Treatment Options
Introduction: Since Addiction and Chronic Pain are complex biopsychosocial disorders, treatments combine medical, counseling, environmental, and social interventions. Support group participation is not considered treatment per se, but involvement with a group is often the most important factor in improving outcomes. Another important factor in success is to establish a trusting relationship with a knowledgeable counselor or medical provider.
Addiction without chronic pain: There are many different approaches to treating addiction. Important factors in determining which treatment options are best would include factors such as whether the addiction is to alcohol or specific drugs, age, duration of addiction, social function, prior treatments, and readiness to change. Individuals with early addiction and good social support may do well with outpatient counseling. Individuals who fail to improve with outpatient treatment may be candidates for inpatient rehab. Most specialists would refer longstanding heroin addicts for treatment in a therapeutic community or with medications such as methadone or buprenorphine (Suboxone TM). These treatments are recognized by SAMHSA as a effective, but many in the 12-Step community harbor negative attitudes those who maintain abstinence from illicit drug use by using prescribed medication. Read more about the pro's and con's of medication-assisted treatments.
Addiction accompanied by chronic pain: A significant proportion of addicts also have chronic pain, and treating pain in the context of addiction can be challenging, especially when opioid (narcotic) medications are part of the treatment plan. Those with a prior history of addiction run a risk of relapse, even when their drug of choice may have been cocaine or alcohol. Consultation with a physician experienced in managing pain in the context of addiction is strongly advised, but finding a specialist can be difficult. Those with current addiction and chronic pain need treatment for their addiction first, and pain management second. For many patients, pain improves with detoxification, but not always. There are specialized programs for those with addiction and chronic pain. Addiction-Free Pain Management (R) is one such program. Casa Palmera, located near San Diego, also specializes in treating addiction in the context of chronic pain. A number of studies have shown that substituting buprenorphine for short-acting opioids (e.g. oxycodone) improves pain and social function; while Suboxone (TM) is not FDA approved for the treatment of chronic pain, other buprenorphine formulations are. An increasing number of pain specialists are prescribing buprenorphine, and many are listed in the Here to Help program.
Chronic pain with addiction concerns: In the past decade, physicians are increasingly prescribing opioids for chronic noncancer pain. Current treatment guidelines recommend a trial of opioids for the treatment of chronic pain if the potential benefits outweigh the risks. Pain relief is not the primary measure of success; rather improvement in function--family, work, relationships, physical activity--is the key measure. Many have been consuming opioid medication for medical problems such as herniated spinal discs or RSD with little improvement. Over the years. opioid doses may have increased. Sometimes patients find themselves using more medication than prescribed. For such patients, a comprehensive pain program that includes opioid detoxification, medical treatments, counseling, physical and complementary modalities is usually the best choice. Good programs are often hard to find, as many pain centers specialize in procedures such as cortisone injections, spinal blocks, and nerve stimulators and do not include other important components of care. Most metropolitan areas have good programs, but many patients need to travel outside their area to programs such as the Rosomoff Pain Center in Miami.
Co-occurring psychiatric disorders: Mood, anxiety, and personality disorders often accompany addiction and chronic pain; treatment may require medication or psychological treatments. While most residential addiction programs prescribe psychiatric medications, some addiction treatment programs specialize in treating patients "dual diagnosis" or "co-occurring disorders." Patients with a history of serious depression, bipolar disorder, OCD, severe anxiety, or PTSD should strongly consider programs that offer specialized services. A number of screening questionnaires have been developed to help individuals determine whether they should be professionally evaluated for a psychiatric disorder; some of these questionnaires are included within this website.