Chronic Pain and Going to Treatment

March 18th, 2024

By P. Casey Arrillaga, LCSW, LCDC

Over 50 million adults in the United States live with
chronic pain. Of these, over 17 million experience a significant impact on
their daily activities and quality of life. Unfortunately, many of these people
are at high risk of developing an addiction, otherwise known as a substance use
disorder. At such time as they realize they need help, some will hesitate,
because they fear giving up the addictive medications that are so often
prescribed for chronic pain. In this post, we’ll look at the realities of chronic
pain and how it can be addressed safely so that those who have it can still get
the treatment they need.

What We Know So Far

Chronic pain is bodily pain that lasts for at least three
months, and it can persist for years and even decades. For some people, chronic
pain is a defining feature of their lives. The Center for Disease Control
estimates that over 50 million U.S. adults, or about 1 in every 5, experience
chronic pain. Of these a little over 17 million find that the pain gets in the
way of daily activities and thus has a significant negative impact on their
lives. This level of chronic pain is known as high-impact chronic pain.

Out of the general population, some groups are at higher
risk for chronic pain. Some of these statistics are less surprising, such as
that chronic pain is 4 to 6 times as prominent in at-risk populations including
Native Americans  and people whose
incomes are below the poverty line, or people who generally report poor health
or disability. Other facts may be more surprising, such as seeing that chronic
pain rates are about twice as high in people who are separated or divorced as
those who are married, or that those in rural areas are about twice as likely
to have chronic pain as those who live in or near cities. Perhaps most
surprisingly, federal researchers found the bisexual adults experienced chronic
pain at about 1 ½ times the rate of people who identified as straight or gay.

Chronic pain impacts family, work, and social life. It has
been linked to a number of mental health conditions, including increased rates
of depression, dementia (including Alzheimer’s), substance use, and risk of
suicide. The association between chronic pain and depression is strong enough
that research shows that children with chronic abdominal pain are likely to
become adults with depression. It is not certain whether the pain or depression
starts first, or if they are so intertwined that it cannot be known where the
trouble starts. Even without resolving this chicken-or-egg debate, the link
between them is clear.

Suicidal thinking, sometimes called suicidal ideation [SI],
more clearly seems to be motivated by chronic pain. People with chronic pain
are about twice as likely to have SI as those who don’t have such pain. They
are 2-3 times as likely to have at least one suicide attempt, and they are 9
times as likely to die by suicide. Part of this association is based on the
fact that so many people with chronic pain are prescribed opioid painkillers.
Even among those who do not develop a problem with the painkillers, these prescriptions
provide easy access to a lethal method for suicide, to the point that among
chronic pain patients with SI, 75% say they would overdose on their opioid
medications as their preferred plan.

Adding to the problem with having opioid painkillers go hand
in hand with chronic pain is the fact that opioids are so inherently addictive.
This has to do with the similarity between these drugs and the natural
chemicals our brain produces to achieve a sense of wellbeing and motivation,
and to control pain. Furthermore, our brains can quickly become reliant on the
use of such drugs, so that people who take them do not feel like they can
function without them. Chronic pain patients are particularly at risk for this,
because they are already dealing with pain that they want to escape. Once they
become reliant on opioid medications to deal with that pain, it is hard to
imagine being okay without the drugs. If they become addicted to the
medications, they may want more and more, which in many cases leads to
obtaining them illegally and/or moving to use of other opioid drugs including
fentanyl and heroin.

What Can Be Done?

People who are in this kind of predicament clearly need
treatment, but they are often scared to accept it because even if they can beat
the addiction, the chronic pain is still there. Luckily, we can offer hope to
anyone in this position. At Windmill, we have helped many people find
non-addictive solutions to their addictions, other mental health disorders, and
their pain. A comprehensive treatment plan includes our medical team helping
each client to first safely get them off the opioids, then working with them to
find the best medications, our therapists helping the client find solutions to
the emotional cognitive issues that might otherwise make it tempting to return
to opioid use, and our certified physical and nutrition team members
individualizing activity and nutritional plans. Our entire team has the common
goal of setting the client up for success. We also offer access to cutting edge programs including
Brain Frequency and NET that can help the client find unique solutions.

The Bottom Line

Chronic pain is a serious and widespread problem. It often
leads to addiction and other mental health issues that can become
life-threatening. It also makes it harder for people who have it to accept
treatment, out of fear that they can’t be okay. Luckily, there is help
available to help those with chronic pain live happy and fulfilling lives.

About The Author

P. Casey Arrillaga is the Team Leader for Education at
Windmill Wellness Ranch, and he is the author of books including “Realistic
Hope: The Family Survival Guide for Facing Alcoholism and Other Addictions”.