Pain and Chemical Dependency

2021 ◽  
Author(s):  
Sanford M Silverman
Keyword(s):  
Substance Abuse ◽  
Chronic Pain ◽  
Interpersonal Relationships ◽  
Behavioral Control ◽  
Chemical Dependency ◽  
Opioid Therapy ◽  
Key Words Pain ◽  
Controlled Substances ◽  
Reward Motivation ◽  
Complex Chronic Disease

Pain can mean different things to different people. At the same time, it is a subjective and objective sensation. For the patient experiencing pain, it is an unpleasant sensation that causes undue suffering. Chemical dependency or addiction is characterized by inability to consistently abstain, impairment in behavioral control, and craving; diminished recognition of significant problems with one’s behaviors and interpersonal relationships; and a dysfunctional emotional response. It is a complex chronic disease of brain reward, motivation, memory, and related circuitry. The prevailing view of opioid therapy for chronic pain is a pendulum swinging between opiophobia and opiophilia. The intersection between pain and addiction is also a moving target. Various stakeholders have attempted to find a balance between addressing the crisis of chronic pain in society and not exacerbating the problem of substance abuse. The pain practitioner must recognize the duality that exists between chronic and chemical dependency and must assess risk prior to using controlled substances to manage that pain, and if things go awry, the physician must have an exit strategy. Discharging problem patients merely transfers the problem elsewhere. Offering patients a solution to iatrogenic dependence on controlled substances is a viable and compassionate path for both the patient and the practitioner. This review contains 2 figures, 2 tables, and 20 references. Key Words: pain, opioids, opiophobia, opiophilia, substance abuse, chemical dependency, addiction, chronic pain

Substance abuse treatment for high risk chronic pain patients on opioid therapy

2009 ◽  
Vol 10 (4) ◽  
pp. S62 ◽  
Author(s):  
R. Jamison ◽  
A. Wasan ◽  
E. Michna ◽  
E. Ross ◽  
L. Chen ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Chronic Pain ◽  
High Risk ◽  
Substance Abuse Treatment ◽  
Opioid Therapy ◽  
Chronic Pain Patients ◽  
Abuse Treatment ◽  
Pain Patients

Management of Chronic Nonmalignant Pain

1998 ◽  
Vol 11 (5) ◽  
pp. 374-381 ◽  
Author(s):  
James T. O'Donnell ◽  
Moriah B. Richie ◽  
Lori A. Nesbitt
Keyword(s):  
Chronic Pain ◽  
Clinical Research ◽  
Interpersonal Relationships ◽  
State Level ◽  
Social Consequences ◽  
High Quality ◽  
Level Of Functioning ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

Although advances in knowledge about the pathophysiology of pain have been impressive in recent years, high-quality clinical research in patients with chronic pain has not been abundant. Because chronic pain often leads to profound changes in psychologic state, level of functioning, and interpersonal relationships, treatment requires attention not only to the pathophysiologic cause of the pain (if one can be found) but also to the psychologic and social consequences (and antecedents).

scholarly journals Managing Chronic Pain in Cancer Survivors Prescribed Long-Term Opioid Therapy: A National Survey of Ambulatory Palliative Care Providers

2019 ◽  
Vol 57 (1) ◽  
pp. 20-27 ◽  
Author(s):  
Jessica S. Merlin ◽  
Kanan Patel ◽  
Nicole Thompson ◽  
Jennifer Kapo ◽  
Frank Keefe ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Cancer Survivors ◽  
National Survey ◽  
Opioid Therapy ◽  
Care Providers

scholarly journals Mindfulness-Oriented Recovery Enhancement remediates anhedonia in chronic opioid use by enhancing neurophysiological responses during savoring of natural rewards

2021 ◽  
pp. 1-10
Author(s):  
Eric L. Garland ◽  
Spencer T. Fix ◽  
Justin P. Hudak ◽  
Edward M. Bernat ◽  
Yoshio Nakamura ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Skin Conductance Level ◽  
Opioid Therapy ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Natural Reward ◽  
Before And After ◽  
Natural Rewards ◽  
Chronic Opioid Use ◽  
Opioid Users

