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Multidisciplinary treatment of benign chronic pain syndrome in substance abusing patients

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Abstract

This article presents a model for combined treatment of benign chronic pain and substance abuse. The combined treatment program illustrated draws resources from a comprehensive pain treatment center and an addictions program, which affiliated to better serve these challenging patients. Three illustrative cases are presented. Potentially divisive conceptual issues, such as lack of understanding of the biopsychosocial model of benign chronic pain, and the debate over the role of long-term opioid medication in the treatment of addiction and chronic pain disorders, are discussed.

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References and Recommended Reading

  1. Portenoy RK: Pain specialists and addiction medicine specialists unite to address critical issues. Am Pain Soc Bull 1999, 9:2–13.

    Google Scholar 

  2. Flor H,Fydrich T,Turk DC: Efficacy of multidisciplinary pain treatment centers: a metaanalytic review. Pain 1992, 49:227–230.

    Article  Google Scholar 

  3. Gatchel JM,Turk DC:Interdisciplinary treatment of chronic pain patients. In Psychosocial Factors in Pain. Edited by Gatchel RJ, Turk, DC. New York: Guilford; 1999:435–444.

    Google Scholar 

  4. Fordyce WE,Roberts AH,Sternbach RA: The behavioral management of chronic pain: a response to critics Pain 1985, 22:122–125.

    Article  Google Scholar 

  5. Sanders SH:Operant conditioning with chronic back pain: back to basics. In Psychological Approaches to Pain Management: A Practitioners Handbook. Edited by Gatchel RJ, Turk DC. New York: Guilford; 1996:112–130.

    Google Scholar 

  6. Bradley LA: Cognitive-behavioral therapy for chronic pain. In Psychological Approaches to Pain Management: A Practitioners Handbook. Edited by Gatchel RJ, Turk DC. New York: Guilford; 1996:131–147.

    Google Scholar 

  7. Pawl RP:Organization of the multidisciplinary pain treatment center. In Textbook of Neurological Surgery. Edited by Burchiel K. Philadelphia: Lippincott, Williams and Wilkins; 1999, in press.

    Google Scholar 

  8. Robinson JP,Allen T,Fulton LD, et al.: Perceived efficacy of pain clinics in the rehabilitation of injured workers. Clin J Pain 1998, 14:202–208.

    Article  CAS  PubMed  Google Scholar 

  9. Kee WG,Middaugh SJ,Redpath S, et al.: Age as a factor in admission to chronic pain rehabilitation. Clin J Pain 1998, 14:121–128.

    Article  CAS  PubMed  Google Scholar 

  10. McGrath PA,Hillier LM:Controlling children’s pain. In Psychological Approaches to Pain Management: A Practitioners Handbook. Edited by Gatchel RJ, Turk DC. New York: Guilford; 1996:331–370.

    Google Scholar 

  11. Feuerstein M,Zastowny TR:Occupational rehabilitation: multidisciplinary management of work-related muscoloskeletal pain and disability. In Psychological Approaches to Pain Management: A Practitioners Handbook. Edited by Gatchel RJ, Turk, DC. New York: Guilford; 1996:458–485.

    Google Scholar 

  12. Mersky H: Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. Pain 1986, (suppl 3):1–225.

  13. McCaffery M,Vourakis C: Assessment and relief of pain in chemically dependent patients. Orthop Nurs 1992, 11:13–26.

    Article  CAS  PubMed  Google Scholar 

  14. Sarno JE: Mind Over Back Pain. New York: Berkley Publishing Group; 1986.

    Google Scholar 

  15. Lippe PM: An apologia in defense of pain medicine. Clin J Pain 1998, 14:189–170.

    Article  CAS  PubMed  Google Scholar 

  16. American Psychiatric Association In Diagnostic and Statistical Manual of Mental Disorders edn 4. Washington, DC: American Press; 1994.

    Google Scholar 

  17. Atkinson JH,Slater MA,Epping-Jordan JE: Identifying individuals at risk for chronicity Pain Forum 1997, 6:137–139.

    Article  Google Scholar 

  18. Fordyce WE:Back Pain in the Workplace: In Management of Disability in Nonspecific Conditions. Seattle: IASP Press; 1995.

    Google Scholar 

  19. Verhaak PF,Kerssens JJ,Dekker J, et al.: Prevalence of chronic benign pain disorder among adults: a review of the literature. Pain 1998, 77:231–239.

    Article  CAS  PubMed  Google Scholar 

  20. Lipowski ZJ: Somatization and depression. Psychosomatics 1990, 31:13–21.

    Article  CAS  PubMed  Google Scholar 

  21. Bakal D: Minding the Body: Clinical Uses of Somatic Awareness. New York: Guilford; 1999. Excellent discussion of the nature of somatization and the importance of developing self-regulation in pain management. His elucidation of self-medication versus self-soothing gets to the heart of the discussion about treatment goals in benign chronic pain syndromes.

    Google Scholar 

  22. Fishbain DA: Somatization, secondary gain and chronic pain: is there a relationship? Curr Rev Pain 1998, 2:101–108.

    Article  Google Scholar 

  23. Sullivan M,Katon W: The path between distress and somatic symptoms. Am Pain Soc J 1993, 2:141–149.

    Google Scholar 

  24. Gatchel RJ: Perspectives on pain: a historical overview. In Psychosocial Factors in Pain. Edited by Gatchel RJ, Turk, DC. New York: Guilford; 1999:3–17.

    Google Scholar 

  25. Aronoff GM: Myofascial pain syndrome and fibromyalgia: a critical assessment and alternate view. Clin J Pain 1998, 14:74–85.

