Picture this. You’ve already completed one of the most challenging experiences an individual could ever go through. You’ve successfully battled your addiction and you’re working to rebuild and restart your life. But, as life goes on, we often encounter more challenges. For many, that challenge involves pain.
The nature of pain falls into two distinct camps: either physical or emotional. Although neither type necessarily requires the use of drugs for treatment, the number of prescriptions written to treat these conditions can only be described as excessive, and often inappropriate. The number of prescriptions written globally for pain killers has catapulted from about 76 million in 1991 to nearly 203 million in 2013. Meanwhile, 254 million prescriptions were written for antidepressants in 2011. It was the second-most common drug class for which prescriptions were written that year — bested only by cholesterol-lowering agents. Recent research into prescribing patterns for these drugs revealed that 45% of prescriptions were written for nondepressive indications, including anxiety disorders, insomnia, pain and panic disorders.
Health conditions commonly associated with chronic pain include fibromyalgia, rheumatoid arthritis and osteoarthritis, while persistent pain may also be associated with cancer, multiple sclerosis, AIDS, gallbladder disease or stomach ulcers.
Of particular concern are opioids — the class of powerful pain medications that has been at the center of an explosive upward trend in both addiction and mortality. Notorious drugs in the class include codeine, morphine, OxyContin, Percocet and Vicodin. Earlier this year, the CDC classified deaths from opioids as an epidemic.
While treating patients with concurrent chronic pain and addiction is certainly possible, the risk of addiction to any of these drugs should be enough for prescribers to carefully consider how to manage pain in addicted patients. They should take more care to counsel patients on the benefits of pursuing alternative treatment strategies. Evidence suggests this doesn’t really happen. Fortunately, there are many strategies to help all people, including individuals who once struggled with addiction, avoid using pharmacological treatments for their pain.
Chronic Physical Pain: More Than Most Can Bear
Physical pain is one of the most common complaints from patients. A recent survey conducted by the National Institute of Health Statistics revealed lower back pain to be the top cause of pain (27%), while severe headaches/migraines account for 15%, neck pain for 15% and facial ache/pain for 4%.
Data from the American Academy of Pain Medication reveal that more Americans suffer from chronic pain than from diabetes, heart disease and cancer combined. 100 million Americans have diagnosed chronic pain, while 25.8 million, 23.3 million and 11.9 million Americans suffer from diabetes, heart disease (heart attacks/stroke) and cancer, respectively.
According to the American Society of Addiction Medicine, 1.9 million Americans ages 12 or older suffered from an addiction to prescription pain drugs. 586,000 others were addicted to heroin. Estimates from the National Institute on Drug Abuse (NIDA) suggest that around 23% of people who use heroin end up developing an opioid addiction, because prescription opioids act on the same areas of the brain as many illicit drugs.
NIDA also estimates that, following addiction recovery, the relapse rate for individuals suffering from drug addiction falls between 40-60%. Meanwhile, the CDC says pain management drug abuse may disproportionately affect women. The agency says women are more likely to experience chronic pain and receive prescription pain drugs to manage the condition. Those prescriptions tend to be for higher doses and last for a longer duration than those of their male counterparts. The mortality rate among women for prescription opioid overdose has skyrocketed 400% since 1999.
If you count yourself among these 100 million Americans that suffer from pain, you’re likely already aware that balancing the trials and tribulations of life can prove a formidable task. Luckily, there are many ways to have your cake and eat it, too. You can manage pain while avoiding the addiction risk that comes with taking prescription painkillers.
Physical therapy can help teach you to move, extend muscles and strengthen joints to allay the source of pain. Unlike using medications, physical therapy can actually help to address the source of pain and potentially improve pain over time. Similarly, hot therapy can help relax your muscles by increasing blood flow and reducing inflammation in areas affected by pain. Cold therapy can slow blood flow to an area to reduce swelling in a painful joint. This hinders nerves’ ability to send pain messages quickly.
The American Physical Therapy Association touts its therapists as having an important role in providing crucial strengthening and flexibility exercises, manual therapy, posture awareness and body mechanics instruction. Meanwhile, physical therapists can also help people understand and ultimately address the underlying cause of their pain.
Then, there’s acupuncture. Acupuncture is a fairly popular way to treat physical pain. In fact, 3.5 million Americans purport to have tried acupuncture within the past year. After completing certain physical examination assessments, the acupuncturist recommends a particular treatment. You then lie on a table while precise needles are gently placed in the affected areas. The needles remain in place for anywhere between five and 30 minutes. Many individuals say they feel relaxed during and after treatment.
As an added bonus, many insurance plans cover the cost of acupuncture, and it has proven effective in alleviating other conditions, such as:
- Allergic rhinitis
- Dysentery, acute bacillary
- Malposition of fetus, correction
- Morning sickness
- Hypertension and hypotension
Acupuncture, however, is not for everyone. The procedure may be dangerous for certain patient populations, including people with pacemakers or those who have a high risk of developing an infection, suffer from chronic skin issues or are pregnant. Always consult with a physician prior to pursuing an acupuncture treatment regimen.