Abstract Background Neuropsychopharmacologic effects of long-term opioid therapy (LTOT) in the context of chronic pain may result in subjective anhedonia coupled with decreased attention to natural rewards. Yet, there are no known efficacious treatments for anhedonia and reward deficits associated with chronic opioid use. Mindfulness-Oriented Recovery Enhancement (MORE), a novel behavioral intervention combining training in mindfulness with savoring of natural rewards, may hold promise for treating anhedonia in LTOT. Methods Veterans receiving LTOT (N = 63) for chronic pain were randomized to 8 weeks of MORE or a supportive group (SG) psychotherapy control. Before and after the 8-week treatment groups, we assessed the effects of MORE on the late positive potential (LPP) of the electroencephalogram and skin conductance level (SCL) during viewing and up-regulating responses (i.e. savoring) to natural reward cues. We then examined whether these neurophysiological effects were associated with reductions in subjective anhedonia by 4-month follow-up. Results Patients treated with MORE demonstrated significantly increased LPP and SCL to natural reward cues and greater decreases in subjective anhedonia relative to those in the SG. The effect of MORE on reducing anhedonia was statistically mediated by increases in LPP response during savoring. Conclusions MORE enhances motivated attention to natural reward cues among chronic pain patients on LTOT, as evidenced by increased electrocortical and sympathetic nervous system responses. Given neurophysiological evidence of clinical target engagement, MORE may be an efficacious treatment for anhedonia among chronic opioid users, people with chronic pain, and those at risk for opioid use disorder.

scholarly journals New Model for Couple Therapy for Patients with Chronic Pain and their Caregivers: An Attempt to Improve Quality of Life and Reduce Pain

2020 ◽  
Vol 16 (1) ◽  
pp. 53-58
Author(s):  
Shima Rouhi ◽  
Payman Dadkhah ◽  
Manijeh Firoozi ◽  
Masoud Hashemi
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Interpersonal Relationships ◽  
Couple Therapy ◽  
Short Form ◽  
Control Group ◽  
Improve Quality ◽  
Innovative Therapy ◽  
Quasi Experimental

Background: Several psychological interventions have been implemented to manage chronic pain. In this study, in addition to the patients, his/her spouses have participated in the program. Besides, this innovative therapy integrates several practical approaches into one comprehensive protocol. Objective: This study aimed to analyze the effectiveness of couple therapy (patient/caregiver-oriented) on improving the quality of life and reducing pain among patients with chronic pain. Methods: The present study is a quasi-experimental and clinical trial with a control group with pretest and posttest. The authors conducted this study at LABAFINEJAD Hospital in Tehran on 30 patients with chronic pain and their spouses by having a short form of a questionnaire for quality of life and chronic pain score questionnaire to measure the effectiveness of the treatment. Results: The results indicated that this treatment increased two aspects of quality of life remarkably, social function and strength for continuing the performance; that help boosts interpersonal relationships as well. Regarding the results, although the couple-based treatment could improve all aspects of pain, the two primary subscales, physical health and mental health, both enhanced. Besides, the treatment reduced the intensity of pain. Conclusion: Couple-based intervention through increasing social support, improving the quality of sex, decentralizing of pain, and paying attention to the neglected needs of caregivers and patients with chronic pain can improve quality of life and reduce pain in patients.

Chronic pain, substance abuse and addiction

2003 ◽  
Vol 38 (3) ◽  
pp. 525-537 ◽  
Author(s):  
Peggy Compton ◽  
Peter Athanasos
Keyword(s):  
Substance Abuse ◽  
Chronic Pain

scholarly journals Chronic Opioid Therapy Modifies QST Changes After Ketamine Infusion in Chronic Pain Patients

2017 ◽  
Vol 18 (12) ◽  
pp. 1468-1475 ◽  
Author(s):  
Dermot P. Maher ◽  
Yi Zhang ◽  
Shihab Ahmed ◽  
Tina Doshi ◽  
Charlene Malarick ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Opioid Therapy ◽  
Chronic Opioid Therapy ◽  
Ketamine Infusion ◽  
Chronic Pain Patients ◽  
Pain Patients

Efficacy of the Opioid Compliance Checklist to Monitor Chronic Pain Patients Receiving Opioid Therapy in Primary Care

2016 ◽  
Vol 17 (4) ◽  
pp. 414-423 ◽  
Author(s):  
Robert N. Jamison ◽  
Marc O. Martel ◽  
Chuan-Chin Huang ◽  
Dylan Jurcik ◽  
Robert R. Edwards
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Opioid Therapy ◽  
Chronic Pain Patients ◽  
Pain Patients
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