NCAD session explores tenets of pain recovery

A physician and a psychologist from Father Martin’s Ashley in Maryland suggested in a National Conference on Addiction Disorders (NCAD) breakout session a language change from “pain management” to “pain recovery,” or moving from treating pain symptoms to addressing root causes of pain and avoiding addiction potential in its treatment.

At the Sept. 23 session co-presented by Carol L. Bowman, MD, and Peter Musser, PhD, the leaders described details of Ashley’s Pain Recovery Program, which Bowman directs and for which Musser serves as a staff psychologist. The year-old effort encourages abstinence from addictive medications, reduced perception of pain, and improved quality of life, and is beginning to collect significant data showing improved functional outcomes.

“We teach [patients] to cognitively accept pain, and to realize that they will get to the other side,” said Musser. He added, “It’s not about extinguishing pain.”

The presenters added that usually the biggest challenge in working with patients in this way involves gaining their initial buy-in. In essence, “They are mistrustful of the medical community,” Bowman said. “They’ll tell us, ‘No one’s ever really listened to me.’”

The program employs a 5-to-7 day Suboxone detox protocol, then uses a variety of clinical approaches in the main treatment phase. Musser said, “[Cognitive-behavioral therapy] is really the mainstay for the pain recovery approach,” but the program at Father Martin’s Ashley also employs non-addictive medications; supplements such as omega-3 fish oil; acupuncture; yoga; exercise; and experiential therapies.

Bowman and Musser also discussed the importance of erasing client and public misperceptions about pain management, often fueled by the pharmaceutical industry. Bowman said the studies of opiate medications on chronic (as opposed to acute) pain are small and generally industry-sponsored, adding that there is no clear evidence that these medications improve chronic pain.

Yet these misconceptions remain pervasive throughout American society, the presenters pointed out. One of their presentation slides for the NCAD conference in Anaheim, Calif., read, “We now take a pill to feel normal and thus have redefined what normal is.”

The root causes that the program explores range from mental health conditions such as depression and anxiety to unresolved family conflicts. In the population Ashley has seen in this program, “There’s always something going on in the family,” Musser said.