronic pain. They have the potential for significant side effects, along with the possibility of abuse, physical dependence, and addiction. Sometimes, using opiates actually causes more pain—a phenomenon known as opiate-induced hyperalgesia. This often affects people with chronic pain who take opiates for long periods of time. The only effective treatment for this condition is to stop these medications so the brain can “reset” and eliminate the hyperalgesic effect of the opiates.
Obviously, physical interventions like spinal injections, nerve blocks, surgeries, and other more aggressive treatments have their own risks, some of which are considerable. Chronic pain patients and their caregivers must weigh the level of pain and the potential benefits of what is usually temporary relief against these problematic consequences in the pain management process.
Pain management is about the quick fix and the desire for that very short-term improvement in everything. Initially, people’s fear, depression, and anger decrease when they take their medications, but the long-term effect of that is the worsening of depression, fear, and anger, as well as mobility. So managing pain needs to take into consideration improvement of function, and traditional pain management does not necessarily do that. Also, with most chronic pain conditions, the goal of eliminating pain altogether is simply not realistic. The goal of pain recovery is to learn ways to accept and coexist with pain, rather than “kill” it.
Pain Recovery Vs. Pain Management
|
Pain Management |
Pain Recovery |
|
Medically managed |
Individually managed |
|
Medication-based |
Abstinence-based |
|
Medical model |
Twelve-step model |
| Dependent on medications and medical procedures to “kill” pain | Personal responsibility; learning to accept and coexist with pain |
|
Victim/Patient |
Empowered/Advocate |
|
Externally focused |
Internally focused |
|
Problem-oriented |
Solution-oriented |
[books] photo credit: Mercy Health via photopin cc