Relapse Prevention Planning Is Crucial For Chronic Pain Management
This Article Relapse Prevention Planning Is Crucial For Chronic Pain Management With Coexisting Substance Use Disorders, was first published on RecoveryView.com, an Online Journal on June 4, 2020.
Clearly Defining Relapse Is Crucial
If you ask someone in the medical field about relapse, they most likely will say relapse is going back to an active state of a disease after a period of remission. When you ask someone recovering from inappropriate use of medications, including using alcohol or other drugs they may say it’s going back to using the substance again.
While that definition is partially correct, it can be dangerous, especially if people thinks the only criteria for recovery is abstinence. Another common definition of relapse is that a person goes back to their addiction process. The full explanation of relapse is much more complex and must include not only maintaining abstinence or an appropriate medication management plan but also stop following their mental health treatment plan or sabotaging their chronic pain management plan.
- People can head back towards relapse without even thinking of using
- They can start sabotaging their effective chronic pain management plan
- People also stop following their mental health treatment plan
What many people don’t realize is that the chemical use or coming out of remission is not the beginning of a relapse. It is the final step in an ongoing relapse process. In addition, relapse is a common symptom of a medication use disorder or other chemical use disorders, and one-third to two-thirds of all recovering people in chemical recovery relapse despite their best intentions not to do so. The good news is we can take the mystery out of relapse and increase people’s chances for positive recovery without a chemical relapse episode.
If someone is also living with a coexisting disorder—e.g., chronic pain, depression, PTSD or an anxiety disorder—the instance of relapse can be even higher because these other problems can easily become relapse justifications. Fortunately, the risk of relapse can be lowered if recovering people are exposed to education and training about relapse prevention and how to deal more effectively with all of their coexisting problems. Prevention is much easier than crisis management.
Relapse is the process of becoming dysfunctional in your recovery!
I believe relapse education must start with a new definition of relapse. The definition I propose and share with my patients is: Relapse is the process of becoming dysfunctional in your recovery process. Relapse is a progressive series of events that takes people from a stable recovery through various stages of dysfunction, and eventually go back to using inappropriate medications, alcohol or their other drugs of abuse.
I tell my patients that when you start on the slide to relapse you will undergo many changes. One of the first changes is a return to denial that at first has nothing to do with substance use, sabotaging your pain management plan or addictive behaviors. In other words, you begin denying that you need to work a program of responsible living, healthy communication with others, and constantly looking at yourself for evidence of progress and problems in yourself and your life. To deny these needs leads to thinking problems.
Now instead of responsible recovery-prone positive thinking people start experiencing relapse-prone negative thinking and eventually euphoric recall. This negative thinking leads to experiencing uncomfortable and/or painful emotions. These feelings produce self-defeating urges which are often followed by self-destructive behaviors or ineffective chronic pain management. Inappropriate use of medications, alcohol or other drugs may not be an option in the early stages of relapse, but the negative behaviors often set people up to experience even more problems including increased pain flare ups.
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Identifying Red Flags For Pain Medication Problems
I developed the information in this article to help my patients take a look at their relationship with medications. Differentiating between appropriate use of psychoactive medications with abuse or addiction potential and the beginning of abuse can sometimes be difficult for patients and their healthcare providers to determine. Some medications also have the potential for problematic use including medication dependency, medication abuse, pseudo-addiction, and finally addiction. The confusion and uncertainty of this progression can be challenging for everyone.
The Benefits and Risks of Using Medication
The benefits of medicines are the helpful outcomes people get when they use them, such as lowering blood pressure, curing infection or relieving pain. The risksof medicines are the chances that something unwanted or unexpected could happen to people when they use them. Risks could be less serious things, such as an upset stomach, or more serious things, such as liver damage or even addiction.
When a medicine’s benefits outweigh its known risks, The U.S. Food and Drug Administration (FDA) consider it safe enough to approve. But before using any medicine—as with many things that people do every day—people should be clear about what those benefits and risks are in order to make the best choices.
Some of the Risks from Medication Use
- The possibility of a harmful interaction between the medicine and a food, beverage, dietary supplement (including vitamins and herbals), or another medicine. Combinations of these products can increase the chance of interactions.
- The chance that the medicine may not work as expected.
- The possibility that the medicine may cause additional problems.
Every choice to take a medicine involves thinking through the helpful effects, as well as the possible unwanted effects. The best choice depends on someone’s personal situation. People must decide what risks people can and will accept in order to get the benefits you want. For example, if facing a life-threatening illness, people might choose to accept more risk in the hope of getting the benefits of a cure or living a longer life.
On the other hand, if people are facing a minor illness, they might decide that they want to take very little risk. I always encourage my patients to think it through and work together with their healthcare team to better manage the benefits and risks of their medicines.
Weighing the Risks—Making the Choice
Directions: The benefit/risk decision is sometimes difficult to make. The best choice depends on a person’s particular situation. People must decide what risks they can and will accept in order to get the benefits they want. In many situations, the expert advice of peoples’ doctor, pharmacist, or other health care professional can assist them making the safest decision. Now please review the table below for some specific ways to lower the risks and obtain the full benefit from your medications.
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The Role of Spirituality in Chronic Pain Management Is Crucial
Chronic pain is often misunderstood and undertreated. In addition to the biopsychosocial impact a chronic pain condition frequently has on a person, a spiritual crisis often accompanies the situation as well. Long-term chronic pain is a body-mind-spiritual problem that requires a multifaceted solution. I believe that complementary spiritual practices are necessary components of any effective chronic pain management plan.
Many people have found spiritual interventions like the traditions of prayer and meditation to contribute to the reduction of the sense of suffering. Unfortunately, in our fast-paced world and the secular treatment modality, adding a spiritual component to chronic pain management does not get enough attention.
The concept of spiritual pain requires healthcare providers to go beyond the bounds of traditional clinical treatments and be prepared to devote the time required to give supportive and understanding care. It is crucial to explore spirituality and its impact on a person’s pain in a multidimensional assessment.
It’s Time To Think Outside The Box
Spirituality is vital aspect of being human which is difficult to fully understand or measure using scientific methods; yet convincing evidence in medical literature supports its beneficial role in the practice of medicine. It will take many more years of study to understand exactly which aspects of spirituality hold the most benefit for health and well-being.
Many of the world's great wisdom traditions suggest that some of the most important aspects of spirituality lie in the sense of connection, inner strength, comfort, love and peace that individuals derive from their relationship with self, others, nature and the transcendent.
I believe that spiritual healing is an important component of a multifaceted chronic pain treatment plan. One goal of spiritual healing is to help patients improve their well-being and quality of life, rather than to cure specific diseases or in this case eliminate pain. Spirituality as part of a treatment plan may include encouraging patients to use visualization, prayer and positive thinking.
The Difference Between Religion and Spirituality
Over the years I have found it important to have a discussion with my patients regarding spirituality and effective pain management, as a common understanding of terminology is essential as is an understanding of what their beliefs are.
One concept that rang true was the simple saying: “Religion prepares people for the next life while spirituality helps them live this life to their fullest potential.” Many of my colleagues also recommend clarifying the difference between the terms “spirituality” and “religion.” They advocate developing a broad-based definition of spirituality that encompasses religious and nonreligious perspectives.
To request the remainder of this article, please connect with me at drgrinstead@yahoo.com.