Aubrey Proud, Director of Communications and Community Relations, Magellan Behavioral Health of Pennsylvania, avproud@magellanhealth.com  

According to the National Health Interview Survey from 2019, approximately 20% of U.S. adults suffer with chronic pain₁. As such, it is important to look at how pain management treatment is handled by a physician and to review alternative treatment options for patients struggling with chronic pain, especially those with a Substance Use Disorder (SUD). Unfortunately, it is rare that an individual struggling with chronic pain will find a treatment that will completely rid themselves of their discomfort. However, patients that receive individual treatment based on their full medical history are most likely to have their pain minimized in the most efficient way.

Pain is a very fluid concept and many times hard to accurately measure due to individual tolerances and thresholds. Many things can influence the amount or intensity of pain that a person experiences on any given day such as environmental (cold, weather, physical climate etc.) and physiological (mental health issues, memories, lack of sleep etc.) issues. Due to the unique nature of how pain can be defined by an individual, it is important anyone seeking pain management services speak to a physician about their history and past experiences with various types of treatment in an open and honest nature.

Many times, physicians request that a patient include their family, other medical professionals, and pharmacists into the assessment for their pain management to ensure that a full and accurate picture of the situation is being presented. One of the main reasons this is done is to be able to treat the patient most effectively while also trying to prevent someone who has had a SUD from relapsing. Some of the areas that are explored in a pain assessment are: impairment related to the individual’s pain; pain onset and severity; cognitive and emotional changes; a family history related to pain; past treatments; and a physical and mental status examination.

When working with an individual whom is in recovery or actively in addiction it is important to include questions about their current/past use and lifestyle. Individuals should be encouraged to provide specific details such as how much they drank or used of a certain substance, date of last use, and when/how they administered the substance while talking to their physician. It is also important to consider how their use impacts other aspects of their life such as work, relationships, school etc. A physician should also explore treatment options and other pain related medications the individual may or may not have been prescribed or used in the past.

Once the physician has the full picture for the patient’s history, it is possible the treatment solution could include medication. However, it is important that other options be explored for all patients. For example, Cognitive-Behavioral Therapy for Chronic Pain (CBT-CP) can be effective in helping people change the way that they think about their pain and how they cope with their pain. It helps a patient challenge themselves to move forward. There are other remedies that a patient can utilize to help treat their chronic pain such as exercise, acupuncture, massage, yoga, and physical therapy. Relaxation strategies are a way that a patient can become in charge of their own mind and body. This helps the patient to manage their everyday functioning. These options should be explored whether medication is being discussed or not.

Medical professionals can help individuals adhere to their pain management treatment goals by scheduling regular visits and discussing expectations of what treatment will entail. Someone with a SUD often will need to meet with a provider on a more frequent basis than someone who does not have this same condition, and they may be asked to provide a urine sample to ensure that dosages are being taken as directed. If at any point over the course of treatment an individual becomes noncompliant, the provider should have a discussion with the patient to understand what the reason is for the behavior and document this information.

In conclusion, pain management treatment should not be a one-size-fits-all approach. Physicians must be patient and comprehensive as they evaluate the individual’s history along with their treatment preferences. Chronic pain is not likely to go away, but treated compassionately with an individual approach can create the most effective and best long-term solution.

1 – https://www.cdc.gov/nchs/data/databriefs/db390-H.pdf