Chronic Pain and the Hijacked Brain
Knowledge Is Power In Order To Rescue The Hijacked Brain
In order to achieve the best quality of life and level of functioning, people living with chronic pain must learn as much as they can about the subject of pain and what constitutes effective pain management. We know that pain is a signal that tells us there is damage or something wrong with our system. However, with some chronic pain conditions the system (including the brain) gets altered. The pain system gets turned on and cannot be turned off. I call this the “hijacked” brain or what is often referred to as Neuroplasticity (also called brain plasticity, cortical plasticity or cortical re-mapping).
A surprising consequence of neuroplasticity is that the brain activity associated with a given function can move to a different location as a consequence of normal experience or brain damage/recovery. In the case of chronic pain this can mean that pain signals keep occurring despite lack of a trigger or tissue damage.
Opioid Use Can Also Hijack The Brain
According to research published in Annals of the New York Academy of Sciences titled Spinal Cord Neuroplasticity following Repeated Opioid Exposure and Its Relation to Pathological Pain; states that convincing evidence has accumulated that indicates there are neuroplastic changes within the spinal cord in response to repeated exposure to opioids. Such neuroplastic changes occur at both cellular and intracellular levels. Unfortunately, most pain conditions in this country are treated with opiates – research indicates that as high as 90 percent of people undergoing pain management are prescribed opiates. With so many people living with chronic pain and using opiates, these neuroplastic changes need to be better understood.
I like to use simple language and metaphors or visual images when educating my patients. Many of the people I have worked with would not understand the term Neuroplasticity so I use the metaphor of the hijacked brain. I tell them the reality or neuroplasticity science are much more complex but in essence what is happening is that the brain forms pathways (called neuro-networks) that eventually become super highways—in other words the new neuro-network becomes more complex and elaborate.
Building Better Highways
What I believe needs to happen in chronic pain management is developing new pathways or highways to replace self-defeating pain behaviors or suffering that can lead to a reduction or elimination of pain. My Mentor and colleague Terence T. Gorski uses the example of living in a rural area with an outhouse over a hundred yards from the back door. Between the back door and the outhouse is a field of heavy vegetation that is very hard to walk through. On the first trip it takes a long time and is very difficult but some of the vegetation is getting tramped down just a little so the trip back is not quite as hard. After several trips it gets much easier.
I expand this metaphor by saying treatment is like gaining access to landscaping equipment that will assist you in putting in a paved path to your goal—effective pain management. It is crucial to develop new ways of thinking, more effective methods of managing painful emotions and new ways of behaving that will improve pain management and quality of life. To do this, new neuro-pathways need to be generated and used over and over until the highway is built. Unfortunately, there are many obstacles that can get in the way and detour people back to the old highways and people need a strategic integrated plan to stay on the new highway.
Utilizing Addiction-Free Pain Management®
To assist keeping people on the new highway, I started developing The Addiction Free Pain Management® (APM) Manualized Treatment System in 1996. The APM™ System is a comprehensive method of addressing the four quadrants of suffering: biological (psychical), psychological, social, and spiritual. This system was first utilized by me in my own quest to find chronic pain relief without reliance on opioid medication and to stop suffering with my pain.
The APM™ Treatment System is based in part on the Gorski-CENAPS® Developmental model of recovery. It also includes the best practice standards reported by the National Institute on Drug Abuse (NIDA), the American Society of Addiction Medicine (ASAM) and the Substance Abuse and Mental Health Services Administration (SAMHSA) along with the leading evidence-based chronic pain management best practice standards.
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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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