The Role of the Hijacked Brain in Chronic Pain Management

Written By: Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II Date: June 16th, 2009. Topic: Member Blogs.

I just spent the past week at Valley Forge Medical Center (VFMC) — our first Addiction-Free Pain Management® Center of Excellence. In addition to conducting a three day staff training, I also had time to sit in on patient groups and talk one to one with several of VFMC’s chronic pain management patients. One common theme for most of the pain patients was shame about letting “this” happen to them. It was exciting to listen to more senior patients explain to their new peers that they aren’t “bad” because they started having problems with their chronic pain management medications that they are experiencing a medical phenomenon.

I have trained the staff at VFMC over the last two years on ways to de-pathologize addiction and denial for more effective chronic pain management outcomes. One of the ways we do this is to educate the patients about the process they go through before reaching prescription drug addiction or pseudoaddiction. Part of this is to give them accurate definitions of common misunderstood terms.

There is quite a bit of confusion and mislabeling of people on long-term use of chronic pain management medication. Many patients are identified or labeled as “addicts” when in fact they are definitely not. To help clarify this issue a consensus document was developed in 2004 by the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine. They agreed upon the following definitions for physical dependence, tolerance, addiction, and pseudo addiction:

Physical Dependence

Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

Tolerance

Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution (lessening) of one or more of the drug’s effects over time.

Addiction Versus Pseudoaddiction

Addiction

Addiction is a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

Pseudoaddiction

The term pseudoaddiction has developed over the past several years in an attempt to explain and understand how some chronic pain patients exhibit many red flags that look like addition. Pseudoaddiction is a term which has been used to describe patient behaviors that may occur when pain is undertreated. Patients with unrelieved pain may become focused on obtaining medications, may clock watch, and may otherwise seem inappropriately drug seeking. Even such behaviors as illicit drug use and deception can occur in the patient’s efforts to obtain relief. Pseudoaddiction can be distinguished from true addiction in that the behaviors resolve when the pain is effectively treated.

The other educational component that is really helpful any chronic pain management patients is telling them about the hijacked brain. With some chronic pain management conditions the system (including the brain) gets altered. The pain system gets turned on and cannot be turned off. I call this the “hijacked” brain or what is often referred to as Neuroplasticity (also called brain plasticity, cortical plasticity or cortical re-mapping).

A surprising consequence of neuroplasticity is that the brain activity associated with a given function can move to a different location as a consequence of normal experience or brain damage/recovery. In the case of chronic pain this can mean that pain signals keep occurring despite lack of a trigger or tissue damage.

To learn more about the hijacked brain and chronic pain management please read my article Chronic Pain and the Hijacked Brain that you can download for free on our Ariticles page.

If you would like attend one of my upcoming trainings please check out our Calendar page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people undergoing chronic pain management and want to learn how to develop a plan for chronic pain management and coexisting psychological disorders including depression, addiction and other coexisting psychological disorders effectively please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Be Sociable, Share!