Transcutaneous Electrical Nerve Stimulation
Meanwhile, transcutaneous electrical nerve stimulation (TENS) has also been shown to help reduce pain in many patients. TENS works by electrically stimulating the nerves in the area where the pain is localized. This function stops pain signals from reaching the brain. A small device attached to the pained area delivers TENS, and some evidence suggests they can help stimulate the production of endorphins, as well. Endorphins are essentially the body’s natural painkillers.
TENS devices are an especially popular nonpharmacological treatment option for people suffering from back pain in particular. Though anecdotally effective, scientific research has failed to establish a link between the use of just TENS treatment and sustainably decreased pain. A few must-know facts about TENS devices include:
- TENS units should not be left in place for long periods of time without checking in on the skin beneath them.
- If a rash or burn of any kind starts to form beneath the electrodes and persists beyond six hours, you should definitely stop TENS. Additionally, it is advisable to notify your physician or physical therapist.
- Do not place TENS electrodes on damaged skin of any kind.
- People should refrain from using a TENS unit while driving, taking a shower, sleeping or while using heating pads or cold packs.
Many patients living with pain who don’t want to take drugs turn to massages — and there’s a good reason why. Massaging is one of the world’s oldest pain relief techniques, especially for lower back pain. Massaging stimulates the body into producing serotonin, which is one of the body’s anti-pain hormones. Additionally, sometimes an exacerbating factor in chronic pain is a lack of deep sleep.
Massaging can effectively increase the amount of restorative deep sleep you get. Similar to physical therapy, massages can also help to increase your range of motion. Finally, massages have been shown to reduce stress and anxiety — two conditions known to exacerbate pain.
A survey conducted in 2008 by the American Massage Therapy Association found that around about 21% of adults in the US had at least one massage in the previous year, while nearly 25% have turned to massage therapy to relieve their pain symptoms at least once during their lives.
Diet: Staying Physically Healthy Can Help Ward Off Physical Pain
You’ve probably heard the word “diet” mentioned when discussing proper lifestyle management for virtually every disease state — and physical pain is no exception. A healthy diet has obvious benefits for weight-loss, which can help reduce the amount of pressure on joints.
Eating a well-balanced diet involves consuming the right portions of food from the five major food groups: whole grains, fruit and vegetables, protein, dairy and fats and sugars. Meanwhile, the World Health Organization promotes the following five diet recommendations to reach and maintain optimal health:
- Achieve energy balance and a healthy weight.
- Limit energy intake from total fats and shift fat consumption away from saturated fats to unsaturated fats and towards the elimination of trans-fatty acids.
- Increase consumption of fruits and vegetables and legumes, whole grains and nuts.
- Limit the intake of free sugars.
- Limit salt (sodium) consumption from all sources and ensure that salt is iodized.
Although these foods don’t have a large backing of clinical evidence to prove a link, many people have anecdotally mentioned that the following foods have helped alleviate symptoms of chronic pain:
- Ginger. Tests have shown that ginger contains compounds that can mitigate inflammation.
- Coffee. Some people say caffeine has helped them reduce the perception of pain during particularly tiring and painful tasks.
- Olive oil. Many people who adhere to the Mediterranean Diet appear to be healthier overall, and investigators are beginning to take a closer look at the anti-inflammatory properties of olive oil.
- Salmon. Salmon boasts a sizeable amount of omega-3 fatty acids, which some researchers have said may have inflammatory properties.
- Turmeric (curcumin). Turmeric appears to boast anti-inflammatory properties and has been touted as a possible way to alleviate pain associated with rheumatoid arthritis.
- Red grapes. These grapes are known to contain resveratrol, which is believed to provide anti-inflammatory benefits. Importantly, recent research has suggested that combining red grapes with turmeric may enhance the anti-inflammatory properties of both.
- Thyme. Similar to coffee, consuming thyme has been linked to increased distraction from feelings of pain, though the exact mechanism behind this remains misunderstood.
Emotional Pain: An Underrecognized Public Health Problem
Physical pain and the potentially addictive properties of the go-to drugs get all the airtime — and it’s understandable why. Documented cases of legitimate pain patients inadvertently becoming opioid addicts continue to rise. It’s extremely important to remember, however, that the origins of chronic pain are not always physical. Just as important are strategies to promote emotional and mental pain management without medication.
Physical pain can be exacerbated by depression, stress and anxiety. Ignoring the emotional factors contributing to pain is definitely not helpful and possibly even counterproductive.
Emotional pain is one of the more unfortunate realities of life. Virtually all people experience emotional pain, which can present as a physical disease. Common sources of emotional pain include:
- Rejection from friends, significant others or even co-workers
- Prolonged loneliness stemming from an inability to connect with others
- Emotional distress relating to the death of a loved one or a traumatic experience
- Guilt relating to your wrongdoings
- Dwelling on the sad and traumatic moments in life
- Believing you have failed or are a failure
- Low self-esteem and sense and self-worth
Cognitive Behavioral Therapy
Cognitive-behavioral therapy (CBT) can provide you with instructions on how to manage thoughts, feelings and your body’s physical response. This can help you effectively manage chronic pain. The guiding ethos of CBT is that people create their own experiences, pain included, rather than the outside environment.
