Chronic Pain Management & Alcohol Use Disorder (AUD)

4 types of Chronic Pain 
  • Nociceptive Pain: Typically the result of tissue injury.
  • Inflammatory Pain: An abnormal inflammation caused by an inappropriate response by the body's immune system.
  • Neuropathic Pain: Pain caused by nerve irritation.
  • Functional Pain: Pain without obvious origin, but can cause pain
Data from the National Health Interview Survey - https://www.cdc.gov/nchs/products/databriefs/db390.htm
In 2019, 20.4% of adults had chronic pain and 7.4% of adults had chronic pain that frequently limited life or work activities (referred to as high impact chronic pain) in the past 3 months. That's over 60 million people!
If you became alcohol dependent on some level, it's not your fault. You didn't get Alcohol Use Disorder on purpose. No one ​ever said, I can't wait until I become dependent on alcohol and it adversely effects my life. 
Harvard Health - 8 Non-Invasive pain relief techniques
  • Cold and heat. These two tried-and-true methods are still the cornerstone of relieving pain for certain kinds of injuries. If a homemade hot or cold pack doesn't do the trick, try asking a physical therapist or chiropractor for their versions of these treatments, which can penetrate deeper into the muscle and tissue.
  • Exercise. Physical activity plays a crucial role in interrupting the "vicious cycle" of pain and reduced mobility found in some chronic conditions such as arthritis and fibromyalgia. Try gentle aerobic activities such as walking, swimming, or cycling. Start slow and gradually increase the exercise.
  • Physical therapy and occupational therapy. These two specialties can be among your staunchest allies in the fight against pain. Physical therapists guide you through a series of exercises designed to preserve or improve your strength and mobility. Occupational therapists help you learn to perform a range of daily activities in a way that doesn't aggravate your pain.
  • Mind-body techniques. These techniques, which include meditation, mindfulness, and breathing exercises (among many others), help you restore a sense of control over your body and turn down the "fight or flight" response, which can worsen chronic muscle tension and pain.
  • Yoga and tai chi. These two exercise practices incorporate breath control, meditation, and gentle movements to stretch and strengthen muscles. Many studies have shown that they can help people manage pain caused by a host of conditions, from headaches to arthritis to lingering injuries.
  •  Biofeedback. This technique involves learning relaxation and breathing exercises with the help of a biofeedback machine, which turns data on physiological functions (such as heart rate and blood pressure) into visual cues such as a graph, a blinking light, or even an animation. Watching and modifying the visualizations gives you a degree of control over your body's response to pain.
  • Music therapy. Studies have shown that music can help relieve pain during and after surgery and childbirth. Classical music has proven to work especially well, but there's no harm in trying your favorite genre — listening to any kind of music can distract you from pain or discomfort.
  • ​Therapeutic massage. Not just an indulgence, massage can ease pain by working tension out of muscles and joints, relieving stress and anxiety, and possibly helping to distract you from pain by introducing a "competing" sensation that overrides pain signals.

Chronic Pain Resources

YouTube Video from Dr. Huberman describing the SIGH technique describing the physiology to help with Chronic Pain
How to Reset you nervous system - Dr Alan Mandell, DC

Medscape Neurology Pain Management Links

Physicians React: Are They Taking Right Path Now With Pain Management and Opioids?

Two Exercise Interventions May Ease Acute, Subacute Spine Pain

Are Pain Meds Bad for Your Gut?

​Placebo Effect a Major Driver of Pain Reduction in Cannabis Trials

Narrative Review of Kratom, an Emerging Psychoactive Substance With Perianesthetic Implications
Two Traditional Chinese Therapies Better Together for Neck PainCan New Guidelines Keep Docs From Undertreating Pain?
Articles
Startling new science reveals the truth about chronic pain - Article - https://www.cnn.com/2022/06/27/health/haider-warraich-chronic-pain-qa-wellness?cid=external-feeds_iluminar_newsbreak
​
Acceptance and Commitment Therapy - https://www.psychologytoday.com/us/therapy-types/acceptance-and-commitment-therapy

Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain - https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2784694/​

Rational Recovery: The New Cure for Substance Addiction - https://www.amazon.com/Rational-Recovery-Cure-Substance-Addiction/dp/0671528580
Rewire: Change Your Brain to Break Bad Habits, Overcome Addictions, Conquer Self-Destructive Behavior - https://www.amazon.com/Rewire-Overcome-Addictions-Self-Destruc-Behavior/dp/0147516323​

