Drug-Free Options Coming for Addicts With Chronic Pain
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Drug-Free Options Coming for Addicts With Chronic Pain


Addicts With Chronic PainAs if opioid addiction wasn’t difficult enough, the treatment of chronic pain can be an even rockier road for addicts in recovery. Very often, the only treatment option for addicts includes painkillers that turn out to be as potent and addictive as the substances they’re trying to kick. It’s a common problem that, unfortunately, condemns many addicts to an endless, vicious cycle. Instead of overcoming their issues, addicts with chronic pain get further away from the help they desperately need. The results of a new study, however, indicate that a successful drug-free treatment is on the horizon for addicts. The approach could be a potential game-changer for addiction recovery and save thousands of lives.

Low Risk, High Reward

Treating addicts without painkillers sounds almost too good to be true. But that’s precisely the method researchers are testing. In fact, there’s little cost and risk involved and a high probability that it will actually work. The approach “combines behavioral therapy and social support to help them manage their pain,” according to ScienceDaily. Called Improving Pain during Addiction Treatment (“ImPAT” for short), the technique takes 10 weeks to complete and yields an effect that lasts an entire year. On paper, using behavioral therapy and social support together doesn’t make a lot of sense. Cancer patients, for example, have long benefited from behavioral therapy in order to cope with pain. Combining the two approaches is unusual. Doctors generally prescribe the “quick fixes” of opioid painkillers rather than steer a patient elsewhere—mainly because it’s easier.

Easier isn’t better, of course. That’s where ImPAT comes in. The program works to “help patients focus less on their pain and more on other aspects of life,” the ScienceDaily story said. “This includes techniques to help people adapt to their pain, find ways to distract themselves from their pain, and think of ways to function in the face of pain.” In other words, it’s a method that helps patients to not only out-think their addictions, but learn to live with their circumstances.

The approach was first tested on 55 veterans—all of whom reported improvements in their pain: “Veterans who received this pain-focused care while also being treated for addiction found that the intensity of their pain decreased, their ability to function increased, and their alcohol use went down, compared to veterans who received a less-focused approach.” The findings aren’t simply encouraging—they’re echoed in the follow-up studies that are currently underway. “We want to take the focus off pain and put it onto functioning, and finding pleasurable ways to spend time,” Dr. Mark Ilgen, the study’s lead author, said of the studies. “There’s also a strong link between depression and pain. Pain is responsive to mood, and mood is responsive to social support.”

Epidemic Proportions

Opioid addiction is a national health crisis that, according to the CDC, claims the lives of 29,000 Americans per year (that’s 80 every single day). Since 1999, the number of Americans who’ve died of opioid overdoses has quadrupled while the number of opioids prescribed has followed the exact same trend in the same amount of time. Incredibly, many sources estimate that the US consumes a staggering 80 percent of all the world’s opioids. It’s highly unlikely that the US has more pain the rest of the world. And since the US represents “5 percent of the global population,” the findings suggest that there “a larger divide between affluent nations and the rest of the world when it comes to prescription painkillers.”

Opioid addiction has largely skyrocketed because painkillers are being prescribed to treat acute and chronic pain. It’s also why a drug-free option is needed now more than ever, the researchers say. What makes pain treatment even trickier with addicts, though, is the fact that addicts might simply be more sensitive to pain. “Long-term use of opioids can sometimes lead to a hypersensitivity to pain, so there may actually be a causal link between use of these medications and pain,” Dr. Ilgen noted. “We need to study psychological pain management approaches in opioid-dependent patients, including those receiving addiction therapies such as buprenorphine.

What’s Next?

As they exist now, most addiction treatment programs simply aren’t built for those who suffer from chronic pain. In an editorial on the study, chronic pain isn’t something just a few random addicts suffer from: “Among [the]patients seeking substance abuse treatment, 30–50% report chronic pain and, among those with opioid use disorder…there is a staggering 70–80% prevalence of chronic pain.” Those are numbers that demonstrate an appetite for addiction treatment programs that do more than just simply deal with substance abuse. Hybrid programs like ImPAT, which take pain into consideration, can be doubly effective. “We’ve shown that it’s possible to improve pain outcomes in people with addiction, and even have some spillover effects on their substance use,” Dr. Ilgen said of his team’s approach.

It’s unclear just how many addicts haven’t been properly treated, either, having fallen through the cracks of an overly complicated system. “Past studies of psychosocial approaches for pain have often excluded people with drug or alcohol problems,” Ilgen observed. “Addiction treatment programs do not usually have providers trained in pain care, and many pain specialists will not treat people who also have addiction. So patients are caught in the middle.” And that’s a gap that can be filled by the ImPAT program.

While some critics take issue with the study’s findings, others contend those faults are actually successes. The editorial’s author argued that the ImPAT study was actually put up against a “more robust comparator than was probably necessary, yet it still showed superiority.” He also believed that ImPAT’s innovative ability to treat pain and substance abuse at the same time bodes well when it comes to cost. Doing both at the same time is simply cheaper, he said. Still, hybrid programs like ImPAT aren’t an immediate answer to addicts’ prayers regarding pain treatment. Much work needs to be done to fine-tune the approach. If nothing else, though, ImPAT suggests that addicts who suffer from chronic pain may also find relief in the place they least expected: inside themselves.

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About Author

Paul Fuhr is an addiction recovery writer whose work has appeared in The Literary Review, The Live Oak Review, The Sobriety Collective and InRecovery Magazine, among others. He is the author of the alcoholism memoir “Bottleneck.” He's also the creator and co-host of "Drop the Needle," a podcast about music and recovery. Fuhr lives in Columbus, Ohio with his family and their cats, Dr. No and Goldeneye.