(627) Treating the Addicted Chronic Pain Patient: An Alternative Approach to Pain Management

Authors: Daniel Skenderian, Mark Carter, Joseph Galleta, Peter Yuen, Jim Rhoads, Steve Collier; Pacifica Medical Rehabilitation Associates A subset of patients within the chronic pain population who go unnoticed are those who also have underlying addictive disorders. The literature in chronic pain management suggests that these patients comprise anywhere from 3% to 18% of the chronic pain population and place heavy demands on the health care system. Compared to most pain patients, the addicted pain patient has multiple pharmacies and doctors, more frequent emergency room and office visits per month, coexisting chemical dependency, other alcohol or street drugs, and a chaotic life‐style. The Addiction‐Pain Syndrome is characterized by 7 signs that are chronic and repetitive: 1) repetitive pattern of failed treatments and hospitalizations, 2) abnormally high tolerance for pain medications with minimal or no relief, 3) genetic link to addiction with premorbid addictive disorders, 4) history of sexual, physical, or emotional abuse, 5) intrapsychic process of incorporation, internalization, and emotional isolation, 6) somatic preoccupation and obsession with chemical relief leading to demanding behavior and belligerence with care givers, and 7) secondary gains in the family system reinforcing the patient role. A program is described to treat pain patient's addiction to prescription medications. Program goals include the following: 1) alleviate medication addiction and dependency, 2) reduce utilization of medical services, 3) reduce sensory, cognitive, and affective pain, 4) develop independence, wellness, and spiritual identity. Phases of medical detoxification, stabilization, and rehabilitation on both inpatient and outpatient bases are illustrated along with treatment team composition. Alternative treatments to analgesics, including non‐narcotic pain medications, physical therapy, behavior modification, acupuncture/acupressure, group therapy, biofeedback, and 12‐step involvement are described as well. Two case studies will illustrate patient type, treatment strategies, and barriers to treatment. Program evaluation data will show positive outcomes on a Medicare sample.