I have worked with individuals coping with chronic pain for thirty years. I have assisted many of them with the ability to cope with pain and become independent of opioids.
How do I do it? What is my strategy? Well, it goes back to the first step of solving a problem; Identify The problem!
A little background goes a long way in understanding the creation of chronic pain. Chronic pain starts with acute pain; typically from some physical trauma that injures an individual. Pain is the signal that something is wrong; it is an electrical signal that finds it's way to the thalamus in the brain; whereupon this signal is translated as pain. It hurts, and we remember the experience.
Acute pain is distressing. Whether it is sharp, dull, intermittent or continuous it reminds us of how vulnerable the flesh is, and how we may take many painless movements for granted. Individuals wanting relief often welcome the opioids prescribed by the physician. The opioids block pain receptors, and the perception of pain Euphoria also may accompany the dosing!
In a better world individuals would stay on the opioids long enough to not be distracted by the pain, and do their necessary healing, mending, and resume activities. However, what happens is the trauma heals, but the subjective report is the individual complaining of pain.
Since pain is a subjective experience individuals are taken at their word. The pharmaceutical intervention continues either through prescribing healthcare professionals, family members or friends or illicit channels.
So, what causes the pain to remain after the injury or trauma heals? Is there something else to pain?
INTRODUCING THE THREE FACES OF PAIN!
There are three faces of pain; past, present, and future. They exist not only as physical, but also emotional and mental manifestations and presentations. Present pain is due to the injury or trauma that creates the pain experience. This pain has a purpose to communicate to us that there is an injury that we need to manage.
A second face of pain is memories of pain that was experienced in the past. This pain is remembered, and recalled pain. However, it hurts. This is phantom pain.
A third face of pain is anticipated, and continuing pain in the future. This is fantasized pain. This pain is created by expectation of pain continuing.
The past and future pain cannot be managed with narcotics! However, these are the pains likely experienced by individuals with chronic pain.
So, what are these pains? These pains are likely habits of thinking and feeling. They are neurological loops that are created by the experience of pain past, and anticipated. Think of them as magnification of the the physical pain. When you have a physical pain in the present, it is easy to consciously or subconsciously recall pain from the past, and anticipate pain in the future. The future pain is potent, because it imagines activities we will not be able to do, as well as the pain continuing unabated!
So what is an effective intervention? In thirty years of helping individuals manage 'chronic pain' I have had great results. Therapy is used to interrupt the neurological loops (habitual pain). Hypnosis, and bilateral stimulation (EMDR; Eye Movement Desensitization and Reprocessing) are useful in helping the individual get in the present, and process the emotions and thoughts that support the pain.
When in altered states you can give them the opportunity to give up some of the pain. They may choose to let go of the past pain memories or some of the fear associated with the future. This is easier, because they may temporarily forget the pain, and this further empowers them.
In summary part of the opioid problems are due to thinking of pain only in terms of a physical manifestation, and overlooking the emotional components. Looking at chronic pain in a big picture, holistic way is the better paradigm, but it not always understood by healthcare professionals.