What to do about Chronic Pain in Recovery?
One of the dilemmas facing people in recovery, is what do I do if I have a pain issue? Doctors tend to divide pain into 2 main categories, Acute and Chronic.
Acute pain is time limited and there is usually a precipitating event. Such as a sprained ankle or a surgical procedure etc. These can be handled with a combination of non-steroidal anti-inflammatories, such as Motrin or Aleve and Tylenol. But if the pain is more severe and opiate type medications are needed, be sure to share with the prescribing doctors that you are in recovery. Hopefully, that will then alert them to the need for close monitoring and a limited number of pills prescribed. IF you have to take opiates, please make sure your sponsor is aware of the fact, and I would encourage you to let someone else take possession of the medications, and to only give them as prescribed. (Make sure it is not someone with Addicts Dyslexia :), that gives you 4 pills every hour instead of 1 pill every 4 hours)
The bigger problem for recovery is Chronic Pain, meaning more than 3 months in duration. Here opiate use is relatively contra-indicated. There have been some reports of using Suboxone (a partial opiate agonist) for pain control in recovery. The problem with Suboxone is that it is also addicting with long term use. The other issue for Suboxone is that for pain control, the lower the dose, the better is seems to work. Meaning that a 1 to 2mg dose up to 4 times per day is the recommended dosing schedule. Most doctors and addicts assume that the higher the dose the better it will work, not so with Suboxone.
So what other choices are there for chronic pain, in recovery? There are multiple options available. A few of them are listed below:
1. Exercise. This needs to be done on a regular basis and needs to include some weight training as well as cardiovascular work. If you are severely hampered, then start off with water exercises, such as walking in the water, or swimming or water aerobics. Exercise not only increases your pain tolerance, but also helps to raise your endorphin levels and helps with anxiety and depression and sleep.
2.Anti-depressants. These types of medications have been used for pain control even in the absence of depression. The Tricyclics have been around for decades, medications like Elavil or Pamelor, but are quite sedating and need to be taken at bedtime. The usual starting dose is 10 to 25 mg per day, but can increase to up to 150 mg at bedtime. Then newer classes also are helpful, such as Cymbalta. It’s starting dose is 30 mg with a ramp up to 90 mg/day if needed.
3. Muscle relaxers. These are most helpful if the origin of the pain seems to be musculoskeletal. The only muscle relaxer that is a definite NO is Soma. The other types can cause some sedation as well and are usually dosed up to 4 times a day as needed.
4. Anti-seizure medications. The most common one here is Neurontin. It’s dosage range is anywhere from 100 mg 2 times a day to 900 mg 4 times per day. The key for Neurontin is to start low and gradually ramp up. Otherwise, you can get very dizzy, sleepy and may get pretty significant fluid retention. The other anti-seizure medications have also been effective, like Depakote, Tegretol, Dilantin, and Topamax. There is a new one out called Lyrica. It is recommended for several types of Chronic Pain Syndromes, but we have had patients addicted to Lyrica, so do not feel it is safe to use in recovery.
5. Meditation or Mindfulness. It is not medications and can be practiced anywhere. It does take training to learn how to practice it, but is very helpful at reducing stress as well as helping to increase your pain tolerance.
6. Acupuncture. Not for the needle phobic, and requires someone trained in the art, but can be helpful for musculoskeletal pain syndromes.
There are many other modalities available to you as well.
So, if pain is an issue in your recovery, get your sponsor involved, be upfront with your doctor about your fears of medications and relapses, and start some type of exercise program. It also helps a great deal to meet with others who also have pain issues, as you can share your struggles and successes, and get hope and encouragement from them as they share theirs. It also is helpful to set yourself a goal of what you are trying to achieve. My goal, for example, is not to live pain free (as we all have pain issues), but to keep my pain from interfering with my function.
Let us know if there are ways we can help you or guide you.
Daniel Boone MD
…depression/anxiety or substance abuse?? The answer doesn’t matter, the solution is to look at and treat both areas. Our great doctors and psychiatrist look at whole picture when treating our patients. Did you know that our patients see a doctor every single day??? Every. Single. Day. That is pretty amazing.
Here are a few books we have in the store that address co-occuring disorders:
We have a published author in the house! You may remember the Off The Clock with Dr. Layne post a few months ago. He told us about the mission work he has done for 25 years in Mexico and that he was putting the finishing touches on his book. Well, the book is done and available for purchase on Amazon. All royalties go to support the mission.
Changing Lives on Both Sides of the Border
“In 1986 Dr. Ottis Layne and Sara Allerkamp, R.N. are asked to bring medical clinics into the remote vastness of the Chihuahuan Desert of northern Mexico, equipped with little more than faith and medical savvy. Little do they know this one step into the unknown is launching a twenty-five year effort to bring medical and spiritual support to a remnant of hard-working people who still eke out a living on co-operative ranches in the spectacularly beautiful, arid back-country of the states of Coahuila and Chihuahua. Read as they strive for excellence in mission medicine, personal ministry, construction, and service in a wonderful culture in which time is measured out in long, slow intervals and life is accepted simply.”