    Article  CAS  PubMed  Google Scholar 

  26. Berger J: A critical view of pain, hypochondriasis and somatoform disorder. Hippocrates Lantern 1999, 6:1–5.

    CAS  Google Scholar 

  27. Weisberg JN,Keefe JF: Personality disorders in the chronic pain population: basic concepts, empirical findings, and clinical implication. Pain Forum 1997, 6:1–9.

    Article  Google Scholar 

  28. Polatin PB: Chronic pain and personality disorder: cause or effect. Pain Forum 1997, 6:10–11.

    Article  Google Scholar 

  29. Gatchel RJ: The significance of personality disorders in the chronic pain population. Pain Forum 1997, 6:12–15.

    Article  Google Scholar 

  30. Fishbain DA: Can personality disorders in chronic pain patients be accurately measured? Pain Forum 1997, 6:16–19.

    Article  Google Scholar 

  31. Turk DC, Flor H: Chronic pain: a biobehavioral perspective In Psychosocial Factors in Pain. {fdEdited by} Gatchel RJ, Turk, DC. New York: Guilford; 1999:18–34.

    Google Scholar 

  32. Turk DC:Biopsychosocial perspective on chronic pain. In Psychological Approaches to Pain Management: A Practitioners Handbook. Edited by Gatchel RJ, Turk, DC. New York: Guilford; 1996:3–32. cise discussion of the biopsychosocial factors underlying multidisciplinary treatment of benign chronic pain syndromes.

    Google Scholar 

  33. Ferrell BR: All of the above. Pain Forum 1996, 5:273–274.

    Article  Google Scholar 

  34. Jacobson L,Mariano AJ,Chabal C, et al.: Expanding the role of anesthesiologists in the management of chronic nonmalignant pain. Anesthesiology 1997, 87:1210–1218. These authors recommendations for realignment with the biopsychosocial model in pain treatment, although specifically directed at anesthesiologists, should be considered by any biomedically trained professional working in chronic pain treatment.

    Article  CAS  PubMed  Google Scholar 

  35. Dalton JA,Blau W: Changing the practice of pain management: an examination of the theoretical basis of change. Pain Forum 1996, 5:266–272.

    Article  Google Scholar 

  36. Breithart W: The practice of pain management: change from within or from without? Pain Forum 1996, 5:275–278.

    Article  Google Scholar 

  37. Feinberg SD: The pain medicine specialist as physician healer. Clin J Pain 1996, 12:3–5.

    Article  CAS  PubMed  Google Scholar 

  38. Von orff:Pain management in primary care: an individualized stepped-care approach. In Psychosocial Factors in Pain. Edited by Gatchel RJ, Turk, DC. New York: Guilford; 1999:360–373.

    Google Scholar 

  39. Gallagher RM: The pain medicine and primary care community rehabilitation model: monitored care for pain disorders in multiple settings. Clin J Pain 1999, 15:1–3.

    Article  CAS  PubMed  Google Scholar 

  40. Taylor CB,Zlutnick SI,Corley MJ, et al.: The effects of detoxification, relaxation, and brief supportive theory of chronic pain. Pain 1980, 8:319–329.

    Article  CAS  PubMed  Google Scholar 

  41. Brodner RA,Taub A: Chronic pain exacerbated by long term narcotic use in patients with non-malignant disease: clinical syndrome and treatment. Mt Sinai J Med 1978, 45:233–237.

    CAS  PubMed  Google Scholar 

  42. Maruta T,Swanson DW,Finlayson RE: Drug abuse and dependence in patients with chronic pain. Mayo Clin Proc 1979, 54:241–244.

    CAS  PubMed  Google Scholar 

  43. Gallagher RM: Outcomes and moral hazards in the medical culture of opioid phobia. Clin J Pain 1998, 14:185–186.

    Article  CAS  PubMed  Google Scholar 

  44. Schofferman J: Long-term opioid analgesic therapy for severe refractory lumbar spine pain. Clin J Pain 1997, 15:136–140.

    Article  Google Scholar 

  45. Harden RN: Pain, psychological status, and functional recovery among patients on daily opioids. Curr Rev Pain 1999, 3:18–23.

    Article  Google Scholar 

  46. Haddox JD: Gullible’s travels. Clin J Pain 1998, 14:187–188.

    Article  CAS  PubMed  Google Scholar 

  47. Fordyce WE: Opioids, pain, and behavioral outcomes. Am Pain Soc J 1992, 1:282–284.

    Google Scholar 

  48. Weissman DE,Haddox JD: Opioid pseudoaddiction—an iatrogenic syndrome. Pain 1989, 36:363–366.

    Article  CAS  PubMed  Google Scholar 

  49. Chabal C,Erjavec MK,Jacobson L, et al.: Prescription opiate abuse in chronic pain patients: clinical criteria, incidence and predictors. Clin J Pain 1997, 13:150–155.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Center for Rehabilitation, 660 N. Westmoreland Road, 60045, Lake Forest, IL, USA

    Neil D. Mahoney PhD

  2. Rush Behavioral Health Services, 2001 Butterfield, Suite 320, 60515-9989, Downers Grove, IL, USA

    James E. Devine PhD & Daniel Angres MD

Authors
  1. Neil D. Mahoney PhD
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  2. James E. Devine PhD
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  3. Daniel Angres MD
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Mahoney, N.D., Devine, J.E. & Angres, D. Multidisciplinary treatment of benign chronic pain syndrome in substance abusing patients. Current Review of Pain 3, 321–331 (1999). https://doi.org/10.1007/s11916-999-0049-2

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