Cake – Chronic Pain – Courage

LOUISE A. STANGER ED.D, LCSW, CDWF, CIP AND ROGER PORTER

In the hit independent movie Cake, Jennifer Aniston plays a woman who knows pain. Barely surviving a horrific car accident which kills her 3-year-old son, she is left with a scarred face and wounds with pins in them decorating her arms, legs, and back. Consumed with bodily pain and emotional grief, she cannot sit, rather, she must lie down in a prone position. While she attempts physical therapy and group counseling, her unresolved grief and anger soon lead her to make friends with OxyContin, hydrocodone and alcohol.

She unsuccessfully uses sex as a means of release with anyone she can find, from her gardener to passing-by strangers. In her sorrow, she refuses all help, rejects her husband and lets rage be her only ally. At one point, desperate for more pills, she begs her trusted housekeeper to take her to Mexico so she can smuggle pain medication back into the United States. Like so many men and women who have experienced debilitating traumatic injuries, her physical injuries were compounded by anxiety, grief, rage, depression, alcohol and other drug use. In earnest, her attempts to manage long-lasting chronic pain gave way to a dangerously devastating empty lifestyle that reaches beyond the stories Hollywood tells and into the communities in which we live.

In the United States, chronic pain affects 133 million Americans; and 65% of Americans seek care for persistent pain at some point in their lives. In total, this issue affects more lives than diabetes and heart disease combined. Pain is big business for the healthcare industry – an estimated $100 billion is spent annually to manage pain, including healthcare expenses, lost income, and lost productivity at work and home.

In lieu of these growing numbers, one must distinguish between acute and chronic pain. Acute pain is short term, typically brought on by a physical ailment such as inflammation or injury, and clears up when the source is treated and heals. Chronic pain, however, is long-lasting, generally over three months of persistent pain. Chronic pain is believed to be a disease that causes changes in the nerves and persists long after the initial source of the pain heals.

Physical therapy, surgery, and nerve blocks are common forms of treatment as well as alternative treatment approaches like acupuncture, mindfulness and massage therapy. Many Americans through no fault of their own turn to prescription drugs which have been prescribed, including opioids, antidepressants etc… to address their chronic pain. This has inadvertently given rise to the opioid epidemic – a catch twenty-two whereby the very cure for pain coupled with over prescribing sparks an addiction that can cause serious harm. Though most patients who are prescribed pain pills use responsibly, research shows close to five million Americans are taking prescription pain medication in unsafe ways.

Since chronic pain is a serious condition that can cause months and even years of pain, people who use painkillers long-term can develop problems such as hyperalgesia. Hyperalgesia is a condition where a person becomes overly sensitive to pain. Doctors and researchers have linked this phenomenon to opioids. Essentially, the prolonged use of pain medication to treat pain develops a change in the person’s nervous system, so that their pain threshold goes down and sensitivity goes up.

Jay Tracy, a clinical psychologist at both the Chronic Pain Rehabilitation Program and the Phoenix Center for Pain Services, both in Golden Valley, MN, says “opioid-induced hyperalgesia is not fully understood. [Still] it is apparent that a person can become hypersensitive and hyper-responsive to painful stimuli due to the use of opioids.” It’s a vicious cycle – more pain sensitivity prompts the person to increase pain medication use and it builds. As such, Dr. Tracy says “clinicians and patients should be aware of the risks and implications when using opioids.”

Despite these challenges, treatment centers such as Driftwood Recovery (Dr. James Flowers) and Las Vegas Recovery (Dr. Mel Pohl) and other behavioral health pain recovery programs are at the forefront of this issue. Recently, Dr. James Flowers treated a woman named Harriet who suffered from a clipped nerve during a surgery to remove a small tumor from her cervical spine. The clipped nerve induced intense pain. After months of trying to manage the chronic pain with medications, Harriet arrived at fentanyl, an extremely potent substance not far from heroin, which led to 10 years of misuse and addiction. Harriet became so consumed with the medication that she could no longer walk, lost her family business and insurance, and slipped into a deep depression.

To begin treatment, Harriet completed detox to rid her body of foreign substances. Medically assisted detoxification is the process of removing the substance from his or her system at a measured pace to ease the symptoms of withdrawal. Withdrawal is the normal reaction of an individual’s body to the sudden removal of drugs or alcohol and can be very uncomfortable. After detox, Harriet had a 20% reduction in her pain level simply due to hyperalgesia. She then attended a chemical dependency educational class on medication management and addiction, along with a series of cognitive behavioral therapy sessions. She found support in her team of friends and family, as well as yoga and a walking class. Forty-five days later, Harriet reduced her pain by more than 70%, resumed a regular fitness program, and got her family and career back on track.

In addition to injury, chronic pain can develop from a birth defect.

I recently worked with a family who has a 22-year-old son named Jordan with scoliosis, a birth defect that causes a curve in the spine, which can lead to difficulty walking and breathing. For Jordan, his complications from scoliosis caused chronic pain. He endured several surgeries and began taking pain medications to ease the pain. Though very bright, Jordan was bullied from a young age for his birth defect, which in turn heightened his emotions and fueled his anxiety, anger and depression. He used the pills to escape the pressures of growing up with a disability that gave him chronic pain. Jordan received treatment at several centers where physical activity was a major component to help with the curvature of Jordan’s spine. He is at a continuing care residential treatment center and has made huge progress participating in counseling sessions, group activities and exercise.

There are also new methods coming to the forefront to help individuals treat chronic pain. A new study published in the journal Addiction in 2016 by a team from the Veterans Administration Ann Arbor Healthcare System’s Center for Clinical Management Research found a non-drug approach that combines behavioral therapy and social support to help manage pain. In the study, 55 veterans took part in therapy rooted in the psychological theories of pain, and felt the effects last up to a year.

“We want to take the focus off the pain and into functioning and finding pleasurable ways to spend time,” says Mark Ilgen, the study’s lead author and psychologist specializing in addiction research. Although combining behavioral therapy and social support is in the ground stages as a way of managing pain, Dr. Ilgen sees a connection. “There’s a strong link between depression and pain. Pain is responsive to mood, and mood is responsive to social support.”

The theory behind this approach is self-management of pain. The person experiencing chronic pain needs help learning to think, feel, and do better, despite the persistence of pain. Much the same way Harriet and Jordan found recovery through therapy and educational support. Self-management programs engage the individual in problem-solving, pacing, decision-making, and taking action to manage their pain. Research continues to support that abstinence from mind altering substances is an integral part of pain recovery along with evidenced based modalities that allow an individual to live effectively. Family education is viewed as an integral part of the treatment plan. Families must learn about chronic pain, and how addiction may start with a simple prescription. With the medical community re-thinking how opioids are prescribed, and the attention being given to training behavioral health care professionals in this arena, there are new ways developing to more
effectively deal with chronic pain and the co-occurring issues of depression and anxiety that arise from these conditions.

Dr. Louise Stanger is a speaker, educator, clinician, and
interventionist. She uses an invitational intervention approach with
complicated mental health, substance abuse, chronic pain and
process addiction clients.
Her book Falling Up: A Memoir of Renewal is available on Amazon
and Learn to Thrive: An Intervention Handbook on her website at
www.allaboutinterventions.com.
Roger Porter has two bachelor degrees, film and marketing, from
the University of Texas at Austin. He works in the entertainment
industry, writes screenplays and coverage, and when he’s not doing
that he tutors middle and high school students.