August 9, 2014 by Steve Grinstead
I’ve been working with people with chronic pain and coexisting problems, including addiction, since 1984. I have found this to be both very challenging and very rewarding. When I started working with Terry Gorski he mentored me and encouraged me to develop the Addiction-Free Pain Management® System. My first challenge was to educate others in what I had been doing well for the past decade. Please check out my Video Blog below and then read the remainder of my post on the synergistic impact of chronic pain and addiction.
The negative consequences more than double when patients undergoing chronic pain management experience both addictive disorders and pain disorders. Addictive disorders lead to one universe of biopsychosocial problems, and the pain disorders lead to a different set of problems. 1 + 1 no longer equals 2, rather 1+ 1 now equals 3 or more. This is called synergism. Synergism is a condition where the combined action is greater in total effect than the sum of the individual effects.
As I was developing the Addiction-Free Pain Management® System in 1996 I started researching to see what was published about this population. What I looked for was information on people who had chronic pain and co-existing addiction. What I found was disturbing. There wasn’t anything there!
What I did find was a large amount of data on people with addiction and an abundance of information about people who had chronic pain. But I couldn’t find much that addressed someone who suffered with both conditions. Instead of giving up I decided to conduct my own research.
During my research I surveyed addiction and pain programs to find out what happened to these people when they tried to seek help. What I discovered was when they went into an addiction treatment program the entire focus was on the addictive disorder. Unfortunately, their pain was not adequately addressed. The addiction programs really struggled with what to do about the chronic pain.
I also looked at what happened if that same person went into a pain clinic for chronic pain management. I found there that the entire focus was on the chronic pain, and maybe the physiological pain. On the other hand, the pain clinics struggled with what to do when people were acting out with the addiction. I realized that the focus needs to be on concurrent treatment for both pain and addiction.
Addiction treatment programs cover about a third of the problem (what I call the Addictive Disorder Zone) when dealing with a chronic pain patient. The pain clinics cover a different third of the problem (I call this the Pain Disorder Zone). Each of the above modalities when implemented independently misses about two thirds of the problem.
Sometimes addiction treatment centers recognize the need to refer a patient to a pain specialist or the pain clinics refer a patient to an addiction specialist. This is definitely an improvement. Now about two thirds of the patient’s needs are being addressed (both the Addictive Disorder Zone and the Pain Disorder Zone). But what about the third zone?
I called the third area the Addiction Pain Syndrome Zone™. This is why I developed the Addiction-Free Pain Management® (APM) system so people living with these conditions and their treatment providers can learn how to effectively deal with both conditions concurrently.
You can learn more about this synergistic phenomenon and how to effectively intervene. If you are person living with chronic pain and coexisting addiction you can check out my Addiction-Free Pain Management® Recovery Guide and if you’re a treatment provider serving this very challenged population check out my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System.