Chronic Pain and Addiction

It is estimated that 116 million Americans have difficulty with chronic pain. It is not uncommon for those suffering from chronic pain to turn to drugs and alcohol as a way of relief.  Increased feelings of hopelessness arise out of daily struggles with pain which increases the risk of depression. Depression is then a risk factor for addiction. While not everyone who uses drugs and alcohol become addicted to them, there certainly is a high rate of dependence.

What is chronic pain?

According to Treede et al (2015), chronic pain is “pain that persists past normal healing time…and lasts or recurs for more than 3 to 6 months”. Treede, et al discusses how the nociception or psychological receptors in our brain that signal to us that we are in pain is over-active. In acute pain (such as breaking your arm), these receptors activate to protect the body and signal for us to rest and allow it to heal properly. Over time, as the arm is healing, the receptors stop activating as the body is returning to a normal state of functioning. This causes the pain to dissipate. However, for someone experiencing chronic pain, the mind and body continue to think that there is a threat and is continually activated. These perceived or real threats can be physical in nature, emotional or psychological.

How can my chronic pain be addressed in addiction treatment?

To understand better how chronic pain can be addressed in a treatment setting, below is an interview completed with a therapist who works very closely with clients experiencing chronic pain.

Anastasia Bean, MS, LPC,NCC.             Photo courtesy of Psychology Today

Anastasia Bean LPC, NCC is a licensed professional counselor, a nationally board certified counselor (NCC), a Certified Complicated Pain Recovery™ Coach, and she holds a Masters in Clinical Mental Health Counseling from Georgia State University.  She has developed an expertise in chronic pain through her collaborative work with pain management specialists. Inspired to better serve the chronic pain community she developed Complex Pain Recovery®, which provides support groups, consultation for clients and professionals. She incorporates evidence-based modalities for managing complex pain. She also utilizes a pain recovery language aimed at enhancing coping skills, increasing levels of functioning, with a focus on decreasing medication reliance.  Ms. Bean serves on the CPA (Chronic Pain Anonymous) Board Of Trustees as a professional advocate. Anastasia’s therapeutic approach is strength based and integrative, utilizing solution focused, experiential, gestalt, acceptance and commitment therapy (ACT), and cognitive behavioral therapy 

1. How have you seen the connection between chronic pain and addiction in your practice?

AB:  I initially got into the field to work with those suffering from addiction. Having had my own personal experience in my family with addiction, I was passionate about helping others.

Seven years ago, I was given the opportunity to provide SCS (Spinal Cord Stimulator) Mental Health Evaluation for patients seeking to have a SCS surgery. In the evaluation, I would assess for depression, and anxiety and pain catastrophizing which assesses for hopelessness, magnification, and rumination. I soon realized that the experiences those with chronic pain had were not dissimilar to those in addiction. As I sat with client after client with chronic pain listening to their stories and recognized many correlations. Their obsessions about wanting to feel better through researching every possible procedure or drug was very similar to those struggling with addiction. It was similar in how they felt about themselves, their identity became wrapped up in these behaviors, their relationships suffered, they lost jobs and became isolated. In essence, they were chasing to stay out of pain—they would try anything whether it be the next procedure, next doctor, however much money it required—to just not feel the pain. I began to think about how best to provide support. We have learned that within the addiction field, group accountability is helpful. From there, I developed my own group called Complex Pain Recovery to provide a space for those struggling with chronic pain to begin to work on the psychological issues that were arising from their pain, not just the physical piece.

2. What would you say to someone who has been Diagnosed with Chronic Fatigue Syndrome, Chronic Pain Syndrome or Fibromyalgia?

AB: These are diagnoses that are called deferred diagnoses. Meaning there is not cure and we are simply going to help manage the pain. To instill hope, I like to educate that the medical model is an excellent resource but it can only go so far. The good news is that you have the psychological and emotional piece you can work on these are two other resources for you to access. I help them to look at the other parts of themselves as a human being, learn coping skills and a new perspective to move forward with their lives. I help them shift their self-identify as a “sick person” to someone who can be well and thrive.

3. How do you treat Chronic Pain?

AB: The first step is Accepting what is. According to the American Pain Society, chronic pain management is “managing uncontrollable misery.” If you look up recovery it means “learning to self-advocate to live your life the fullest”. How I treat chronic pain is a shift of mindset, raise coping ability, connect with others. Management is what you do with your doctor and recovery is shift in perspective. I incorporate Acceptance and Commitment Therapy (ACT), Cognitive Behavior Therapy (CBT), and Mindfulness.

4. How would you explain a Mind, Body Spirit approach and how do you implement this in practice?

AB: Those suffering from chronic pain will tend to first seek medical care (Body), which can be a great option. However, at some point, that begins to not work or not be sufficient support. It is at this point, that tapping into the Mind and Spirit is essential. I have found my clients have developed a lot of catastrophizing and negative expectancy (for example: “the procedures haven’t worked.”). It is important to understand these judgmental thoughts as just that, thoughts and begin to separate them from how it’s interacting with the physical body. It is also critical to confront all the emotions that arise. When we begin to face what is, we can learn to accept it. When we learn to accept what is, our body in turn begins to listen. It is critical to raise the ability to cope, lessen the feelings of hopelessness they feel. Once you do this, healing occurs.

5. What are the emotions that come up the most with clients?

AB: Many of my clients are angry which is, of course, a secondary emotion. As we explore this anger, what comes up often is a sense of grief. Grief of the life they’ve lost, grief of never being able to run a marathon again or play with their kids the way they used to. Another emotion I hear is a sense of shame as they feel they are a “burden” to their loved ones. They feel bad for who they are. Fear is another common emotion that arises—fear of how it will continue to deteriorate, how, tomorrow is not guaranteed and could be a “bad” day. In my groups I describe what is called the Gate Control Theory. You can open and close the gates in your spinal cord (nervous system) to keep pain in or out. Mindfulness is an excellent exercise to close those gates. However, fear, anger, shame and stress allow those gates to remain open allowing pain to continue.

Not a life sentence!

Pain does not have to be a life sentence. You also do not have to struggle with how chronic pain alone. If you or a loved one is struggling with chronic pain or substance issues, here are some great resources:

• Centered Recovery
• Connections Behavioral Health & Complex Pain Recovery® https://www.connectionsbehavioralhealth.com
• Complex Pain Recovery® Services and Support Groups https://www.connectionsbehavioralhealth.com/services-1
• Chronic Pain Anonymous https://chronicpainanonymous.org
• Your local Pain Management physician (ask your primary care provider for recommendations if they do not specialize in chronic pain themselves)

Written by Staff Clinician Rebekah Tchouta, LCSW

References

Bean, A (April 2, 2020). Personal Interview.

Treede, R. D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., Cohen, M., Evers, S., Finnerup, N. B., First, M. B., Giamberardino, M. A., Kaasa, S., Kosek, E., Lavandʼhomme, P., Nicholas, M., Perrot, S., Scholz, J., Schug, S., Smith, B. H., Svensson, P., … Wang, S. J. (2015). A classification of chronic pain for ICD-11. Pain, 156(6), 1003–1007. https://doi.org/10.1097/j.pain.0000000000000160

When Managing Chronic Pain becomes Addiction (2014). The Ranch Treatment Center.