Full arsenal of treatments needed in pain management

In much the same fashion as addiction, chronic pain manifests as a biopsychosocial illness that addiction treatment programs must approach with the utmost seriousness, Hanley Center’s director of medical research told a plenary session audience Oct. 1 at the National Conference on Addiction Disorders (NCAD) in Orlando, Fla.

Barbara Krantz outlined in her talk several non-addictive treatment alternatives that the abstinence-based Hanley Center employs for its patients dealing with pain. She added that the field needs to see more paid access to non-pharmacologic approaches that can contribute to treatment’s overall effectiveness, such as acupuncture and neuromuscular massage therapy. “Most of the time insurance companies will not pay for that,” she said.

Hailing from a state (Florida) that has earned the standing of being the “pill mill” capital, Krantz likely surprised no one in saying treatment programs often discover that a person suffering from pain was immediately given dependence-producing medications before something as common as an anti-inflammatory was tried. Programs need to ask even the most basic questions in obtaining a history, she indicated, adding that for women a vitamin D deficiency should be explored.

Among the non-pharmacologic pain treatments that Krantz listed in her presentation were biofeedback; cognitive strategies such as meditation and guided imagery; and transcutaneous electrical nerve stimulation. Her message to the NCAD audience: “You’ve got to try everything.”

Krantz explained that any Hanley Center patient whose chronic pain cannot be controlled with non-addictive treatments will be referred to another provider, such as for outpatient treatment with the Suboxone formulation of buprenorphine. “We try to get each patient to a tolerable level of pain,” she added.

Krantz punctuated her talk with several visually represented patient case studies featuring images from the brain scans that are available voluntarily to every Hanley Center patient. Hanley is using SPECT technology in an attempt to uncover patient-specific clues to addiction that could lead to more targeted treatments.

On an organizational level, pain management in the face of prescription drug addiction risk requires teamwork involving elements of medicine, psychology, spirituality and wellness, according to Krantz. “This is an exciting time to be in the field; we know so much more than we did when I was in treatment back in 1981,” she said.