Traditional chronic pain management uses a multitude of interventions, including medications. This is a relatively new subspecialty of medicine. Most chronic pain management specialists are trained as anesthesiologists, and usually go through a fellowship training program to learn to deal with chronic pain. Opiate medications are the primary drugs used to treat chronic pain and are often the cornerstone of chronic pain management. Unfortunately, they carry with them a potential for side effects, decrease in function, and in some cases the development of dependence and addiction. The side effects of opiates may include cloudy thinking, drowsiness, depression, and sleep disturbance. In women, opiates and chronic pain can lower estrogen levels, even leading to menopause and osteoporosis. In some cases, increasing the dose of opiates can actually cause more chronic pain, a phenomenon we described in Chapter Two known as opiate-induced hyperalgesia (OIH) that occurs in some people who are on long-term opiates. The proper treatment of OIH is to discontinue opiate medications so the brain can “reset” and eliminate the hyperalgesic effect of the drugs. It may amaze you to know that there are no scientifically reliable studies that justify the use of opiates for longer than three months, even though that is standard operating procedure for treatment of chronic pain. There are a number of reasons for this disparity, but probably the best explanation is that opiates offer temporary relief to a permanent problem that is complex and difficult to treat. Doctors and drug companies have created an industry that promotes these powerful drugs for chronic pain, even though for many that is not the best course. Many patients have reported to us that they would never have started taking prescribed chronic pain medication if they had known how much havoc it could wreak in their lives. Additionally, painkillers are frequently prescribed in conjunction with other habit-forming medications, such as muscle relaxants (specifically Soma), stimulants used for sleepiness caused by the opiates, antianxiety drugs, and sleeping pills. The use of medications to treat the effects of other medications can be extremely frustrating for people with chronic pain and their families. You may end up on so many medications that your quality of life is severely compromised and you still have significant chronic pain. Not all medications are bad for you, but when taking any drugs, ask yourself what effect you are expecting and experiencing. Taking an extra vitamin for energy or a muscle relaxant to decrease anxiety is not addiction, but might underlie a thinking style that looks for a psychological effect from a drug. Many medications are not habit-forming and may be prescribed as part of a chronic pain management plan; these include muscle relaxants, antiseizure medicines, and antidepressants. Each may be helpful, but if prescribed, should be taken under the supervision of a health professional knowledgeable about recovery and chronic pain. Furthermore, we recommend that you remain mindful of the effects of any medication that you are using, as well as its possible interactions with other prescription and over-the-counter medications. Chronic pain management also often includes invasive procedures such as injections (epidurals, facet blocks, and others) and surgeries, as well as nonmedication, nonsurgical techniques such as acupuncture, chiropractic, physical therapy, massage, and hydrotherapy. You have most likely used a variety of substances and techniques to try to deal with your chronic pain. The following exercise concerns your treatment experiences up to this point. This blog post is an excerpt from Pain Recovery – How to Find Balance and Reduce Suffering from Chronic Pain by Mel Pohl, MD, FASAM, Frank Szabo, LADC, Daniel Shiode, PhD, Robert Hunter, PhD; Published by Central Recovery Press (CRP).
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