Twenty some odd years ago, the American Academy of Pain Medicine and the American Pain Society, two large pain-related professional organizations, teamed up to agree upon what it means to have both chronic pain and be addicted to opioid pain medications at the same time.1 They did it because addiction to opioid medications when patients are prescribed them for legitimate health reasons seems different than addiction to other substances like alcohol, cannabis, cocaine, or even illegally obtained opioid medications when not used for pain. The difference involves the phenomena of tolerance, physical dependence, and withdrawal, which in part serve as criteria for the diagnosis of addiction when it comes to all other substances.
The most vexing of all questions in the debate over long-term opioid management for pain is subtle, difficult to articulate, and rarely considered. It lies at the heart of whether and how we maintain patients with severe pain on long-term opioids or whether we help them learn to self-manage it instead.
This most vexing of questions involves how we understand the nature of pain severity and its relationship to its degree of tolerability in the long-term opioid management patient. For depending on how we understand the intolerability of severe pain, it leads to contradictory treatment considerations among well-meaning, competent patients and providers, and even within the larger society.
What is biofeedback?
Biofeedback is a treatment used for a variety of chronic pain and other medical conditions that consists of sensors placed on the patient’s body while physiological data is viewed on a computer screen or other monitor in real time. It is considered a self-regulatory therapy because it is a tool for increasing awareness of and changing individual physiological responses to reduce symptoms or improve performance. The Association for Applied Psychophysiology and Biofeedback (AAPB), the Biofeedback Certification International Alliance (BCIA), and International Society for Neurofeedback and Research (ISNR) provide this standard definition:
Teaching People About Pain
Pain is a normal human experience. Without the ability to experience pain, people would not survive. Living in pain, however, is not normal.1 Pain that lasts beyond the normal healing time of tissues is called chronic or persistent pain. Worldwide, chronic pain is increasing. In the US alone, chronic pain has doubled in the last 15-20 years.2 With this increase, comes increased cost. Within Medicare, a US government-based insurance, epidural steroid (pain) injections have increased 629% in the last five years and the use of opioids (for example, hydrocodone and oxycodone) is up 423%.1 This increase is not isolated to the US and represents a global concern. In the shadow of this growing epidemic, we are faced with serious questions. Why is chronic pain increasing? Why are some of our most heroic treatments (opioids, injections, surgery, amputations, etc.) not working? The answer to these questions is complex and contains a variety of issues.
Chronic low back pain affects about 10% of the population.1 Healthcare providers consider back pain as chronic when it lasts longer than six months and when they believe it will last indefinitely.
Opioid, or narcotic, pain medications are beneficial in many ways. Patients with pain from terminal cancer benefit from their use. Patients benefit from their short-term use when recovering from an acute injury or following a painful surgical procedure. However, the long-term use of opioid medications for chronic, noncancer pain remains quite controversial.
We live in an age of chronic health conditions. Chronic pain, diabetes, heart disease, inflammatory bowel disorders, obesity, and sleep apnea are just a few of the most common chronic conditions. Many patients and healthcare providers attempt to treat these conditions by solely medical approaches. It makes sense, of course. Many, if not most, of these conditions are medical conditions. So, it makes sense to take medications and get different types of medical procedures and surgeries in order to try to get better. These medical treatments are usually worthwhile to pursue.
What is a chronic pain rehabilitation program?
Chronic pain rehabilitation programs are a traditional type of chronic pain management. They have long been used to help patients with chronic pain live a normal life. People who most benefit from chronic pain rehabilitation programs are those who have come to accept that their pain is truly chronic and cannot be cured. So, they want to learn what they can do to live a normal life despite having chronic pain.