So, I always like to have something visual to go with my posts. However, with this one it was better that I didn’t….
Good news for those who suffer from Chronic Hepatitis C. The FDA has released a new drug that will be combined with Interferon and Ribavirin, called Victrelis. This is an oral medication, it has to be taken 3 times a day with meals. It does have the side effect of nausea, fatigue and headaches. You also have to keep an eye on your liver counts and your blood counts but the addition of the drug to the older regimen had higher “cure rates”, meaning that the viral load dropped to zero. As with your older regimen of Interferon and Ribavirin, you need to have at least six months of sobriety before you take the medicines, AND, it is very important to be involved in a regular exercise program. The main side effect of the weekly Interferon shot is the achy, flu type syndrome that hits on the day of your injection every week, and can last for 3 to 4 days. IF you exercise heavily on the day of the injection, your flu type symptoms are greatly abated, and may not appear at all. But you have to be exercising regularly in order to “hit it” on the injection day.
So, if you have active Hepatitis C talk to your doctor. Even if you have failed the previous treatments, this is worth the time and effort.
You may be asking yourself what do chili’s have to do with anything….meet Dr. Layne, if you haven’t already. He is another great inspiration on our medical team!
Hi Alumni! At the moment I have two things going on off the clock. First, I have done medical missions to Mexico for 25 years, and I’m now putting the finishing touches on a history of the mission. It will be published by Amazon and available on Kindle, hopefully in time for our 25th anniversary celebration on August 6 in Fredericksburg. My second hobby, I grow my own cayenne chilis for a special salsa which I make by the gallon. These chili’s are my favorite and I grow them because I’ve never seen them for sale anywhere. However, I recently lost a battle for my summer garden to gophers; I’ve been reduced to replanting cayennes in pots on the patio. It’s late to get them started and the prospects for salsa in the fall are uncertain. Hope all is well at home for you!
Just when I thought they couldn’t be any more fabulous……the Boone’s continue to help others and have fun while doing it! Who knew Dr. James had award winning fishing skills, and Dr. Dan knew his way around a bowling alley?
The Annual JP Griffon Fishing tournament was held recently out of Port Mansfield, with close to 400 anglers attending in the largest in-shore tournament in the state. The tournament is held annually to raise money for high school graduates. I have fished this tournament annually for 15 years and after fishing it with my son, his best friend and his father we have won the lure only (no bait) division 3 out of the last 4 years. Each team is allowed to weigh in a total of 12 speckled trout, 6 redfish, and 4 flounder over a 2 day period. Our team, which is captained by my son David, weighed in just over 91 pounds to beat every team including the live bait and guided divisions. It was an amazing few days of fishing. As always, the best part is getting to be with my sons for several days from daylight to dark. All in all a wonderful gift wading in God’s fantastic creation, the flats of the Laguna Madre. Dr. James
Dr. Dan helped raise money for Big Brothers Big Sisters at their annual Bowling event.
Part of healthy recovery and community living is learning to give back where you live. You need to stay plugged into the recovery community, but you also need to broaden your horizons to include other groups who need the talents, skills and gifts that God has uniquely given to each of you. So, as you continue your recovery, look to see where else you can be of service, and then “just do it!” Dr. Dan
Last June I completed my first Sprint Triathlon – ½ mile swim, 12 mile bicycle, and 3.1 mile run. It was a great experience. For those of you who don’t know, in August of 2009 I shattered my left shoulder, broke my right wrist, and cracked two of my vertebrae. Completing the Triathlon was important to my physical, emotional, and spiritual recovery. Well, it’s time to tri again. There are several recovery lessons in training for me, but this morning I can think of three:
1. It’s important to take care of myself. Taking care of my health puts me in a better position to support others in their journey to health.
2. It’s important to listen to others. Right now I need to listen to my trainer and not make up what exercises or drills are best. When Susi says, “Swim!” I say “How far?” when she says, “Run!” I say, “How fast?” when she says, “Bike!” I say, “Oh thank you.” I like to bike.
3. I have a goal – finish in under 2 hours. It is a tough goal because I finished in 2 hours 22 minutes last year. Goals are useful, but the process of training and feeling good about giving myself completely to the task is more important than the outcome.
Life is good here. – Dr. Katie
A couple of weeks ago when there was no significant rain in months the hill country and fire hazards were high. There was very little green grass, minimal wild flowers and the rivers were low. There was smoke from distant fires and dust was in the air. Everything was brown and near lifeless, all signs pointed that we were in a drought.
As I look at life I am always amazed at the spiritual and life truths that surround me if I can keep my mind open to the Light. What I know is that there are times in my own life that reflect the landscape mentioned above. These are times when nothing is going right and there are struggles, my life seems dry and dreary. There are many times when I have been in this spiritual drought.
However, what I know is………………the rains will come, trees will bud and the flowers will bloom. I will walk in puddles and look at meadows of verdant green grass and smell rain in the air. In my own life I can’t trust my emotions, but I can trust a Power greater than myself to restore my soul and flood my spirit with renewing, life-giving, spiritual rain.
Stay patient and do the next right thing and trust in One greater than yourself.