​Alcohol Misuse and Chronic Pain, Dr. Weaver, MD
Alcohol Neuropathy and Chronic Pain: A Tale of Two Problems,
​Dr. Andrea Furlan, MD, PHD

Chronic Pain Worksheets

Worksheet 1 - PDF download - Pacing for Pain and Fatigue 

​Worksheet 2 Introspective Exposure - PDF Download - Increasing awareness about thoughts and emotions to manage pain.​

Cycle of Inactivity - PDF Download

Weekly Schedule for Behavioral Activation - PDF Download

Click on the photo below to download PDF File

Techniques for pain management and AUD (Alcohol Use Disorder)

Prepare for each day. 
Before your day begins, clear your mind and imagine how you would like to feel. Rate your pain on a scale of 1 to 10 with 10 being the highest. Acknowledge the level of pain you experience and engage in the breathing exercise below. 
Find a morning ritual that includes a few minutes of self-care if possible. Take a few minutes to stretch and breathe before the day begins. Read or repeat something that inspires you to get through the day such as a daily affirmation. 

Acknowledge your feelings
Be conscious of when you feel anxious, angry, or depressed, and acknowledge the feelings. Pain can increase anxiety. The faster you acknowledge your anxiety, the better you will get at this process of healing. 

Rate your anxiety or craving
Rate the level of anxiety on a scale from 1 to 10 with 10 being the most anxious. Acknowledge cravings or thoughts about drinking to relieve pain. Rate your craving the same way. Right after you rate your anxious thoughts, practice breathing in the next step.   
​Breathing
Take a huge breath and exhale. You’ll notice that your thoughts clear quickly because the increase in oxygen sends a message to your brain to calm down and relax. The increase in oxygen signals the limbic system to relax and then sends this message to your body. When you are experiencing symptoms of stress, such as increased heart rate and blood pressure, sweating, tense muscles, breathing decreases these symptoms. 
Breathing activates the Vagus Nerve which calms the sympathetic nervous system and activates the parasympathetic nervous system. 

​Box Breathing exercise
Take a huge breath and release the air 
Breathe in through the nose for 7 seconds
Hold your breath for 7 seconds
Breathe out through the nose for 7 seconds
Wait 7 seconds and repeat. 
The entire exercise takes 49 seconds 
Rate your anxiety and craving again after you complete the box breathing exercise and assess if the number is lower. ​
Nutrition and blood sugar 
Eating small meals throughout the day to keep your blood sugar balanced. Being Hungry, Angry, Lonely, bored or tired can trigger the desire to drink. 

Divert your attention 
Cravings usually lasts a short time such as 2 or 3 minutes. Have an alternative activity to divert your attention. Change the environment by leaving the place your at, or close your eyes if you can’t leave. Have an alternative drink such as a nonalcoholic drink or substitute. 

Attend Group sessions or reach out for help
Group sessions help you understand you’re not alone, and others are going through the same thing. The people who attend the groups are genuine, kind, insightful, understanding, knowledgeable, intelligent, respectful, positive, thoughtful, excellent listeners, and genuinely want to help you. 
Talk about your pain! You may often feel like your complaining, and you are not. Expressing the pain is is an extremely important way to process the pain so it can be diminished as much as possible. 

The function of the Sympathetic and Parasympathetic Nervous System

The sympathetic system controls “fight-or-flight” responses. In other words, this system prepares the body for strenuous physical activity. The events that we would expect to occur within the body to allow this to happen do, in fact, occur. The parasympathetic system regulates “rest and digest” functions.
The sympathetic nervous system can accelerate heart rate, widen bronchial passages, decrease motility (movement) of the large intestine, constrict blood vessels, cause pupil dilation, activate goose bumps, start sweating and raise blood pressure.
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1959222/#:~:text=The%20sympathetic%20system%20controls%20%E2%80%9Cfight,%E2%80%9Crest%20and%20digest%E2%80%9D%20functions.
Source: https://www.physio-pedia.com/Sympathetic_Nervous_System

