Karen L. Kehler, MA,  MSHA - Private- Professional- Affordable Counseling Services
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Kehler Counseling Blog

What to Do if You Need Pain Management and Have Addiction History

Our country is in the midst of an epidemic of Heroin addiction and deaths by overdose.  As many as 80% claim they started by using prescribed opioid medications for seemingly 'normal' life events requiring pain management: teeth extractions, sports injuries, accidents involving injuries, surgeries, child birth, cancer, and/or cosmetic/ re constructive surgeries.   Physicians often prescribed them for increasingly lower level painful events - because they wanted their patients to be 'comfortable' and insurance companies often paid for the prescription that was reported as 'effective'.   
Little did we all know how extremely addictive they were!  I had read previous reports of many being physically addicted within 14 days - now they have reduced that to 7!   What left us shocked is that the physical 'addiction' or dependency - meaning that your body goes through a period of withdrawal - is that the person doesn't need to be a 'addict' or have an 'addictive personality' to become physically addicted to these drugs.   This is why we have to fight against the stigma of 'druggies' because so many innocent people have been caught in the cycle of trying to get free from this class of drugs and too many end up using heroin - because its cheaper and more accessible than the prescribed drugs. 

I am writing this to help those who already dealt with addiction.  I am sharing it to share with others who are concerned about the risk of addiction yet NEED real pain management.  
Unfortunately this dilemma is real.  I see clients who need to have surgeries, get injured or in vehicle accidents that require serious pain management.  Many attempt to go through without opiate based pain management while others - with proper supervision can successfully use them temporarily and return to their lives without them.   This is how you can do that - or help someone else do it. 
The other reason I share this is that if a person is abusing a substance like alcohol and adds a prescription for pain management a lot can go wrong!   This can be a deadly combination - especially when you combine alcohol abuse with opiates and or benzodiazaphines like Xanax or Ativan.  A person who is under the influence of another chemical may not take their prescription when or how they are supposed to - leading to even less quality of effectiveness to manage pain.   Combining these can cause significant problems including death. 

1- Assign someone trusted to dispense the medications prescribed -only provide a 3 day supply to the person if someone can't attend to task daily.   Lock up all remaining supply.   Ask the physician to limit the prescription to a short period of time - that can be renewed after follow up assessment.  

2- Use any and all alternative strategies to reduce pain within 4 categories including:
PHYSICAL:
  • Thermal: Ice/ heat
  • Counter stimulation:
  • TENS
  • Nerve Stimulation
  • Vibration
  • Exercise/stretching/strengthening/conditioning
  • Manual therapies: massage/manipulation
  • Orthotics /braces/pillows/splints
  • Acupuncture
PSYCHO-BEHAVIORAL:
  • Relaxation/Biofeedback
  • Stress Reduction
  • Psychotherapy for co-occurring mental illness
  • Cognitive restructuring
  • Pacing
  • Behavioral modification
  • Treatment for mood disturbances
  • Sleep management
INTERVENTIONIST:
  • Nerve blocks
  • Ganglion injections
  • Steroid joint injections
  • Epidural steroids
  • Spinal cord stimulation
  • Spinal infusions
MEDICATION:
  • Non-steroidal anti-inflammatory:  Tylenol, Advil, Motrin -available over-the-counter 
  • Anti-convulsants
  • Anti-depressants with noradrenegic effects
  • Topicals: lidocaine, capsaicin, aromatics
  • Opioids 
Work with your insurance company and health care professionals proactively to manage the type of pain you have and adjust as effective methods work!   You can contact your insurer in advance to ask what treatments they will cover or not!    
3- Increase Recovery Activity.   
  • Be proactive about staying 'recovery minded'.  
  • Attend more meetings. 
  • Journal. Pray. Meditate. Walk. 
  • Increase communication with Program sponsor, mentors and recovery minded peers.
  • Increase activity in faith community. 
4- Work WITH Health care Providers - and encourage collaboration. 
  • Talk openly with each involved professional about your concerns.
  • Sign appropriate documents to allow communication between staff and professionals.
  • Encourage 'cross talk' between professionals to monitor appropriate use of prescriptions as well as adding alternative solutions to pain management.  
  • Ask about their experience with addicted individuals - get referrals for those are most experienced within your insurer network.  
  • This is especially important if the person has difficulty understanding the complexity of their illness or injury and the requirements to treat it effectively. 
5- Work With MEDICAL RECOVERY PROFESSIONALS 
  • If you are already in a medical recovery program receiving opiate blockers/methadone you must coordinate treatment!   They can adjust and even use these medications as part of your healing process.   Again, make sure all physicians involved talk to each other to manage effective treatment for you. 
6- Attend regular Medical Appointments
  • Report regularly throughout process to your health care team so they can assess:
  • Level of pain changes
  • Improved or deteriorating functioning
  • Mood
  • Use of medications
  • General well-being 
  • If you become 'unstable' or behavior reflects inappropriate or abuse of pain management medications have a 'Plan B' determined in advance.   In some cases, medical de-tox may be necessary but careful monitoring including drug testing may be helpful for all involved.  
7- Once the pain event is treated - REMOVE any extra medications from your home or secure in a LOCKED place.  Many young people get addicted because of the access to medications in their own homes or those of peers - secure your supply carefully!  Local police have information about returning unused medications.  

The key is to be pro-active! Protect your recovery, family and loved ones, even employer from the negative consequences that can happen if you don't stay aware of your need to address both pain and addiction.   

Remember pain management is about relieving pain - not getting high!   

Karen  






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