Pain Relief Without Relapse

Pain-Free Living for Drug-Free People: A Guide for Pain Management in Recovery

Marvin D. Seppala, MD, and David P. Martin, MD, PhD, with Joseph Moriarity; Hazelden Publishing and Educational Services, Center City, Minn., (800) 328-9000; 2005; ISBN: 1-59285-097-9; softcover; 232 pages; $12.95.

At some point in most everyone's life, pain that requires medical intervention will occur. Most people will be offered adequate medical relief. Unfortunately, people in recovery from addiction—especially former opioid addicts—are often undertreated for pain.

“When physicians know of the addiction, they may appropriately hesitate to give potentially addictive medications,” write the authors of this volume. “What's more, because of their addiction history, these individuals may need higher doses than the average person because they have developed a residual tolerance to opioids.”

This book aims to help professionals know their options, be aware of what may trigger relapse, and plan ahead to avoid disaster.

Comprehensive examination of opioids

The authors choose to begin with a proper definition of pain, and end with a thorough discussion of opioids—the strongest and most potentially dangerous medication for persons with addictions. However, they have written in a way that allows the reader to skip around without losing context. One may read all or part, even beginning in the middle or near the end of the book, without becoming confused.

Dr. Seppala, vice-president of medical affairs at Hazelden, and Dr. Martin, a consultant in the Department of Anesthesiology at the Mayo Clinic, operate from the premise that “forewarned is forearmed.” All too often, the authors state, pain comes from accidents, leaving little time to explore preferred methods of pain management. To be responsible for maintaining sobriety, persons in recovery will want to consider the possible pitfalls associated with pain management, Drs. Seppala and Martin write. The book offers information needed to inform wise decisions.

Early chapters present information about the emotional and psychological components of pain and explain how drugs alter biologic systems, including the way in which they can hijack the reward circuit. Here, the authors give the reader an understanding of why persons recovering from addictions might have serious concerns about taking pain medications.

Exploring alternatives

The authors cover a host of techniques for addressing pain, traveling all the way from over-the-counter analgesics, with little or no potential for triggering relapse, to opioids. Complementary pain management methods run the gamut from acupressure to yoga, with prayer and meditation in between. The authors also discuss the benefits that can be derived from combining traditional and complementary pain management methods. An especially pertinent section here looks at the need to evaluate Web sites' reputability when looking for health-related resources.

The final two chapters offer a comprehensive discussion of psychological and behavioral techniques for pain control, and how to employ them. “If you let it, the rational side of your mind can exert control over, or at least provide perspective on, your emotional side,” Drs. Seppala and Martin write. “When people are trying to live with pain, and in particular with chronic pain, it's not unusual to fall into some unproductive or even negative thinking patterns. Cognitive behavioral therapy provides effective techniques to deal with flawed ways of thinking.”

Drs. Seppala and Martin seek to achieve the goal of providing as many tools as possible for dealing with pain in ways that avoid triggering relapse. They accomplish that with an easy-to-read text that does not cross over into being preachy.