The parasympathetic nervous system is part of the body's autonomic nervous system. Its partner is the sympathetic nervous system, which control's the body's fight or flight response. The parasympathetic nervous system controls the body's ability to relax. It's sometimes called the "rest and digest" state.
Source: ​https://www.physio-pedia.com/Sympathetic_Nervous_System
Anatomy and Physiology of the Endocrine System
  • Endocrine system – a collection of glands located in various parts of the body that produce hormones that regulate physiologic function.
    Hormones – secreted substances that regulate metabolism, maintain fluid balance, control the life cycle, stimulate growth, and generate responses to stressful stimuli.
    Negative feedback system – regulates hormone release; as more hormones are released into the bloodstream, receptors detect the rise in hormone concentration and signal the associated gland to slow further production.
  • Pituitary gland and the hypothalamus
  • Pituitary gland – plays an important role in controlling several other endocrine glands and body functions.
    Hypothalamic-pituitary-adrenal (HPA) axis – a core feedback mechanism that controls endocrine and adrenal function.
    Hypothalamus – area of the brain that works in concert with the pituitary gland to regulate the production of hormones that affect body temperature, hunger, thirst, sleep, and mood.​
  • Adrenal glands – located on the tops of the kidneys.
    Adrenal medulla – the inner layer of these glands, produces adrenaline (epinephrine) – elevates blood pressure and diverts blood from body organs to muscles; prompts the release of stored glucose and fats into the blood.
    “fight-or-flight” response
    Adrenal cortex – releases corticosteroids – mineralocorticoids – regulate fluid and electrolyte balance; glucocorticoids – affect day/night cycles and metabolism.

    Adrenocorticotropic hormone (ACTH) – is made by the pituitary gland in response to the hypothalamus producing corticotropin-release factor.
    Cortisol – is released as ACTH travels through the blood to the adrenal glands, the primary glucocorticoid, according to a circadian rhythm – cycles every 24 hours.
    Cortisol affects glucose metabolism, fat deposition, water retention, and the anti-inflammatory action of the immune system.

Cognitive Reframe

Cognitive reframing is a psychological technique that consists of identifying and then changing the way situations, experiences, events, ideas, and/or emotions are viewed. Cognitive reframing is the process by which such situations or thoughts are challenged and then changed. Below are a few examples which explain the process. 
Example 1
Situation: I was diagnosed with Fibromyalgia and the doctor told me that was the reason I was in pain. 
Thoughts: I will always be in pain and not be able to work or do the things I used to.
Feelings: Anxious. Fearful. Depressed. Hopeless. Stressed.
Evidence that supports the thought: I read stories about people on the internet that were in chronic pain and I'm afraid I'll ever get better. .
Evidence that doesn't support the thought: The is an effective treatment protocol for Fibro which includes progressive exercise, medical evaluation such as cortisol levels, Thyroid function, Vitamin D levels, sleep, anxiety treatment, pain medications such as SRI (Doxepin, Effexor in some cases, etc..) and Cognitive Behavioral Therapy. (CBT)
If you have been diagnosed with Fibromyalgia and don't know what to do or where to start, please email me.  
Alternative/balanced thought: Once I learn about the effective treatment outcomes, I will gradually get better. 
​Outcome: I feel calmer. I no longer feel stressed about this.

Example 2
Situation: I talked about my medical condition to my friends and family and they think I'm complaining. 
Thoughts: My friends don't like me. They think I am a winer and no fun. I will end up having no friends.
Feelings: Sad. Disliked. Disrespected, Alone. Stressed.
Evidence that supports the thought: I experience chronic pain and talk about the pain I'm in.
Evidence that doesn't support the thought: My friends have told me several times that they care about me and listen to what I have to say. When I express how I feel about my pain, I feel better.  I told them I'm grateful for listening and they seem to be receptive. 
Alternative/balanced thought: My friends care about me but that doesn't mean that they understand what I'm going through. I thank them for listening and they seem to understand and want to listen. They tell me I'm not wining and how brave and courageous I am to carry on. 
Outcome: I feel happier. I no longer feel stressed about this.

Example 3
Situation: I met with my thesis supervisor and she had many comments about my work.
Thoughts: My supervisor doesn’t like the work I am doing. I will never finish my thesis. I will never have a good career.
Feelings: I feel stressed. I feel stupid. I feel sad.
Evidence that supports the thought: The comments that my supervisor made were valid.
Evidence that doesn't support the thought: I have received many comments in the past on my work and have used the critique to improve it. My supervisor has always been supportive. I have succeeded in all of my academic work in the past ... surely this won't be the first time I fail. The university does not want me to fail and will support me.
Alternative/balanced thought: The comments that my supervisor has made will help to make my research better. Both she and the university want me to succeed.
Outcome: I feel hopeful, intelligent, encouraged, not stressed.
Limbic System Anatomy (Advanced)