How To Manage Chronic Pain When You're in Recovery

By John Lavitt 01/05/16

The SAMHSA TIP guidelines are designed to help identify and treat adults with chronic pain who are recovering or managing substance use disorders.

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SAMHSA TIP Guidelines On Managing Chronic Pain While Avoiding Opioid Misuse
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SAMHSA has developed new guidelines for managing chronic pain while avoiding opioid misuse. According to SAMHSA’s Treatment Improvement Protocol (TIP) 54 - “Managing Chronic Pain in Adults with or in Recovery from Substance Use Disorders” - almost one third of chronic pain patients may have substance use disorders. With the opioid abuse epidemic raging across the country, the question of chronic pain treatment has come to the forefront of treatment professional debates. Time and time again, opioid prescriptions for chronic pain lead to a relapse.

SAMHSA’s Chief Medical Officer Elinore F. McCance-Katz says, “(People with chronic pain) require extra care, support, and monitoring to help prevent relapse. It also means that opioids should not be a first consideration for the treatment of pain in those with substance use disorders. There are many alternatives to opioids for pain relief and these should be considered first for patients with substance use disorders who are at risk for relapse.”

When patients with chronic pain are evaluated, health care providers need to ask about underlying medical conditions that are contributing to the pain. A greater inquiry is needed into a patient’s history, including previous response to treatment, history of substance use and mental health concerns, and family history of substance use disorders. Only after such an inquiry should opioids be considered.

Many medical providers do not realize that there is little evidence for effectiveness of opioids in the long-term treatment of chronic pain. As Dr. McCance-Katz points out, “In medical school, there’s not a lot of time devoted to either the recognition and treatment of substance use disorders or the appropriate management of pain.”

As a result, non-opioid pain treatments or other services, such as physical therapy or acupuncture, are better options. If other treatments prove unsuccessful, opioid pain medication may be needed. For those with a history of substance use disorder, SAMHSA emphasizes the importance of having a plan in place for such monitoring before starting opioid therapy. 

SAMHSA has developed resources for medical providers and treatment professionals. The TIP guidelines are designed to help identify and treat adults who have prescription medication misuse and other substance use disorders. The manual guides clinicians through the process of conducting a thorough assessment; developing a treatment plan that addresses pain and psychological symptoms while closely monitoring for signs of relapse. 

The TIP points out the benefits of working in teams with other health care professionals, including psychologists, pharmacists, addiction counselors, and others. Too often medical providers work in isolation, ignoring the needed strengths of other specialties. The TIP also includes a bibliography, assessment tools, sample consent forms, and other resources.

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Growing up in Manhattan as a stutterer, John Lavitt discovered that writing was the best way to express himself when the words would not come. After graduating with honors from Brown University, he lived on the Greek island of Patmos, studying with his mentor, the late American poet Robert Lax. As a writer, John’s published work includes three articles in Chicken Soup For The Soul volumes and poems in multiple poetry journals and compilations. Active in recovery, John has been the Treatment Professional News Editor for The Fix. Since 2015, he has published over 500 articles on the addiction and recovery news website. Today, he lives in Los Angeles, trying his best to be happy and creative. Find John on Facebook, Twitter, and LinkedIn.