What is Chronic or Persistent Pain?
Chronic or persistent pain is broadly defined as either ongoing or recurrent pain that lasts for more than 12 weeks, and can either be continuous or recurring pain. This pain may be due to an injury, an episode of acute illness (pain related to cancer is not considered chronic or persistent pain), or in relation to a chronic illness. Sometimes there is no clear cause for chronic pain. For example, fibromyalgia is a poorly understood condition characterized by chronic pain that is required for diagnosis, although there is no consensus about its cause.
Pain is very subjective, because each individual’s sensation of pain, and ability to tolerate it, is different. Traditionally, addiction and chronic or persistent pain have been treated as two separate conditions. However, someone with a drug or alcohol abuse disorder, or certain mental health disorders may also have chronic pain, and these co-existing conditions should be addressed concurrently. Like addiction, chronic pain involves dysfunctional processing of signals in the brain.
Ongoing, chronic pain can result in sleeplessness, anxiety and depression, which creates more pain, creating a spiral of increasing pain. Depression can result in chronic pain, and chronic pain can result in depression. Research has demonstrated that depression, the most common mental health disorder, negatively affects the outcome of pain treatment. Both chronic pain and substance abuse disorders are strongly associated with co-occurring mental health problems including depression, anxiety, post-traumatic stress disorders, and mental health problems that result in physical symptoms including pain (known as somatoform disorders).
Sovereign Health Group’s addiction, mental health and dual diagnosis treatment center in San Clemente, California, provides individualized treatment for all patients, including those who have a chronic pain condition. This may include prescribing medication to reduce pain when deemed appropriate after a medical assessment. Our sophisticated electroencephalogram (EEG) technology and data analysis can be use for diagnostic “brain mapping,” and neurofeedback to help patients learn to control the sensation of pain by controlling brainwaves. Core treatment modalities offered by Sovereign Health include dialectical behavior therapy (DBT), an offshoot of cognitive behavioral therapy (CBT). Mindfulness activities such as meditation and yoga are also available in order to alter a person’s response to pain and reduce suffering. For more information about our programs, call (866) 264-9778.
How Many People Have Chronic Pain and Who Treats Them?
A 2011 report from the federal Institutes of Medicine (IOM), Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research, estimated that 116 million adults in the United States experience chronic pain every year; that is more than the combined number of people affected by heart disease, cancer and diabetes.
Research has found that physicians who specialize in pain treat only 2 percent of the people who have chronic or persistent pain. Of the remaining 98 percent:
- 7 percent are treated by acupuncturists
- 40 percent are treated by chiropractors
- 52 percent are treated by primary care physicians.
The American Chronic Pain Association (ACPA), a non-profit, tax exempt organization, provides support for people with chronic pain, including a resource guide to chronic pain medication and treatment. The ACPA notes that there are many additional therapeutic approaches to chronic pain, including behavioral-psychological modalities such as cognitive behavioral treatment and surgery. The most common treatment is prescription pain medication, frequently opioid (narcotic) painkillers such as:
- Fentanyl (Actiq, Duragesic, Fentora)
- Hydrocodone (Lorcet, Lortab, Norco, Vicodin)
- Hydromorphone (Dilaudid, Exalgo)
- Meperidine (Demerol)
- Methadone (Dolophine, Methadose)
- Morphone (Avinza, Kadian, MS Contin, Ora-Morph SR)
- Oxycodone (OxyContin, Oxyfast, Percocet, Roxicodone)
Pain is the most common health reason that adults turn to complementary health practices, according to the National Center for Complementary and Alternative Medicine (NCCAM). People who experience chronic pain often turn to complementary and alternative health practices as a supplement or alternative to conventional medical treatment. The NCCAM is the federal government’s lead agency devoted to scientific investigation of the effectiveness of such treatments.
Overview of Pain Clinics
Generally, chronic pain becomes increasingly common as people get older and have more chronic health problems in general. Almost 25 percent of the U.S. population, or 75 million people, are Baby Boomers, born between 1946 and 1954. As of 2014, almost 14 percent of the U.S. population is 65 or older, and that is expected to reach 20.9 percent by 2050, as every month, 250,000 people turn 65. In that context, it makes sense that the number of clinics devoted to treating chronic pain is increasing, particularly in states that attract retirees, such as Florida.
Pain clinics focus on the diagnosis and treatment of chronic pain. They prescribe opiate and non-opiate medications for pain, and may also provide injections of local anesthetics into nerve roots, muscles or joints. Injections of anesthetics into nerve clusters may also be administered. However, due to the widespread and sometimes indiscriminate prescribing of opioid painkillers, pain clinics are sometimes referred to as “pill mills.” The attorney general of the State of Florida has said that: “While legitimate pain-management clinics do exist to serve those with chronic pain or terminal illness, other unscrupulous clinics, called pill mills, merely serve as drug traffickers.”
How Pain Works
The body’s opioid system controls pain, reward and addictive behaviors. There are three different kinds of opioid receptors in the brain (mu, delta and kappa receptors) that affect most known neuroreceptors and hormones. These receptors react to the presence of opioids, whether they are naturally produced in the body or administered into the body. The opioid substances bind to receptors in the brain and spinal cord, blocking the pain signals.
These drugs can be helpful for people with chronic pain, but produce different physical reactions in different people. Opioids generally do not eliminate chronic pain; it is estimated that on average, they reduce pain by about 30 percent.
Overuse, misuse and abuse of prescription medications have become a national problem; the Centers for Disease Control and Prevention (CDC) calls the problem an epidemic. Abuse of prescription opioid drugs is the second most common drug problem in the U.S., after marijuana use. One of the issues is that prescription opioid drugs have many side effects, including a high potential for addiction, and the risk of fatal overdose.
There are two kinds of persistent pain, one that involves a specific kind of nerve endings known as nociceptors, and another, known as neuropathic pain, that involves damage to nerves in either the central or peripheral nervous system. Prolonged use of opioid pain medication can result in opioid-induced hyperalgesia (OIH), a condition in which the narcotic drugs causes the pain receptions to reset, so that sensations of pain are the normal state. OIH is very different from the tolerance, addiction, and dependence that can develop in a substance abuser, because the precise molecular mechanism is not well understood. Current thinking is that OIH occurs when the brain restructures or reprograms itself, changing the brain’s interpretation of internal electrical signals so that they trigger sensations of pain.
Much of the research into OIH has been conducted with former opioid addicts on methadone maintenance therapy, as well as people taking opioids after surgery. One discovery is that administration of an opioid agonist such as naloxone does not relieve OIH; instead, it makes the pain worse.
Sovereign Health Group Helps Patients Manage Chronic Pain
Sovereign Health Group provides comprehensive, expert, evidence-based treatment for substance abuse, mental health disorders, and concurrent disorders. Our experienced staff of health professionals will conduct a thorough assessment and develop an effective, comprehensive, individualized treatment plan for each patient. Although we are not a pain treatment center, we do offer pain treatment and pain management services when needed. To learn more about our programs or to speak with our Admissions team, call 866-264-9778.