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Pain is real

February 3, 2015
by Julie Miller, Editor in Chief
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Speaking to attendees at the Addiction Professional Academy, Mel Pohl, vice president of medical affairs and medical director of Las Vegas Recovery Center, led the discussion on the treatment of chronic pain in today's era of growing substance-abuse epidemics.
 
"Everybody to some extent becomes tolerant on opioids used for pain," he said. "Then we give them higher and higher doses."
 
And that is where the epidemic of opioid addiction in communities often begins. Currently in medical practice, the pendulum is swinging toward using such medications less often, however, limiting their use more for acute pain rather than chronic pain.
 
Pohl outlined five facts that every stakeholder must keep in mind about the crossover from pain treatment to addiction.
 
1 Pain is real. 
Everyone experiences pain, and it serves a purpose in human functioning, he said. While it's useful in communicating to the brain certain conditions of the body, many individuals seek to avoid pain and respond to it with fear. 
"These aren't bad people," he said. "This is just people doing the best they can with what they have."
 
2 Emotions drive the experience of chronic pain.
In addition to fear and anxiety, individuals with chronic pain often feel anger about their painful conditions and become depressed. Patient emotions must be addressed as a key variable in the reduction of physical pain, and clinicians must merge the two aspects to achieve optimal treatment. This is something that doctors in Western medicine too often fail to recognize, Pohl said.
 
"Physicians and practitioners who prescribe medication discount emotions, but I'm here to tell you that 80 percent of pain works on the emotional center of the brain," he said.
 
3 Opioids often make pain worse.
"We see invariably in our center that people's pain is less when they're off the opioids," he said.
 
4 Treat pain in terms of functioning.
Pohl also noted that while some patients are more sensitive to pain than others--even with some of the more objective measures--the treatment goal should be centered around functioning. Focus on reducing pain and increasing the patient's ability to be "up and around," so they aren't avoiding situations because of pain's grip on their life, he said.
 
5 Expectations play a role in outcomes.
For example, patients might make comments such as "My back is killing me," or "This headache is so bad, my head is going to explode." But overstating the problem can set up a patient for increased pain and the emotional response that comes with it.
 
"That cognitive distortion is powerful and it speaks to how expectations influence outcomes," Pohl said.
 
Thinking terrible thoughts can actually increase the sensory sensation of pain, therefore, thinking more realistically can and often does reduce pain. Intensity can be reduced with cognitive therapy, he said.
 
Mel Pohl spoke to AP Academy attendees.
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