According to the American Chronic Pain Association, speaking with a care professional about pain levels when performing the following daily tasks can provide great insight into potential solutions:
- Getting out of bed
- Climbing stairs
- Descending stairs
- Getting out of a chair
- Personal care, such as showering
- General daily activities
- Activities of leisure
Overall, the key aspects of a successful CBT program for providing pain relief are:
- Encouraging a proactive attitude to approaching problems. A key factor in this is eliminating the idea of helplessness. You can do something about your pain. You do have a degree of control over how you feel.
- Promoting homework. Employing skills learned in CBT outside of therapy sessions is crucial to ensuring that those skills become a part of your normal routine.
- Fostering life skills — namely, coping mechanisms that can be applied to dealing with bouts of path or any other tribulations that may come your way.
- Provides you with the tools and confidence you need to keep up pain management after you stop visiting the CBT therapist.
Biofeedback is a technique by which you attempt to control normally involuntary actions, such as a heartbeat or blinking. This can include how to control your body’s reactions to pain. The method works by harnessing the power of your mind and becoming acutely aware of what’s going on inside your body. This, researchers say, can improve your health.
During a biofeedback appointment, electrodes or finger sensors are attached to your skin. These units send signals to a monitor that utilizes either a sound, flash of light or images to demonstrate both your heart and breathing rate, blood pressure, the temperature of your skin, sweating or muscle activity.
These bodily functions are the primary ones that change when you’re stressed out. Under stress, your heart rate ramps up, your muscles constrict and tighten, your blood pressure jumps, you start sweating and your breathing becomes faster and more shallow. You can see these stress responses as they happen on the monitor, and then get immediate feedback as you try to stop them.
Biofeedback sessions are typically done in the setting of a therapist’s office, but there are computer programs that can enable you to connect the biofeedback sensor to your own computer within your own home.
A biofeedback therapist guides you through practicing relaxation exercises. These exercises have distinct nuances according to which body function you’re attempting to control. For example, you could try a relaxation technique to turn down the brainwaves that activate and ramp up when you’re experiencing a headache.
Biofeedback therapy employs several other relaxation techniques, including:
- Deep breathing.
- Progressive muscle relaxation. This technique involves switching between tightening and then relaxing different and distinct muscle groups.
- Guided imagery, which involves concentrating on a certain image (for example, the color and texture of a kiwi) to focus your mind and generate relaxation.
- Mindfulness meditation, which involves a conscious effort to focus your thoughts and let go of negative feelings.
Emotional Freedom Technique
Additionally, you can try the emotional freedom technique (EFT), which is essentially the same idea as acupuncture but without needles. EFT works by tapping your fingers onto certain parts of your head or chest and verbally expressing positive thoughts while thinking about whatever is causing your pain. The proper technique ideally utilizes your index and middle finger tips from only one hand (neither hand is more effective than the other).
Before you go and dismiss EFT, consider that there has been scientific research to back up the efficacy claims. In one such study, published in the International Journal of Healing and Caring, PTSD rates among veterans dropped by 50% from clinical to subclinical levels.
There is a growing body of evidence that suggests music can help heal both chronic physical pain and pain derived from an emotional or mental state. Many credit music’s abilities to provide distraction from many forms of pain. Music’s analgesic effect has proven extremely effective in many patients. Long-term music therapy has been shown to help improve quality of life. Notably, music chosen by the individual in pain tends to be more effective than suggested music.
Previous research has suggested that our furry friends can help to decrease levels of depression, loneliness and overall isolation — all of which are linked to increased instances of pain. The explanation behind this phenomenon is that caring for the needs of a pet can give you purpose greater than yourself. No matter how poorly you may be feeling, you still have to walk, feed and play with a dog each day in order to give them the life they deserve.
All things considered, however, pets are not an appropriate addition to therapy for all people. Pet ownership should always be carefully thought through prior to commitment.
Other nonpharmacological pain management strategies can include:
- Relaxation techniques, such as breathing
- Gel packs
No Matter Your Pain, You Don’t Have to Walk the Path Alone
Addiction is a disease that’s as important to treat as pain.
One analysis published in The Primary Care Companion to the Journal of Clinical Psychiatry purports that non opioid and nonpsychotropic pain treatments should be used when possible to treat acute pain. Pain management for recovering addicts can be especially trying, because, although someone may have completed a recovery program five years ago and maintained sobriety since then, the potential for relapse persists for their entire lives. That risk, however, can be managed. The quality of an individual’s substance abuse recovery and support program can increase or decrease the risk for relapse.
Getting started at 12 Keys Rehab is an individual’s best option for finding a solution for recovering from the pain of addiction. The aftercare program can help you remember the tools and resources you need to fight off the compulsion to abandon the straight and narrow and fall back into addiction. Importantly, 12 Keys Rehab’s signature 12 Step Rehab Program is available to help you remember possible triggers for relapse and promote strategies for lifelong success in sobriety.
Many of the staff members at 12 Keys Rehab are themselves former addicts. Drawing from experience and training, they have the expertise in both addiction treatment and pain management that most primary care settings lack. Contact us today.