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Drug Rehab Options for Those Suffering From Chronic Pain

Because the experience of chronic pain is so common and individuals with substance use disorders often have issues with chronic pain, many rehab programs can manage both problems. 

Many rehab programs use alternative pain management options, so clients don’t have to take opioid painkillers to manage chronic pain. 

PAIN IS SUBJECTIVE

The experience of pain is not the same for everyone. Most people with chronic pain can benefit from treating their pain, even people in rehab for substance abuse. 

Pain is a warning sign that there is damage or potential damage to a particular area of the body. There are four main elements of chronic pain and its treatment.

  • Pain has a physical aspect (actual damage to tissues)
  • Pain has an emotional element to it (how it feels and how one reacts)
  • Pain has a thinking or cognitive aspect to it (how one conceptualizes their experience of pain)
  • Pain has a behavioral aspect associated with its experience (what one does when they feel pain)

The holistic treatment of chronic pain should address all these issues. 

CHRONIC PAIN

Chronic pain may be defined somewhat differently by different organizations, but it is typically considered to be pain that lasts for 12 weeks or longer. Some sources may describe chronic pain as pain that lasts for six months or longer.

Very often, chronic pain may not be associated with any specific cause. It may be the result of some identified disease like arthritis or some other condition. 

As can be ascertained from the description above, the experience of pain occurs over numerous areas of functioning. When someone is treated for it, all these manifestations of pain must be addressed.

There are no specific medical tests that can identify the quality or intensity of one’s experience of pain. Instead, people must report to their caregivers how intense or uncomfortable their pain is for them. This means that the clinical description and assessment of a person’s pain is subject to multiple levels of description. 

HOW COMMON IS CHRONIC PAIN?

The American Academy of Pain Medicine (AAPM) indicates the following:

  • There are probably more than 1.5 billion people in the world suffering from some form of chronic pain.
  • In the United States, it is believed that more than 100 million people suffer from chronic pain.
  • The prevalence of chronic pain increases as individuals get older.
  • Medications are the most commonly used treatment for chronic pain.

MEDICATIONS TO ADDRESS PAIN

There are many different types of medications that are used to treat chronic pain. They may include: 

  • Analgesics that can be purchased over the counter, such as nonsteroidal anti-inflammatory drugs (ibuprofen or aspirin) and other types of pain relievers like acetaminophen.
  • Muscle relaxants to address pain associated with muscle stiffness or muscle spasms, such as Flexeril (cyclobenzaprine).
  • Prescription nonsteroidal anti-inflammatory medications, such as Celebrex (celecoxib).
  • Some anti-depressant medications, such as the tricyclic antidepressants or SSRIs, for certain types of pain.
  • Some anti-anxiety drugs like benzodiazepines.
  • Anticonvulsant medications like Neurontin (gabapentin).
  • Sedatives, such as Ambien (zolpidem).

Opioid drugs for severe pain.

HOW EFFECTIVE ARE MEDICATIONS IN REDUCING PAIN?

“You might be surprised to learn that according to AAPM, roughly 58 percent of people who use prescription medications to treat their pain report achieving significant pain relief. Only about 41 percent of those who use over-the-counter medications report getting significant relief.”

Part of the issue is that medications do not directly address all the factors associated with the subjective experience of pain. Very often, tolerance to pain-relieving medications of all types develops very quickly.

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NON-MEDICATION OPTIONS THAT MIGHT BE USED IN REHAB

When you are in rehab for substance abuse, you can also be effectively treated for issues with chronic pain. Various non-pharmaceutical alternatives may be used.

  • Massage therapy is often used as an effective pain management technique.
  • Most rehab facilities will include stress management training, such as progressive muscle relaxation, diaphragmatic breathing, meditation, and other therapeutic techniques that can be used to reduce the subjective experience of pain.
  • Hypnosis can be useful in addressing specific types of pain, but it must be used with caution.
  • Physical therapy is a documented approach to effectively managing chronic pain.
  • Certain types of alternative therapies, such as animal-assisted therapy, music therapy, art therapy, and others, can be useful in reducing the subjective experience of chronic pain.
  • Acupuncture may be an effective approach to pain control for some individuals. However, many insurance companies will not cover the cost of acupuncture if it is used to address substance abuse specifically.
  • Stretching and exercises like yoga or tai chi may be helpful in reducing pain.

There are also many other medical procedures that may reduce the experience of chronic pain depending on the cause of the pain.

DUAL DIAGNOSES

A compounding factor associated with substance abuse is the co-occurrence of a substance use disorder and some other type of mental health disorder (a dual diagnosis). This is a common situation.

While the different types of pain can be identified according to their causes, there is also a psychiatric diagnosis that can be associated with the experience of chronic pain. The American Psychiatric Association lists somatic symptom disorder as a formal psychiatric diagnosis that is the result of the experience of physical symptoms that lead to significant emotional distress.  

One of the special designations is somatic symptom disorder with predominant pain, which was previously recognized simply as a pain disorder.

When the symptoms have been occurring for more than six months, the disorder is characterized as being persistent (chronic). 

This particular disorder, when the diagnostic criteria are met, qualifies as a psychiatric disorder that occurs as a result of the person’s dysfunctional experience with chronic debilitating pain.

Person rubbing their knee

When this disorder co-occurs with substance abuse, this is a dual diagnosis.

HOW DO I FIND THE RIGHT REHAB FOR ME?

When you are looking to get into a rehab program, and you suffer from chronic pain, you should prioritize your choices, so those that specialize in treating issues with pain are at the top of your list. 

It is essential that you undergo a thorough assessment of your emotional, physical, and social functioning. This allows potential treatment providers to develop a specific treatment plan for you.

The treatment plan should address all your needs. If you suffer from any form of chronic pain, this should be documented in the assessment. The current treatment you are using to treat your chronic pain should also be recorded. Treatment providers should be able to discuss various options with you to address your issues with chronic pain. If you can benefit from an operation or other medical procedure, you can be referred for that intervention after the assessment. 

Treatment can include monitored use of medications while in rehab, but the options are also likely to include many adjunctive treatments for your chronic pain. Substance use disorder treatment follows an overall blueprint that is based on research studies that have described what types of interventions are effective across the board, but the treatment plan is personalized to fit your specific needs.

Sources

(July 2017) What is pain and how do you treat it? Medical News Today from https://www.medicalnewstoday.com/articles/145750.php

(Spring 2011) Chronic Pain: Symptoms, Diagnosis, & Treatment. National Institute of Health from https://medlineplus.gov/chronicpain.html

The American Academy of Pain Medicine from http://www.painmed.org/patientcenter/facts_on_pain.aspx

(May 2018) Chronic pain: Medication decisions. Mayo Clinic from https://www.mayoclinic.org/chronic-pain-medication-decisions/art-20360371

(2011) Essentials of Pain Management. Springer from https://books.google.com/books?hl=en&lr=&id=rFLLYkCg-FsC&oi=fnd&pg=PR11&ots=-YXZ9ToCZM&sig=59RX51uv_OpT7tC1CeJKadswGcA#v=onepage&q&f=false

(2013) The Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition. American Psychiatric Association from https://books.google.com/books?hl=en&lr=&id=-JivBAAAQBAJ&oi=fnd&pg=PT18&ots=cdRR23NJxb&sig=hqcxV0blNxO5C8MW8Cir3ZUxtVg#v=onepage&q&f=false

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